Mesenteric ischemia is a condition that mainly affects the digestive system where blood flow to the intestines becomes restricted. The three arteries that provide oxygen-rich blood to the small and large intestines are called mesenteric arteries. When these arteries become blocked or narrowed, the amount of oxygen-rich blood traveling to the digestive tract is reduced. When this occurs, a section of the intestines cannot get an adequate amount of oxygen. Insufficient supply of oxygen causes cell death and permanent damage to intestinal tissues. Mesenteric ischemia can be caused by cardiovascular disease, blood clots, blood vessel surgery, or misuse of certain substances. There are two types of mesenteric ischemia. Acute ischemia is typically caused by blood clots, and symptoms appear suddenly. Chronic ischemia develops gradually, and it is usually caused by atherosclerosis. Common symptoms of mesenteric ischemia include diarrhea, nausea, fever, vomiting, bloating, and abdominal pain.
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A bowel resection is a surgical procedure used to remove any part of the bowel, including the rectum, large intestine, and small intestine. A bowel resection is also commonly known as a partial colectomy. When acute mesenteric ischemia occurs, a bowel resection is used to remove any scar tissue, blood clots, and regions of the dead intestine. There are three main ways a bowel resection can be performed. Open resection is a surgical procedure in which the surgeon uses traditional incisions and surgical tools to remove a section of the intestine manually. Laparoscopic resection is a surgical procedure in which a laparoscope is inserted into and used with a series of small incisions to remove a part of the intestine manually. A robot-assisted laparoscopic resection is a surgical procedure where a surgeon-controlled robot performs the surgical procedure with robot attached instruments. When areas of intestinal scarring or dead tissues are not removed, the bowel may become further obstructed, or toxicity can occur.
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Surgical revascularization may be used to treat mesenteric ischemia in individuals who have the chronic form of the condition. Revascularization means the restoration of normal blood flow to the area of concern. A mesenteric artery bypass is a procedure in which an alternate route is constructed for oxygenated blood to flow from the aorta to the mesenteric artery. This alternative route allows the blood to bypass the part of the mesenteric artery that has become blocked or narrowed. The alternate route may be constructed using one of the patient's existing veins, or it is made with lab-created prosthetic material.
Another method of surgical revascularization is called balloon angioplasty and stenting. This minimally invasive procedure opens the obstructed mesenteric artery to restore blood flow to the intestines. During angioplasty and stenting, a catheter or small hollow tube is threaded from an incision in the groin to the affected mesenteric artery. Once the catheter is in place, a balloon is passed through it into the mesenteric artery. The balloon is then inflated to widen the interior diameter of the affected artery. A mesh tube or stent is then used to hold the artery open and restore adequate blood flow.
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Anticoagulation Or Antiplatelet Therapy
Mesenteric ischemia caused by a minor blood clot may be treated with anticoagulation or antiplatelet therapy. Anticoagulants and antiplatelet medications are specialized medications that use different mechanisms to break up existing blood clots and prevent the development of new blood clots. Anticoagulants work by producing a considerable delay in the natural process of blood clotting by acting on the clotting factors themselves. Antiplatelets inhibit the action of the enzymes responsible for the activation of platelets. When platelets are activated, they stick together and to the artery walls easily. Both of these medications are effective at helping break up existing blood clots and preventing new ones, but anticoagulants are generally stronger than antiplatelets. These medications can be given orally, intravenously, or through an injection. Depending on the underlying cause of the blood clotting that results in mesenteric ischemia, antiplatelet and anticoagulant therapy may be used independently of one another. These medications also may be used in a combined therapy.
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Thrombolysis is a treatment used to dissolve or break up blood clots in the blood vessels. This procedure is used to treat mesenteric ischemia caused by a stationary solid-mass blood clot that develops in one of the mesenteric arteries. Clots can form abnormally in the blood vessels as a result of certain diseases and or genetic factors. There are two main methods of thrombolysis. Chemical thrombolysis is performed with the use of clot-dissolving medications delivered directly into the affected artery to dissolve it. These medications may be delivered with an injection, or they can be given through a catheter threaded into the affected artery. Mechanical thrombolysis involves the physical break up of the blood clot using a catheter. The catheter end is equipped with a rotating device, ultrasound device, a tiny suction cup, or a high-speed fluid jet. Thrombolysis is a treatment option commonly used when the blockage causing mesenteric ischemia is emergent.
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An embolectomy is a surgical procedure involving the removal of a particular type of blockage called an embolism. This surgical procedure may be performed to treat mesenteric ischemia caused by an embolism. Obstructions an embolectomy removes from the mesenteric arteries include cholesterol, fat, septic, tissue, and foreign body embolisms. The most common embolism that causes mesenteric ischemia is a cholesterol embolism. When the epithelium or arterial lining has been damaged as a result of high blood pressure or by other factors, a material called cholesterol can penetrate the endothelium. When cholesterol enters an artery, an immune system response is triggered. The combination of cholesterol, cellular wastes, and immune factors can calcify to the walls of the arteries. This calcification forms what is known as atherosclerotic plaque. Pieces of this plaque sometimes become detached from the walls of the arteries and flow freely throughout the circulatory system. Acute mesenteric ischemia occurs when a piece of plaque becomes lodged in one of the mesenteric arteries and stops the flow of blood. An embolectomy can be performed with a traditional open incision, or through the use of a catheter to manually remove an embolism.