A 58-year-old man presents with postprandial abdominal pain, fear of eating, and 12 kg weight loss over 4 months. CT angiography shows stenosis of two major mesenteric vessels. Duplex ultrasound shows a peak systolic velocity of 480 cm/s in the superior mesenteric artery. What is the definitive management?
- A Percutaneous transluminal angioplasty with stenting of the SMA ✓
- B Celiac plexus block for pain control
- C Surgical bypass from the supraceliac aorta to the SMA
- D Long-term parenteral nutrition and observation
Explanation
This is chronic mesenteric ischemia (intestinal angina) with classic triad of postprandial pain, food fear, and weight loss. Duplex ultrasound showing SMA peak systolic velocity greater than 275 cm/s indicates greater than 70% stenosis. Endovascular treatment with angioplasty and stenting is now first-line for suitable anatomy, with lower morbidity than open surgery. Surgical bypass (antegrade from supraceliac aorta preferred) is reserved for failed endovascular treatment or complex anatomy. Celiac plexus block and parenteral nutrition are palliative, not definitive.
Reference: Rutherford's Vascular Surgery and Endovascular Therapy, 9th ed.
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Written and medically reviewed by the StethoPrep medical team.