Pharmacologic Management of Mesenteric Occlusive Disease

Abstract

Mesenteric vascular disease has been diagnosed increasingly over the past 25 years. This rise in incidence has been attributed to the advanced mean age of the population, an increasing number of critically ill patients and a greater clinical recognition of the condition. Although surgical revascularization and resection has long been the standard of treatment, medical management can also play an important adjunctive role. Early diagnosis before irreversible bowel damage, which may occur within 6-8 hours after the insult, is necessary to improve survival and reduce morbidity. Even in the presence of irreversible bowel ischemia, perioperative medical treatment may reduce disease progression, enabling more limited bowel resection. This article outlines the appropriate pharmacologic management of ischemic disorders of the intestine, with an emphasis on the pharmacologic treatments presently being used in clinical practice and those being studied in the laboratory.

Antioxidant enzyme gene transfer for ischemic diseases

“…The incidence of intestinal ischemia has increased steadily over the past 25 years due to the advanced mean age of the population, increasing number of critically ill patients, and a greater recognition of the condition [97]. SMA embolism accounts for 50% of acute mesenteric arterial ischemia (AMI) with sudden severe abdominal pain.…”

“…Emboli most commonly originate from thrombi found in the left side of heart, and are dislodged secondary to a cardiac arrhythmia, less commonly from atherosclerotic plague in the artery or a thrombosed aortic aneurysm. SMA thrombosis accounts for 15% of AMI, and may present acutely or as a slowly evolving chronic disorder [97]. The key treatment for AMI is surgical revascularization, often with resection of necrotic bowel; and angiographic techniques play an adjunctive but critical role.…”

“…The key treatment for AMI is surgical revascularization, often with resection of necrotic bowel; and angiographic techniques play an adjunctive but critical role. Adjuvant drug therapies include vasodilators, thrombolytics, and anticoagulant agents [97]. Increasing attention has been paid to antioxidants based on enhanced oxidant stress in this I/R process.…”

“…Importantly, if bowel is rendered ischemic for more prolonged periods, then antioxidants and other treatments have no effect, indicating that the oxidant damage is only operant in the initial reversible phase of tissue damage. There appears to be a critical time point of 6–8 hours after infarction [97], and beyond this point, the damage to the intestinal tract will be irreversible. Thus, early diagnosis of acute superior mesenteric embolus or thrombosis at a time point where the intestine has not lost its viability is the key for the implementation of treatments and for improving the survival and prognosis of patients.…”

“…Thus, early diagnosis of acute superior mesenteric embolus or thrombosis at a time point where the intestine has not lost its viability is the key for the implementation of treatments and for improving the survival and prognosis of patients. The guidelines for proper diagnosis and surgical and pharmacologic managements of AMI are covered elsewhere [97,105]. The following is the summary of recent attempts in the use of antioxidant and biological therapy for minimizing intestinal I/R injury, mostly in animal experiments.…”