Department of Vascular Surgery

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Open and endovascular treatment of abdominal angina

Abdominal (or intestinal) angina refers to a chronic circulatory disorder of the intestinal wall (chronic mesenteric ischemia). It is an early symptom and a warning sign of impending occlusion of a vessel supplying the intestine.

Overview

It usually occurs about 20-30 minutes after food intake and lasts about one to two hours, with pain being dull or sharp in character. The stomach and intestinal walls stretch after food intake, thereby compromising vessels, which further increases resistance to blood flow. This in turn leads to reduced blood flow and attacks of abdominal pain. . The commonest cause is atherosclerosis of the mesenteric vessels (superior and inferior mesenteric arteries) Risk factors thus also include those of atherosclerosis:

  • Smoking
  • High blood pressure
  • High blood fats
  • Family history

Clinical course

Imaging of the intestinal vessels is necessary if a chronic circulatory disorder is suspected. Doppler ultrasonography is typically the modality of first choice. Detailed assessment by computed tomography is then performed if a circulatory disorder is confirmed. Magnetic resonance tomography is an alternative imaging modality. The findings are discussed by an interdisciplinary team and a treatment plan proposed to the patient.

Open (surgical) treatment

The aorta and involved vessels are exposed by an abdominal incision, followed by an appropriate operative intervention: Relocation of the vessel (re-implantation / transplantation), creation of an antegrade or retrograde bypass, reconstruction using a prosthesis (see image) or removal of calcium deposits (thrombendarterectomy) with vasodilatation (patch repair)

Endovascular treatment

A catheter is introduced in to the vessel through a small puncture  and the narrow segment is then dilated by means of a balloon. Professional associations currently recommend stent implantation in addition. Should treatment be necessary, the patient’s situation and the outcomes of  various methods should be compared: Open surgery has better long-term results overall, while catheter-guided interventions are beneficial in the short-term. Open surgery should therefore be recommended for younger and otherwise healthy patients, while catheter-guided interventions may be considered in older patients with severe comorbidities. Both methods complement may one another in many cases.

Illustration einer Rekonstruktion mittels Prothese
Jimenez et al J Vasc Surg 2002
Illustration eines Katheter in einem Gefäss
Alila Medical Media / fotolia

Preparation

Special preparation by the patient is not feasible. Treatment of risk factors (e.g., smoking, high blood pressure, etc.) is necessary during and after therapy.

Aftercare

Aftercare depends on the selected therapeutic option (open surgery versus catheter-guided treatment), and may be organized in a special rehabilitation clinic after treatment, if desired. Regular consultations are furthermore arranged in the vascular surgery outpatient department for monitoring of therapeutic outcomes. A change and modification of medication is necessary depending on the procedure performed.

Various procedures at the University Hospital Zurich

Treatment at the University Hospital Zurich offers various advantages. All known and modern treatment methods are available, as are combinations of two methods (hybrid methods) for suitable patients (e.g., ROMS Retrograde open mesenteric stenting). Patients with comorbidities also benefit from the interdisciplinary teamwork of the 43 departments of the University Hospital Zurich.

For patients

Register directly with the Clinic for Vascular Surgery for your first appointment.

Tel. +41 44 255 20 39

Opening hours: 8 a.m. – 12 p.m. 1.00 p.m. – 5.00 p.m.

For referrals

Simply assign your patient online.

University Hospital Zurich

Clinic for Vascular Surgery

Rämistrasse 100

8091 Zurich

Tel. +41 44 255 20 39