Three aortic branches provide the arterial blood supply to the gastrointestinal tract: the
celiac artery (CA), superior mesenteric artery (SMA) and inferior mesenteric artery (IMA). The
CA supplies stomach, liver, part of the pancreas and proximal part of the duodenum. The SMA
supplies the distal part of the duodenum, the entire small bowel and the proximal colon.
The IMA is relatively small and supplies the distal colon. The anatomy of these arteries varies
largely and gastrointestinal artery stenotic disease is not uncommon. Occlusive gastrointestinal
arterial disease often remains asymptomatic, due to the presence of abundant collateral
circulation. Only patients with significant arterial stenosis in combination with insufficient
collateral circulation develop clinical signs of mesenteric ischemia. In these cases, the diagnosis
is often missed due to lack of sensitive diagnostic tests. The diagnostic approach in
patients with possible chronic gastrointestinal ischemia (CGI) focuses on identification of
gastrointestinal arterial stenosis and demonstration of mucosal ischemia.
This thesis deals with the diagnosis of chronic gastrointestinal ischemia, which often remains
a clinical challenge. This in part explains why CGI was for long considered to be a very rare
disease, only presenting in patients with multiple stenotic abdominal arterial disease. The
existence of single vessel abdominal arterial disease has long been debated. We therefore
firstly reviewed the existence and characteristics of single vessel abdominal arterial disease.
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