Treatment for mesenteric ischemia will vary depending on whether you have AMI or CMI, how advanced it is and where the blockage is.
If you have AMI caused by a blood clot, you may need procedures to treat and remove the clot.
If you have AMI or CMI, you will probably need surgery.
Stenting can often be used to treat CMI, but bypass surgery is the most common treatment option for AMI. If your AMI has caused tissue breakdown, you will also need surgery to remove the damaged tissue from your abdomen.
Thrombolysis, also known as clot-busting therapy, is a procedure that uses medicine to dissolve blood clots within the blood vessels. Thrombolytic medicines are either injected straight into a vein or delivered through a catheter inserted into an artery near the clot location. During catheter-based thrombolysis, you receive local anesthesia so you don’t feel the incision for the catheter. If you receive systemic thrombolysis, you’ll receive the medicine through an IV. After thrombolysis, you’ll usually be monitored in the hospital for a few days. After you leave the hospital, you may need to follow up with your doctor to monitor your health and prevent additional clots.
Thrombectomy is a procedure that directly removes a blood clot from a blocked blood vessel. Thrombectomy can be performed in two ways:
- During surgical thrombectomy, the doctor makes an incision at the site of the blockage to remove the clot and repair the blood vessel. Surgical thrombectomy is often performed if the clot is large or the blockage is in an area that is difficult to reach with catheters.
- In endovascular thrombectomy, also known as catheter-directed thrombectomy, a catheter is introduced into your artery through a small incision in the groin or arm. Once the catheter reaches the clot, doctors use special tools to remove it. Then, clot-dissolving medicine is used to clear away any remaining pieces.
After thrombectomy, you may be in the hospital overnight or for a few days, depending on the type of procedure you had.
Angioplasty is a procedure to open arteries that are blocked or narrowed by plaque. It can be used in arteries throughout the body to restore blood flow.
Angioplasty is performed with either sedation to allow you to relax or while you’re asleep under general anesthesia. During the procedure, the doctor inserts a catheter into a blood vessel through a small incision in the arm or groin. The doctor then guides the catheter to the site of the blockage. A balloon at the tip of the catheter then inflates, compressing the plaque against the artery wall.
In many cases, doctors use a small metal mesh tube called a stent, which is placed through the catheter. Once inside the artery, the stent helps keep it open to improve blood flow. The stent may be coated in a medicine that helps prevent the artery from narrowing again.
After angioplasty, you’ll remain at the hospital for at least a few hours, possibly overnight. Your doctor may prescribe blood thinners to prevent additional clots. You can usually resume normal activities within a week. Your doctor will guide you on how often you will need follow-up visits to check that the angioplasty is working well and the stent, if you have one, is still in place.
Vascular bypass surgery creates a new path for blood to flow around a blocked or damaged artery. For this procedure, doctors use either a synthetic graft or a healthy vein from another part of your body. They locate the area of the blockage and then sew the graft above and below the blocked artery section. The blood is then rerouted through the graft.
After bypass surgery, you will stay in the hospital for a few days. After that, you may need to regain your strength and mobility with outpatient rehabilitation. Your doctor will let you know when to return to the office for a follow-up visit to have your stitches removed.
