Mesenteric Ischemia, From Anatomy and Pathophysiology to Treatment and Prognosis

SINOPSE

Acute mesenteric ischemia is a gut and life-threatening clinical entity, with increasing incidence, characterized by an adverse prognosis, with a high mortality rate, that represents the second most frequent etiology of short bowel syndrome-associated intestinal failure. 

However, acute mesenteric ischemia still constitutes a time-dependent, challenging, and undertreated disease. 

Contemporary multimodal stepwise management of mesenteric ischemia, focused on the preservation of life and intestinal viability, involves early diagnosis, timely revascularization with endovascular and/or surgical techniques, resection of nonviable bowel and liberal use of second-look procedures, if necessary, intensive resuscitation for the prevention of multiorgan failure, and prompt recognition of the complications of mesenteric repermeabilization. 

This comprehensive monography provides an in-depth review of the scientific theory and clinical practice related to mesenteric ischemia, with particular emphasis on the assessment and management, as part of a patient-centered multidisciplinary approach, principles of referencing networks and relevance of specialized intestinal stroke centers. 

In 14 chapters, the authors share their clinical experience and expertise, offering a practical guide to the management of the acute and chronic mesenteric ischemia, to support decision-making, covering all important issues from the anatomy, pathophysiology of the splanchnic circulation and diagnosis, to the treatment and prognosis. 

This book is a valuable reading for all professionals involved in the care of patients with mesenteric ischemia, including surgeons, radiologists, emergentists, intensivists, gastroenterologists, and also for medical students, and intents to contribute to the improvement of the vital and functional prognosis of this severe disease. 

Beatriz Pinto da Costa

CONTRIBUTING AUTHORS

ANTÓNIO BERNARDES, MD, PHD General Surgery Consultant in the General Surgery Department of the Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal. Coordinator of the Esophagogastric Surgery Unit and of the Referral Center of Esophageal Cancer in Adults of the CHUC. Associated Professor with aggregation of the Faculty of Medicine, University of Coimbra, Coimbra, Portugal. 

BEATRIZ PINTO DA COSTA, MD, PHD General Surgery Consultant in the General Surgery Department and Interim Coordinator of the Surgical Intermediate Care Unit of the Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. Invited Auxiliary Professor of Surgery at the Faculty of Medicine, University of Coimbra, Coimbra. Member of the Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, Coimbra, Portugal; Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal; and of the Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal. Member of the Educational Committee of the Intensive Care, Trauma and Emergency Surgery Chapter of the Portuguese Society of Surgery. Associated Editor of the Portuguese Journal of Surgery, the scientific journal of the Portuguese Society of Surgery. Member of the Portuguese Society of Surgery, of the Portuguese Society of Coloproctology, and of the Portuguese Society of Enteral and Parenteral Nutrition. 

FRANCISCO D’ OLIVEIRA MARTINS, MD, PHD Senior Graduated Assistant of General Surgery in the General Surgery Department of the Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal. Invited Auxiliary Professor of the Nova Medical School, Lisboa, Portugal. 

FREDERICO BASTOS GONÇALVES, MD, PHD Vascular Surgeon in the Hospital de Santa Marta, Centro Hospital Universitário de Lisboa Central, Lisboa, Portugal. Auxiliary Professor at the Nova Medical School, Universidade Nova de Lisboa, Lisboa, Portugal. Fellow of the European Board of Vascular Surgery, Secretary-General of the Portuguese Society of Angiology and Vascular Surgery, national representative at European Consortium of National Vascular Registries (VASCUNET) and at the Union Européenne des Médecins Spécialistes – Section and Board of Vascular Surgery (UEMS-SBVS). Editorial Board member of the European Journal of Vascular and Endovascular Surgery and European Society for Vascular Surgery Guideline Steering Committee member. Among others, has co-authored the European Society of Vascular Surgery (ESVS) Clinical Practice Guidelines on Management of the Diseases of the Mesenteric Arteries and Veins (2017). 

HENRIQUE ALEXANDRINO, MD, PHD General and Emergency Consultant Surgeon of the Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal. Professor of Surgery, Faculty of Medicine, University of Coimbra, Coimbra, Portugal. Member of the Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal. Co-Head of the Emergency Department and member of the Hospital Trauma Committee of CHUC. Member of the European Society of Trauma and Emergency Surgery (ESTES), International Hepato-Pancreato-Biliary Association (IHPBA), International Society of Surgery (ISS), International Association for Trauma Surgery and Intensive Care (IATSIC), Lusitanian Association for Trauma and Emergency Surgery (ALTEC) and Fellow of the American College of Surgeons (ACS). Associate Editor of Acta Medica Portuguesa, the scientific journal of the Portuguese Medical Association. 

JOSÉ GUILHERME TRALHÃO, MD, PHD Senior Consultant of General Surgery and Head of General Surgery Department of the Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. Full Professor of Surgery and Vice-president of the Faculty of Medicine, University of Coimbra, Coimbra, Portugal. Member of the Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, Coimbra, Portugal; Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal; and of the Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal. 

JULIANA VARINO DE SOUSA, MD Vascular Surgeon at the Department of Angiology and Vascular Surgery of Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. 

JÚLIO SOARES LEITE, MD, PHD Past Senior Consultant of General Surgery and Head of General Surgery Department of the Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. Past Full Professor of Surgery of the Faculty of Medicine, University of Coimbra, Coimbra, Portugal. Past President of the Portuguese Society of Surgery and of the Portuguese Society of Coloproctology and fellow of the American College of Surgery. 

LUÍS CURVO SEMEDO, MD, PHD Radiology Consultant and MRI Chief in the Department of Medical Imaging of the Clinical Academic Centre of Coimbra (CACC), Coimbra, Portugal. Assistant Professor at the Faculty of Medicine, University of Coimbra, Coimbra, Portugal. Researcher at the Institute for Biomedical Imaging and Translational Research (CIBIT), Coimbra, Portugal. Fellow of the European Society of Gastrointestinal and Abdominal Radiology (ESGAR). 

LUÍS F. ANTUNES, MD Angiologist and Vascular Surgeon at the Angiology and Vascular Surgery Department of the Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. Invited Assistant of Vascular Surgery and PhD student at the Faculty of Medicine, University of Coimbra, Coimbra, Portugal and Invited Adjunct Professor at the Coimbra Health School, Coimbra, Portugal. Member of several societies of Vascular Surgery, and past member of the board of Portuguese Society of Angiology and Vascular Surgery (SPACV). 

LUÍS FILIPE PINHEIRO, MD Senior Consultant of General Surgery and Past Director of the General Surgery Department, Hospital São Teotónio, Viseu, Portugal. President of the General Assembly of Lusitanian Association of Trauma and Emergency Surgery (ALTEC/LATES). Vice-President of the Portuguese Society of Surgery. Honorary member of European Society for Trauma and Emergency Surgery (ESTES) and member of the Vascular Committee of the Portuguese Society of Surgery, of the International Society of Surgery (ISS) and of the International Association for Trauma Surgery and Intensive Care (IATSIC). Past member of the Editorial Board of the Bulletin of Emergency and Trauma (BEAT). 

MARCO SERÔDIO, MD General Surgeon of the General Surgery Department of the Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal. Invited Assistant of the Faculty of Medicine, University of Coimbra, Coimbra, Portugal. Member of the Hepatobiliopancreatic Surgery Unit and collaborator of the Adult Hepatic Transplantation Unit of the CHUC. Member of the Portuguese Society of Minimally Invasive Surgery, European Society for Organ Transplantation (ESOT) and of the European Liver and Intestine Transplant Association (ELITA). 

NUNO PEREIRA DA SILVA, MD Fifth-year resident of Radiology in the Medical Imaging Department of the Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. Experience in conventional radiology, gastrointestinal fluoroscopy, general ultrasound, Doppler ultrassound, interventional radiology, computed tomography, magnetic resonance imaging, breast imaging, obstetric ultrasound, neuroradiology, PET-CT and pediatric radiology. 

PAULO DONATO, MD, PHD Radiologist and Head of the Radiology Department of the Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal. Chair of Interventional Radiology at the CHUC. Assistant Professor of Radiology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.

RITA CARREIRA GARCIA, MD Resident of Angiology and Vascular Surgery in the Hospital do Divino Espírito Santo, Ponta Delgada, Açores, Portugal, with a partial fellowship in the Department of Angiology and Vascular Surgery of Hospital de Santa Marta do Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal.