MESENTERIC ISCHEMIA (ARTERIAL THROMBOLYSIS/PLASTY/STENTING)
What is mesenteric ischemia:
- Mesenteric ischemia means bowel attack due to reduction or cessation of arterial inflow small intestinal, most commonly to the superior mesenteric artery (SMA).
- It can be acute or chronic.
- Acute Ischemia due to acute mesenteric arterial occlusion caused by emboli.
- Chronic ischemia is usually due to atherosclerotic narrowing/occlusion of artery.
What are the symptoms:
- In acute attack, patient may present with severe abdominal pain, nausea and vomiting despite mild physical signs.
- In chronic attack, patient present with post prandial abdominal pain, weight loss and inability to eat (due to fear of pain).
Why it necessary to treat:
- If left untreated it leads to bowel ischemia, bowel infarction, stricture or bowel perforation leads to sepsis and death.
How it can be treated:
- Traditionally, it is treated with open vascular surgery but now due to medical advancement it is possible to treat with endovascular treatment (without surgical incision).
- Endovascular therapy, including aspiration thrombectomy and local thrombolytic therapy, angioplasty and stent placement. Effective treatment option for mesenteric ischemia depending upon the cause.
The key to endovascular treatment is to establish blood flow quickly before irreversible intestinal necrosis occurs in acute attack.
Preparation for procedure:
- Few basic blood investigations like CBC, PT/INR, viral markers.
- Fasting for 4-6 hrs.
- Bring all the records including imaging record.
- Signing consent form.
What are risk:
- Non target embolization (less than 1 case in 1000).
- Pain and bleeding (less than 1 case in 1000).
