Surgery for Mesenteric Ischemia

NYU Langone specialists may recommend surgery to decrease the risk of life-threatening complications for people who have acute mesenteric ischemia. They may suggest surgery if you need more than medication to remove a blockage.

Surgery can also help increase blood and oxygen flow to the intestines and prevent tissue death from a lack of oxygen, known as gangrene. 

People with chronic mesenteric ischemia may require a procedure to clear blockages when medication doesn’t correct the problem.

Vascular surgeons at NYU Langone are experts in performing surgery to manage this rare and dangerous condition. The goal is to restore blood flow to the intestines.

Balloon Angioplasty and Stenting

Balloon angioplasty and stenting is a minimally invasive procedure that widens a blocked artery and increases blood flow to the intestines. It’s typically used to treat people with chronic mesenteric ischemia. 

During the procedure, the doctor reaches the mesenteric artery through a tiny incision in the groin. He or she inserts a tiny surgical balloon through a hollow tube called a catheter and into the blocked artery. The balloon is then inflated to press plaque buildup against the walls of the artery. 

Next, the doctor places a tiny metal mesh tube, called a stent, into the artery to act as “scaffolding.” The stent holds the artery open so blood can reach the intestines. 

The procedure lasts 30 minutes to 2 hours, depending on how severe the blockage is, and the stent remains in place permanently. You may need to stay in the hospital overnight as you recover. Most people resume everyday activities within two days of the procedure.

Transaortic Endarterectomy

For people with chronic mesenteric ischemia, a doctor may perform a transaortic endarterectomy, in which he or she removes plaque blocking the mesenteric artery. The procedure is performed with general anesthesia.

The surgeon makes an incision in the abdomen and clamps the aorta and the affected mesenteric artery, which is identified with imaging tests. Next, he or she opens it and removes the plaque. When the procedure is done, the doctor stitches the artery, unclamps the arteries, and closes the incision. 

The surgery takes about 5 to 7 hours and typically requires a 7- to 14-day stay in the hospital. You can usually resume normal activities within six to eight weeks.

Arterial Bypass Surgery

Your doctors may recommend arterial bypass surgery if you have a severe blockage in one or more arteries that cannot be treated effectively with a minimally invasive procedure, such as balloon angioplasty. 

To perform arterial bypass surgery, the surgeon uses a graft to redirect blood flow around a narrowed or blocked section of one or more mesenteric arteries. The graft is made from a synthetic tube or a vein from another part of the body. 

If a graft is taken from the body, the surgeon makes an incision in the skin, typically in the thigh, then selects and removes a healthy vein to be attached to the blocked artery. Next, the surgeon sews the vein or synthetic tube onto the mesenteric artery above and below the blockage, allowing blood to bypass the blocked area and flow freely toward the intestines.

The surgeon also examines the intestines for gangrene, or cell death. If any is found, the surgeon removes the dead tissue. 

In order to watch for further tissue damage, the divided ends of the intestines are not reconnected right away. Instead, people typically stay in the intensive care unit for observation for 24 to 48 hours. Then, if the tissue is healing correctly, surgeons reconnect the intestines and close the incision. 

Most people remain in the hospital for a total of 7 to 14 days, depending on their condition. They receive antibiotics to prevent infection and pain medication as needed. The procedure itself requires general anesthesia. 

Recovery at home takes 6 to 8 weeks. When you return home, your doctor may restrict activity until your follow-up visit two weeks later, when your stitches are removed. He or she may ask you to take time off from work and rest frequently.

Laparotomy

If you have acute mesenteric ischemia, an emergency open surgery called a laparotomy may be necessary to diagnose and manage the condition. 

In this procedure, which is performed with general anesthesia, the surgeon makes an incision in the abdomen and the blocked mesenteric artery and removes the blood clot that caused the condition. This is called an embolectomy. 

If an artery has a significant buildup of plaque, the surgeon may perform an arterial bypass to reroute blood flow around the blockage.

In some situations, your doctor may need to remove gangrenous sections of the intestines, in which the tissue has died. People typically remain in the intensive care unit for observation of further tissue damage for 24 to 48 hours. Then, the divided ends of the intestines are inspected for gangrene and the divided parts are reconnected. 

The surgery typically may require a 7- to 14-days hospital stay, plus 6 to 8 weeks of recovery at home.

People with acute mesenteric ischemia typically require longer recovery time than people with the chronic type of this condition and longer monitoring in the hospital.

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