Visceral Stenting
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How is a mesenteric ischemia treated?
The goal of treatment for mesenteric ischemia (both chronic and acute) is to re-open the artery to allow adequate blood flow to reach your intestine to allow it to work properly. Because this must be accomplished before permanent damage is done to the bowel, depending on the situation, your physician may treat mesenteric ischemia as an emergency or as a scheduled procedure.
For chronic mesenteric ischemia, one treatment method is trans-aortic endarterectomy, which is an operation that removes the plaque that blocks your mesenteric artery. To perform this procedure, a vascular surgeon makes an incision in your abdomen, or side, and then removes the plaque contained in the inner lining of the blocked mesenteric artery. Another treatment option for chronic mesenteric ischemia is bypass surgery. In bypass surgery, the surgeon creates a detour around a narrowed or blocked section of the artery. To create this bypass, the vascular surgeon can use one of your veins or sometimes a tube made from man-made materials can be used as an alternative. The surgeon attaches the bypass above and below the blocked area, producing a new path for blood to flow to your intestines. Your physician will advise you what procedure is best for you on the basis of your particular situation.
Angioplasty and stenting is a newer method used by Dr. Julien for opening a mesenteric artery and bracing it open to allow the blood to flow through. It is usually performed at the time of the angiogram. In an angioplasty procedure, your physician inflates a small balloon inside a narrowed mesenteric artery. After widening the artery with angioplasty, your physician may insert a stent, which is a tiny metallic mesh tube that can support your artery's walls to keep your vessel wide open.
Treatment for acute mesenteric ischemia is usually an emergency procedure, since severe intestinal damage can occur rapidly in this setting. In some situations, your physician may use medications, called thrombolytic agents, to dissolve a clot, if one is found soon enough. To perform this treatment, your physician injects clot-dissolving medications into a blood vessel, often at the time of the angiogram. In some cases, the medications flow through your bloodstream to the clot and can disintegrate the clot. However, your physician may need to remove the clot surgically, especially if there is evidence of intestinal damage or too little time is available for the thrombolytic agent to work.
In cases of acute mesenteric ischemia, portions of the intestine can be damaged beyond repair. In addition to restoring the blood flow to your intestinal arteries, some patients require surgery to remove the damaged portions of the intestine. This is a decision your physician will make, often in conjunction with other surgical specialists.
Since the effectiveness, risk, and durability of each tool available for the treatment of mesenteric ischemia depends upon many issues, your physician will advise you as to what procedure is the best for your particular situation.