Chronic visceral ischemia.

Visceral ischemic syndromes constitute a spectrum of diseases that may, if not detected and treated, culminate in fatal intestinal gangrene. Symptomatic chronic visceral ischemia may run a prolonged course before diagnosis and effective surgical revascularization is employed. The internist or general practitioner plays an important role in the management of all patients with chronic visceral ischemia, usually being the first physician to evaluate the patient and often being able to direct the efforts to diagnose the problem effectively. An awareness of the disease and a high index of suspicion will lead to the confirmatory arteriogram, after which appropriate consultation will ensure that treatment which becomes readily apparent. The vascular surgeon who possesses the skill to execute transaortic extraction endarterectomy and antegrade aortovisceral bypass can realistically meet the therapeutic challenge of this disease, relieving the patients' symptoms and, more importantly, preventing fatal intestinal gangrene.