Medical Management of Mesenteric Artery Disease
Management of mesenteric artery disease can be either conservative or emergent, depending on the severity or presentation. For patients who are stable and have clinical signs of bowel ischemia, close surveillance while on anticoagulation (heparin) is quite feasible. As the urgency and severity increase, the options become more aggressive and invasive. Diagnostic imaging, from duplex Doppler ultrasound to CT imaging is used for close surveillance of a condition that can become dangerous very quickly.
Surgical Management of Mesenteric Artery Disease
For those who have no risk factors against tolerating surgery, immediate abdominal surgery (laparotomy) is indicated when there is an exacerbation that involves peritonitis or bowel rupture. The ideal sequence of therapeutic events would be endovascular revascularization prior to any surgery so that any bowel resection could be minimized, but this is often unfeasible.
Open surgical embolectomy is the traditional treatment for acute embolism along with any necessary clearing of thrombus that could provide a site for further embolic development. Open surgery, besides being directly therapeutic, allows the most accurate assessment of bowel wall integrity via direct visualization.
For mesenteric artery thrombosis, mesenteric artery bypass is performed, because merely removing the thrombus is unlikely to remove the thrombogenic atherosclerotic plaques and future embolization’s.
Via invasive radiological techniques, an endovascular access through the femoral or brachial artery can be used to suction out the clot; alternately, thrombolytic therapy can be delivered to the thrombus through a catheter. Endovascular thrombectomy can be performed mechanically or balloon angioplasty and stenting can be accomplished without the increased morbidity an abdominal surgery would have. Some vascular specialists prefer this approach over open surgery, due to evidence it may be as effective as the open surgical approach, while others prefer open surgery so that there can be direct and immediate inspection of the bowel and any necessary resection can be performed in a timely fashion.