From the Guidelines
Pain management in Chronic Mesenteric Ischemia (CMI) primarily involves revascularization procedures.
Options for Pain Management
- Endovascular therapy: This includes percutaneous transluminal angioplasty (PTA) and stent placement, which has become the preferred initial treatment for CMI due to its lower perioperative risks and complications compared to open surgical intervention 1.
- Surgical bypass or endarterectomy: These procedures are recommended when an endovascular approach is not possible or has failed 1.
- Medical management: This may include systemic anticoagulation, which can be used as a bridge to transcatheter or surgical evaluation of the thrombus, or as complementary therapy to invasive procedures 1.
- Vasodilator therapy: Transarterial infusion of vasodilators such as nitroglycerin, papaverine, glucagon, and prostaglandin E1 may be used to manage nonocclusive mesenteric ischemia (NOMI) 1.
Key Considerations
- The choice of treatment depends on the severity of symptoms, the condition of the patient, and the response to initial therapy.
- Endovascular interventions have been shown to have lower mortality and morbidity rates compared to open repair, but may require more frequent reinterventions 1.
- The American College of Radiology Appropriateness Criteria provide evidence-based guidelines for the management of mesenteric ischemia, including CMI 1.
From the Research
Pain Management Options for Chronic Mesenteric Ischemia (CMI)
The options for pain management in CMI include:
- Endovascular treatment, such as percutaneous angioplasty and stenting, which has emerged as a minimally invasive means of obtaining good long-term results 2, 3, 4
- Open surgical revascularization, which still has an important role for patients with more extensive disease 2, 4
- Medical management, including limiting metabolic demand, treatment of the atherosclerotic process, and medication with trombocyte aggregation inhibitors 5
- Lifestyle modifications, such as using smaller and more frequent meals, and cessation of smoking 5
Treatment Outcomes
The outcomes of these treatment options vary, with:
- Endovascular treatment showing high procedural success and low complication rates 2, 3
- Open surgical revascularization providing good long-term results for patients with more extensive disease 4
- Medical management and lifestyle modifications helping to reduce symptoms and improve quality of life 5
Considerations for Treatment Selection
The selection of treatment options depends on various factors, including: