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Stenting Abdominal Arteries Relieves 'Intestinal Angina'
Mar. 23 --
FRIDAY, May 11 (HealthDay News) -- Minimally invasive angioplasty and stenting is a safe and effective method of opening dangerously clogged arteries in the abdomen, a U.S. Study finds.
Clearing these arterial blockages can restore blood flow to the intestines and relieve painful symptoms of a condition called chronic mesenteric ischemia ("intestinal angina"), explained researchers at the Cardiovascular Institute of the South in Lafayette, La.
Patients with chronic mesenteric ischemia suffer symptoms such as nausea, vomiting, or pain after eating. The symptoms can cause patients to significantly reduce the amount they eat, resulting in major weight loss.
Surgery to treat the condition is a complex, lengthy procedure (4 to 8 hours) and can result in death in as many as 15 percent of patients, according to background information in the study.
"Chronic mesenteric ischemia is an ideal condition for treatment with nonsurgical interventions. Angioplasty and stenting are simple and safe, and many times today can be done as an outpatient procedure," Dr. David E. Allie, director of cardiothoracic, vascular and endovascular surgery at the institute, said in a prepared statement.
He and his colleagues used angioplasty and stenting on 50 patients. They found that it restored blood flow to the intestines and relieved painful symptoms in more than 90 percent of the patients, without major complications.
Fifteen of the patients later developed re-narrowing of the stented artery. Of these, three were treated medically and 12 had repeat procedures to reopen the artery.
Overall, 91 percent of patients were alive and symptom-free after one year, 88 percent after two years, and 82 percent after three years.
The study was expected to be presented May 11 at a meeting of the Society for Cardiovascular Angiography and Interventions in Orlando.
More information
The Society of Vascular Surgery has more about mesenteric ischemia.
SOURCE: Society for Cardiovascular Angiography and Interventions, news release, May 11, 2007
What Is An Aortobifemoral Bypass?
An aortobifemoral bypass is a surgery that's done to redirect your blood flow around a large, blocked artery in your groin or abdomen. It increases the blood flow to your legs. It's a major surgery that is usually only done if you're in danger of losing a leg or if your symptoms are severe.
Your surgeon will use an artificial blood vessel to bypass the clogged artery. It is shaped like an upside-down Y. The bottom of the Y will be sewn to your aorta above the diseased part of the artery in your abdomen. The two top parts of the Y will be attached to the femoral arteries below the blocked area.
The femoral arteries are the large arteries in each of your thighs. After this graft is put in, the blood will be able to flow from your aorta to your femoral arteries by going around the clogged area.
You may need an aortobifemoral bypass if one of the major arteries in your abdomen, pelvis, or groin is blocked by a buildup of fatty deposits on your artery walls. The aorta is the largest artery in your body. It's in your abdomen. It splits to form the iliac arteries in your pelvis. These arteries are called the femoral arteries when they reach your thighs.
A buildup of fatty deposits in your artery is called atherosclerosis. It's called peripheral artery disease (PAD) when atherosclerosis affects the arteries leading to your arms, legs, stomach, or head. It usually affects the arteries leading to your legs.
The tissues in your legs can't get enough oxygen if the blood flow is blocked by peripheral artery disease. When this happens, it might cause:
The most serious risk of an aortobifemoral bypass is a heart attack. Other complications that can develop are:
About 80% of people who have aortobifemoral bypass surgery have relief of symptoms and successful bypass of the blocked artery after surgery. Most people don't have pain when they are resting. Their pain is greatly reduced when they are walking, as well. If you smoke, your outlook will be better if you quit smoking before the surgery and don't start back.
Before you have an aortobifemoral bypass, you should try other ways to treat your peripheral artery disease, including:
Anyone who can't have general anesthesia shouldn't have an aortobifemoral bypass. You may also be at an increased risk of complications if you have any of the following issues:
You will be sore and tired for several weeks after your surgery. You'll be able to do many of your normal activities after 4 to 6 weeks. It may take you up to 2 to 3 months to fully recover. The following tips will help you take care of yourself at home:
Call your doctor if you have any of the following symptoms after surgery:
Older Women May Need Better Treatments For Clogged Arteries
Postmenopausal women who have clogged arteries are at higher risk of heart attack than men who are the same age.
That's according to research being presented at the scientific congress of the European Society of Cardiology that was published recently in the European Heart Journal – Cardiovascular Imaging.
In their study, researchers said they found that having plaque is more dangerous in women who are postmenopausal compared to men of the same age.
"The study suggests that a given burden of atherosclerosis is riskier in postmenopausal women than it is in men of that age," Dr. Sophie van Rosendael, an author of the study and a researcher at Leiden University Medical Center in The Netherlands said, in a press statement.
"Since atherosclerotic plaque burden is emerging as a target to decide the intensity of therapy to prevent heart attacks, the findings may impact treatment," she added. "Our results indicate that after menopause, women may need a higher dose of statins or the addition of another lipid-lowering drug. More studies are needed to confirm these findings."
The study involved nearly 25,000 people across six countries in North America, Europe, and Asia.
An imaging technique called coronary computed tomography angiography (CCTA) was used to capture 3D images of the arteries in the heart.
Atherosclerosis is when the arteries narrow due to a build of sticky deposits of plaque.
In the United States, it's estimated that about half of people between the ages of 45 and 84 have atherosclerosis and don't know it. Heart disease—which is associated with atherosclerosis— is the leading cause of death in the United States.
The researchers examined whether the presence of atherosclerosis had the same importance in prognosis for men and women of the same age.
They reported that there was a 12-year delay in the onset of coronary atherosclerosis in women.
The presence of plaque was found to be equally predictive of a major adverse cardiovascular event in men and women aged under 55.
However, in women who were 55 and older and in the postmenopausal group, the risk of an adverse cardiovascular event was higher than in men in the same age group.
Among postmenopausal women, those with a medium or high plaque burden had a 2.21 to 6.11-fold higher risk of a major adverse cardiovascular event.
"In this study, the elevated risk for women versus men was especially observed in postmenopausal women. This could be partly because the inner diameter of coronary arteries is smaller in women, meaning that the same amount of plaque could have a larger impact on blood flow," van Rosendael said.
"Our findings link the known acceleration of atherosclerosis development after menopause with a significant increase in relative risk for women compared to men, despite a similar burden of atherosclerotic disease. This may have implications for the intensity of medical treatment," she added.
Dr. Abha Khandelwal, a clinical associate professor of cardiovascular medicine at Stanford University in California, not involved in the study, said these findings aren't surprising.
"Clinically, what we see is there's a whole host of changes that occur around menopause and several of them are significantly impactful to the cardiometabolic status of a woman. So. It is very common that women will have derangements in their blood pressure, blood sugar, cholesterol, weight, all around the time of menopause. So I always ask my patients to be reassessed around that time," she told Medical News Today.
"In menopause, specifically, women go through not only a lot of cardiometabolic changes, they go through a lot of emotional changes, rates of depression can go up, sleep is disrupted. All these things we know when they're left untreated can influence cardiac outcomes," Khandelwal added.
Experts say there are a number of steps women can take even before menopause to help protect their cardiovascular health.
"At all ages of life, there's an opportunity for each patient to work with her doctor to maximize a healthy lifestyle, to screen for atherosclerosis, or this sticky plaque build up, to screen for the risk factors that cause atherosclerosis, which include high blood pressure, high cholesterol, diabetes, smoking, family history, vasculitis or inflammation of the blood vessels, certain autoimmune conditions and others and then treat these proactively," Dr. Sarina van der Zee, a cardiac electrophysiologist and cardiologist at Providence Saint John's Health Center in California, told Medical News Today.
"So absolutely there are preventative options that a woman with her doctor can identify, treat upstream and prevent from coming becoming an issue. This is especially important after menopause, but certainly is an important process to start even beforehand, if possible," she added.
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