Resistant hypertension and mesenteric ischemia: A unique therapeutic journey

Annals of vascular surgery. Brief reports and innovations Pub Date : 2025-03-01 Epub Date: 2024-12-01 DOI:10.1016/j.avsurg.2024.100352

L.N. Klemperer, E. Rosenthal, B. Sheick-Yousif

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Abstract

Objectives

Chronic mesenteric ischemia (CMI) typically presents with postprandial pain, food aversion, and weight loss. This case report describes an atypical presentation of CMI with intolerance to anti-hypertensive drugs.

Methods

A 54-year-old woman presented with uncontrolled hypertension, bilateral renal artery stenosis, and intolerance to antihypertensive medications. Angiography revealed occlusion of all three mesenteric arteries, compensated by collateral circulation from internal the iliac arteries. Elevated blood pressure was crucial for maintaining intestinal blood flow via collaterals.

Results

A right iliac to IMA bypass successfully improved intestinal perfusion, resolving medication intolerance and successfully lowering the patient's blood pressure.

Conclusions

This case highlights an exceptional presentation of occlusive mesenteric disease and underscores the importance of individualized approaches in complex mesenteric ischemia cases.

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顽固性高血压和肠系膜缺血：一个独特的治疗之旅

目的慢性肠系膜缺血（CMI）通常表现为餐后疼痛、厌食和体重减轻。本病例报告描述了一个不典型的CMI与抗高血压药物不耐受的表现。方法一例54岁女性，高血压未控制，双侧肾动脉狭窄，抗高血压药物不耐受。血管造影显示所有三条肠系膜动脉闭塞，由髂内动脉侧支循环代偿。升高的血压对于维持肠道血液通过络的流动至关重要。结果右髂转IMA分流术成功改善了肠道灌注，解决了药物不耐受问题，成功降低了患者血压。结论本病例突出了肠系膜闭塞性疾病的特殊表现，强调了在复杂肠系膜缺血病例中个体化治疗的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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