How can I prevent acute or chronic mesenteric ischemia?
Acute and chronic mesenteric ischemia are caused by blockage of blood supply to the intestines, causing decreased oxygenation of these tissues. One or more branches of the mesenteric arteries are occluded, and if obstruction is complete, ischemia of the intestinal tissues progresses to necrosis, which is a surgical life-threatening emergency.
Prevention of Chronic Mesenteric Ischemia
Prevention of chronic ischemia to the intestines is via prevention of the underlying conditions that restrict blood flow over time:
- Atherosclerosis: The leading cause of chronic mesenteric ischemia, it will decrease blood flow by narrowing the lumen of the arterial supply. addressing the causes of atherosclerosis will also address these repercussions
- Smoking cessation: Strict glycemic control in diabetes. Correcting of dyslipidemia, and treatment of hypertension will mitigate atherosclerosis as a strategy to prevent mesenteric ischemia
- Acute ligament syndrome: In which the celiac artery is compressed by a ligament of the diaphragm, can be treated surgically
- Aortic or mesenteric artery dissection: Prevention of the natural progression of aneurysms is via the tactics that lower the risk of the dissection occurring or progressing, i.e., treating hypertension, and smoking cessation
- Vasculitis: Treatment includes steroid medication and other immunosuppressive protocols
Prevention of Acute Mesenteric Ischemia
The sudden small intestinal hypoxia from acute hypoperfusion, diagnosed by CT or imaging studies that demonstrate occlusion, can occur from the following which deprive intestinal tissue of blood supply distal to them:
- Embolus: Prevention is by management and treatment of cardiac arrhythmias and cardiac vascular disease, endocarditis, ventricular aneurysm, and aortic atherosclerosis and aneurysm. Anticoagulation is used for high-risk patients or those with recurrence.
- Thrombus: Prevention is by management and treatment of peripheral artery disease, especially in the elderly where age is a progressive risk factor.
- Vasospasm and transient severe hypotension: In unusual drops of blood pressure, the mesenteric arterial supply is vulnerable, such as in hypotensive periods of time during general or conductive anesthesia, or from acute blood loss in trauma.
Prevention of Mesenteric Ischemia Caused by Mesenteric Venous Thrombosis
Mesenteric venous thrombosis represents approximately 10% of all cases of acute mesenteric ischemia, caused by venous stasis due to stagnation, vascular injury, or coagulopathy. Thrombotic occlusion increases the vascular resistance in the mesenteric venous bed and this reduces arterial perfusion.
Prevention is by lowering the severity of risk factors for mesenteric venous thrombus formation:
- Treating abdominal inflammatory processes, e.g., pancreatitis, diverticulitis, and inflammatory bowel disease
- Addressing alcohol abuse, which causes portal hypertension and the increased venous pressure from cirrhosis
- Surgical removal of an abdominal mass responsible for venous compression
- History of deep vein thrombosis (DVT)