Date: September 1, 2012
Sixty-two-year-old Homer Pullen, of West Virginia, had already gone through a triple coronary artery bypass surgery when he developed fatty deposits in the arteries that feed his intestines, a condition known has mesenteric ischemia.
“I tried to eat but couldn’t because of the pain, and I went from 180 pounds to 132,” says Pullen. “It was heartbreaking.”
Although coronary atherosclerosis is in the news all the time, there’s little attention paid to mesenteric ischemia, says vascular and endovascular surgeon Christopher Abularrage. As a result, by the time patients like Pullen come for treatment, they are usually very weak and undernourished and are not good candidates for an open operation to bypass the blockages.
So Abularrage is taking a minimally invasive approach, using covered stents. Patients are awake but sedated, experience minimal pain, and can go home the next day.
“We start by inserting a catheter through the patient’s arm, down the chest into the abdominal aorta,” he says. “From there, we pass a wire through each blockage and then deploy a covered stent that is mounted on a balloon to open the vessels.” While the procedure can also be performed through the femoral artery in the groin, Abularrage explains, going through the arm may be an easier route due to the sharp angled take-off of the superior mesenteric and celiac arteries.
Abularrage believes that covered stents may be more effective than older, bare metal stents in keeping the arteries open because they have more radial force and can decrease the scarring that thickens blood vessels (known as intimal hyperplasia).
“Uncovered stents have been used as a bridge to bypass—treating patients’ symptoms so that they are pain-free and able to eat more and build their strength. However, covered stents may replace the need for a bypass,” says Abularrage. None of the patients he treated more than a year ago with covered stents has had a recurrence.
Such was the case with Homer Pullen. A month after Abularrage performed the covered stent procedure, starting through Pullen’s arm, the West Virginia man had gained back 20 pounds. “I now eat everything—even spaghetti with meat sauce and ham and eggs, and I feel great,” says Pullen. He’s also been able to go back to hunting, fishing, and other activities with his friends that he couldn’t enjoy before.
Abularrage says that most patients with chronic mesenteric ischemia are over age 60, often with a history of smoking and a high cholesterol level. It affects more men than women. Patients present with abdominal pain after eating and significant weight loss, but sometimes the symptoms can be mistaken for gallbladder disease or kidney stones, which is why it is often diagnosed after it has progressed. Ellen Beth Levitt