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Intestinal PAD: Treatment Options

Intestinal ischemic syndromes -- also called visceral or mesenteric ischemic syndromes -- occur when blood flow to the bowel or gastrointestinal system (intestines) is decreased because of a blood vessel blockage.   Treatment is needed to prevent permanent damage to the tissues. 

Thrombolysis

Thrombolytic therapy uses drugs designed to dissolve clots and restore normal blood flow. Your physician will inject a clot-dissolving medication into a blood vessel. A catheter (a long, thin tube) may also be used to deliver the medication or to break up the clot. This is not a common treatment for this disease.

Angioplasty

Angioplasty is used to widen the artery that is narrowed.. During angioplasty, a small balloon at the tip of the catheter is inflated to stretch the artery open and increase blood flow. A stent may be necessary at times and is placed during the angioplasty procedure to keep the artery open. A stent is a small, metal mesh tube that acts as a scaffold and provides support inside the artery.  A balloon catheter, placed over a guide wire, is used to insert the stent into the narrowed vein. Once in place, the balloon is inflated and the stent expanded to the size of the artery holding it open. The balloon is deflated and removed, and the stent stays in place permanently.

When is surgery for visceral ischemic syndrome necessary?

Emergency visceral ischemic syndrome surgical treatment may be performed to remove the blood clot or bypass the blocked vessel and restore blood flow to the intestines. This is particularly true of acute mesenteric ischemia. If tissue death has occurred, the surgeon may need to remove a portion of the intestine if tissue death has occurred.

Otherwise, surgery is indicated when the blockage has drastically reduced the blood flow to the intestines.

Visceral ischemic syndrome surgical treatment may be performed to remove plaque (atherectomy/endarterectomy), bypass the blocked vessel to restore blood flow to the intestines, or remove or repair an aneurysm.

Surgical Bypass

A surgical intestinal bypass reroutes blood flow around the blood vessel blockage by creating a new pathway for blood flow using a graft. To bypass the blockage, the surgeon makes a small opening just below the blockage in the diseased artery and places a graft, which is either a portion of one of your veins or a man-made synthetic tube. The surgeon will connect the graft above and below a blockage to allow blood around the blockage.

Endarterectomy

Intestinal endarterectomy may be performed to surgically remove the blockage. The surgeon will make an incision in the affected artery and remove the plaque contained in the artery's inner lining restore blood flow.

Outcomes for visceral ischemic syndrome surgical treatment at Cleveland Clinic

Surgery for chronic mesenteric ischemia is successful at relieving the pain associated with the disease in more than 90 percent of patients. Unfortunately, nearly 10 percent of patients develop a recurrence of symptoms at some point in their life. The recurrence is typically due to progression of the atherosclerotic disease. This can be prevented by adopting a healthy lifestyle.

Doctors vary in quality due to differences in training and experience; hospitals differ in the number of services available. The more complex your medical problem, the greater these differences in quality become and the more they matter.

Clearly, the doctor and hospital that you choose for complex, specialized medical care will have a direct impact on how well you do. To help you make this choice, please review our Miller Family Heart and Vascular Institute Outcomes.

Cleveland Clinic Heart and Vascular Institute Vascular Medicine Specialists and Surgeons

Choosing a doctor to treat your vascular disease depends on where you are in your diagnosis and treatment. The following Heart and Vascular Institute Sections and Departments treat patients with all types of vascular disease, including blood clotting disorders:

Section of Vascular Medicine: for evaluation, medical management or interventional procedures to treat vascular disease. In addition, the Non-Invasive Laboratory includes state-of-the art computerized imaging equipment to assist in diagnosing vascular disease, without added discomfort to the patient. Call Vascular Medicine Appointments, toll-free 800-223-2273, extension 44420 or request an appointment online.

Department of Vascular Surgery: surgery evaluation for surgical treatment of vascular disease, including aorta, peripheral artery, and venous disease. Call Vascular Surgery Appointments, toll-free 800-223-2273, extension 44508 or request an appointment online.

IVC Filter Retrieval Clinic - to make an appointment, call Vascular Medicine at 216.444.4420. Ask for Dr. Bartholomew in the Filter Retrieval Clinic. Your appointment will include a consultation with Dr. Bartholomew and the physicians who will perform the IVC filter retrieval procedure.

You may also use our MyConsult second opinion consultation using the Internet.

The Heart and Vascular Institute also has specialized centers and clinics to treat certain populations of patients:

Learn more about experts who specialize in the diagnosis and treatment of vascular and arterial disease.

Contact

If you need more information, click here to contact us, chat online with a nurse or call the Miller Family Heart and Vascular Institute Resource & Information Nurse at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.

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Reviewed: 01/16

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This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

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