Mesenteric Artery Stenting
Mesenteric ischemia is a medical condition in which injury to the small intestine occurs due to insufficient blood supply. Acute mesenteric ischemia appears abruptly, while chronic mesenteric ischemia develops over time. The acute form of the disease often presents with sudden, severe abdominal pain and is associated with a high risk of death. The chronic form usually presents more gradually with abdominal pain after eating, involuntary weight loss, vomiting, and fear of eating.
What Is Mesenteric Ischemia?
Mesenteric ischemia occurs when narrow or blocked arteries restrict blood flow to the small intestine. The small intestine may be permanently damaged by insufficient blood flow. Sudden loss of blood flow to the small intestine (acute mesenteric ischemia) due to a blood clot requires immediate surgery. Angioplasty or open surgery was used to treat chronic mesenteric ischemia. Chronic mesenteric ischemia that is left untreated may become acute, resulting in extreme weight loss and malnutrition.
Causes
A blood clot that spreads to one of the mesenteric arteries and suddenly prevents blood flow is the most frequent cause of acute mesenteric ischemia. These clots often originate in the heart and are more common among patients with irregular heartbeats or heart disease.
CHRONIC mesenteric ischemia is often due to atherosclerosis (hardening of the arteries), which slows down the amount of blood flowing through the arteries. An artery becomes blocked with plaque, which is made up of fats and other materials that circulate in the blood. As more plaque builds up along the wall of the blood vessels, the artery can narrow and harden. Over time, enough plaque builds up to reduce blood flow or even completely block arteries.
What is a Mesenteric Angiogram?
Mesenteric angiography is a diagnostic technique that is used to look at the blood arteries that lead to the intestine. This procedure entails inserting a catheter (a small plastic tube) into an artery, by using the catheter along the body's major artery (aorta) to reach the arteries that supply the intestine and injecting a contrast-medium 'X-ray dye' into the arteries that supply the intestine. When your doctor believes that one of the blood vessels feeding your gut is leaking, he or she will order this test. The exam will be performed by a radiologist who will be assisted by a radiographer and a radiology nurse.
What is Mesenteric Embolization?
A mesenteric embolization occurs when one of the blood vessels supplying your intestine is intentionally blocked. Once the radiologist has located a mesenteric artery from the angiogram, small metal coils are inserted through the catheter and left in the artery.
Why do I Need a Mesenteric Embolization?
The procedure is usually done if the angiogram shows that a blood vessel is discharging blood directly into the intestine. Embolization will seal the hemorrhage by allowing blood clots to form within the damaged artery and is an alternative treatment to surgery.
Procedure
Preparation
- You will have blood tests to check your blood clotting ability and kidney function.
- You do not need to stop eating before the procedure (unless you have surgery planned for the same day), but you must drink sufficient water.
- If you have severe kidney problems, you will be given intravenous fluids (one drip) for 6 hours, i.e. one hour before the procedure.
- Some pain relievers (non-steroidal anti-inflammatory drugs) may need to be stopped on the day of the exam for 24 hours; discuss this with the ward nurses.
- You will need to wear a hospital gown. The porters will pick you up from the room and take you to the X-ray department on your bed for the procedure
During
- You will be taken to the X-ray room where you will be asked to lie down on the X-ray table.
- If you are having a mesenteric embolization, a radiology nurse will monitor your blood pressure and stay with you throughout the procedure.
- The radiologist (an x-ray doctor) will inject a local anesthetic into the skin of your groin to freeze the area.
- You may still feel some pressure, but if you feel any pain during the procedure, tell the radiologist. You will be asked to lie down as still as possible.
- The catheter is then inserted into the artery in the groin and, using X-rays to assist, the radiologist moves the catheter to the correct position.
- X-rays are taken while the dye is injected through the catheter into the arteries. Sometimes the injection can cause a feeling of warmth for a while or the feeling that you have urinated.
- At this point, embolization treatment will be performed if necessary.
- When the X-rays are completed, the catheter is removed and a special sealing device is placed in the artery to seal the hole, or pressure is applied to the groin for about ten minutes to minimize any bruising.
- If you had embolization and are having surgery the same day, a small catheter called a sheath may be left in your groin as movement is restricted after removal.
- You will have blood tests to check your blood clotting ability and kidney function.
- You do not need to stop eating before the procedure (unless you have surgery planned for the same day), but you must drink sufficient water.
- If you have severe kidney problems, you will be given intravenous fluids (one drip) for 6 hours, i.e. one hour before the procedure.
- Some pain relievers (non-steroidal anti-inflammatory drugs) may need to be stopped on the day of the exam for 24 hours; discuss this with the ward nurses.
- You will need to wear a hospital gown. The porters will pick you up from the room and take you to the X-ray department on your bed for the procedure
During
- You will be taken to the X-ray room where you will be asked to lie down on the X-ray table.
- If you are having a mesenteric embolization, a radiology nurse will monitor your blood pressure and stay with you throughout the procedure.
- The radiologist (an x-ray doctor) will inject a local anesthetic into the skin of your groin to freeze the area.
- You may still feel some pressure, but if you feel any pain during the procedure, tell the radiologist. You will be asked to lie down as still as possible.
- The catheter is then inserted into the artery in the groin and, using X-rays to assist, the radiologist moves the catheter to the correct position.
- X-rays are taken while the dye is injected through the catheter into the arteries. Sometimes the injection can cause a feeling of warmth for a while or the feeling that you have urinated.
- At this point, embolization treatment will be performed if necessary.
- When the X-rays are completed, the catheter is removed and a special sealing device is placed in the artery to seal the hole, or pressure is applied to the groin for about ten minutes to minimize any bruising.
- If you had embolization and are having surgery the same day, a small catheter called a sheath may be left in your groin as movement is restricted after removal.
Risks
- It is not always possible to see the leaky vessel on the angiogram.
- Surgery may still be necessary if embolization is not possible or is only partially successful.
- There may be bleeding around the groin after the exam. The ward nurses will watch you closely for 4 to 6 hours after the procedure. Rarely, bleeding can be so severe that serious complications can arise. The doctor will discuss this with you when you sign the consent form.
- In rare cases, the contrast medium used for angiograms can cause deterioration in kidney function, which is usually temporary, but can sometimes be longer. This is of particular concern for people who already have impaired kidney function. You will have a blood test to assess your kidney function before the procedure.
- On rare occasions, allergic reactions can occur with the X-ray dye, and only very rarely do they require any treatment. The radiologist will ask you about allergies at that time.
