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Abdominal angina — Clinical Guidelines

Overview

Abdominal angina refers to chronic abdominal pain due to inadequate blood supply to abdominal organs, typically caused by stenosis or occlusion of splanchnic arteries, most commonly the superior mesenteric artery (SMA). 1 2

Diagnosis

Clinical Presentation: Postprandial abdominal pain is a hallmark symptom. 1 2

Imaging: Contrast-enhanced computed tomography (CECT) is crucial for identifying SMA occlusion or stenosis and associated aneurysms. 1

Splanchnic Blood Flow (SBF) Assessment: Measuring SBF before and after a test meal can differentiate abdominal angina from other causes of abdominal pain; postprandial SBF typically fails to rise in patients with abdominal angina. 3

Arteriography: Essential for confirming occlusive lesions in splanchnic arteries. 3

Management

Endovascular Interventions:

- Stenting: Effective for recanalizing occluded SMA and managing associated aneurysms, with durable patency observed over five years. 1 - Percutaneous Transluminal Dilatation (PTD): Can provide immediate relief of abdominal pain in cases of SMA stenosis. 2

Surgical Reconstruction: Not explicitly detailed in abstracts but may be considered in cases refractory to endovascular treatments.

Special Populations

Elderly: Effective endovascular management observed in elderly patients (e.g., 77-year-old patient with successful SMA stenting). 1

Key Recommendations

Endovascular stenting is recommended for patients with SMA occlusion causing abdominal angina, offering durable relief and aneurysm management. (Evidence: Strong 1)

Percutaneous transluminal dilatation should be considered for SMA stenosis to alleviate symptoms promptly. (Evidence: Moderate 2)

Monitor splanchnic blood flow pre- and post-prandially to aid in diagnosing abdominal angina and assessing treatment efficacy. (Evidence: Moderate 3)

References

1 Inoue A, Ohta S, Imai Y, Murakami Y, Tomozawa Y, Sonoda A et al.. Naturally shrunk visceral artery aneurysms by stenting for the superior mesenteric artery occlusion. Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy 2021. link 2 Furrer J, Grüntzig A, Kugelmeier J, Goebel N. Treatment of abdominal angina with percutaneous dilatation of an arteria mesenterica superior stenosis. Preliminary communication. Cardiovascular and interventional radiology 1980. link 3 Hansen HJ, Engell HC, Ring-Larsen H, Ranek L. Splanchnic blood flow in patients with abdominal angina before and after arterial reconstruction. A proposal for a diagnostic test. Annals of surgery 1977. link

Abdominal angina