Bowel prep the patient the night prior to surgery, and arrange for patient to ingest nothing by mouth past midnight. To decrease the risk of vasospasm, intraarterial papaverine may be started at the time of angiogram. Mesenteric artery reimplantation has been performed but is not widely recommended because of the technical difficulties of the procedure. Because of the high incidence of CAD in these patients, a cardiology consult is warranted to evaluate potential risks associated with surgery. Since chronic mesenteric ischemia is a complication of diffuse atherosclerosis of the arterial tree, these patients should maintain a low-fat diet similar to patients with cardiac disease.
Some patients report increased postprandial pain after eating large or fatty meals.
Therefore, the diet should be appropriately altered to small, multiple meals or low-fat meals. Because protein C and S are the first factors to be inhibited, there is a prothrombic effect during initial few days after instituting warfarin. Start patients on heparin first, and then switch to warfarin when the PT, PTT, and INR are therapeutic. Duration of action is 2-5 d. Anticoagulant effect is related to ability to activate plasma antithrombin.