Chronic mesenteric ischemia is a rare afection, wich in 95% of cases is caused by difuse atherosclerosis ( fats accumulation in your blood vessels walls, leading to their narrowing wich decrease the flow of blood to the bowel). Disease’ s progression is associated with more striking symptoms. Almost half of patients present simultaneous the affecting of heart’s blood vessels, but also peripheral artery disease.
Nonatheromatous conditions include: compression of celiac artery, Takayasu arteritis, thromboangitiitis obliterans, radiation-induced vascular injury. The disease generally presents in patients over 60 years and the incidence is three times higher in women. Symptoms commonly occurs when there are two blood vessels affected ( celiac trunk, superior mesenteric artery, inferior mesenteric artery).
Digestive tube receive blood from three main vessels: celiac trunk, superior mesenteric artery (SMA) and inferior mesenteric artery (IMA). The celiac artery suppllies most of blood to the lower esophagus, stomach, duodenum, liver, pancreas and spleen. The SMA commes off the aorta and supplies blood to duodenum, jejun, ileum, cecum and colon. IMA commes also off the aorta and supplies blood to the distal transverse, descending and sigmoid colon and the rectum. Many communications exist within these arteries so as we pointed above, tipically, symptomps appears when there are at least two vessels affected.
Treatment of chronic mesenteric ischemia is essential for preventing acute ischemia ( wich can lead to the bowel infarction and a high risk of death).
Treatment consists of two methods: the surgical way or the interventional way – minimally invasive.
Surgical techniques used involves transaortic endarterectomy of the celiac or SMA, retrograde bypass from external iliac artery and anterograde bypass, wich provides the best orientation of the graft to the aorta.
Yet, the risks associated with the surgical method are high, that’s why the endovascular treatment was develop. This is a minimallly invasive treatment wich consists of dilating the artery using a balloon with or without stenting (placing a small, metal tube called stent into an artery to help hold it open). Also, high risk surgical patients can be eligible for thisd kind of treatment, with a lower risk profile. Usually, asymptomatics patients do not need treatment ( except for those patients who need other abdominal surgical treatment wich can lead to loss of blood vessel communications and the rapid progression of disease).
addΠριν τη θεραπεία - Προετοιμασία
Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
You will be asked to sign a consent form that gives permission to do the procedure.
In addition to a complete medical history, your doctor may perform a physical examination to ensure you are in good health before you undergo the procedure. You may also undergo blood tests and other diagnostic tests.
You will be asked to fast for eight hours before the procedure, generally after midnight.
If you are pregnant or suspect that you are pregnant, you should notify your health care provider.
Notify your doctor if you are sensitive to or are allergic to any medications, latex, iodine, tape, contrast dyes, and anesthetic agents (local or general).
Notify your doctor of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
You may receive a sedative prior to the procedure to help you relax.
Based on your medical condition, your doctor may request other specific preparation.
addΜετά τη θεραπεία - Χρόνος αποκατάστασης
You will be connected to monitors that will constantly display your electrocardiogram (ECG or EKG) tracing, blood pressure, other pressure readings, breathing rate, and your oxygen level. You will be given pain medication for incisional pain or you may have had an epidural during surgery which will help with postoperative pain.
Since the procedure is minimally invasive, the postprocedural recovery is usually very fast. The majority of patients can leave the hospital the following day. Indications about recovery and postprocedural treatment will be clearly specified to all patients.
Your activity will be gradually increased as you get out of bed and walk around for longer periods of time. Your diet will be advanced to solid foods as tolerated. Arrangements will be made for a follow-up visit with your doctor. Check out for fever, pain or alteration at the incision plance, but also for neurologic events.
Is it painful?
The doctor may use general anesthesia or local anesthesia, so the patient will not feel any pain, and after the procedure it will received pain drugs.
How long does it take?
The procedure lasts about 1-2 hours and is performed in the cath lab.
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