Mesenteric ischemia results from a lack of blood flow to the intestines, spleen and liver which may develop in certain patients who are at risk of atherosclerosis (see: PAD). Atherosclerosis is hardening of the arteries due to a build-up of plaque, which are fatty deposits that adhere to the artery wall and result in a reduction of blood flow to these organs.
The most common presentation is one of chronic symptoms over time known as chronic mesenteric ischemia (CMI). The lack of blood flow results in pain after eating as the muscles of the stomach and intestines do not receive the required oxygen as the blood flow is interrupted and will invariably result in weight loss as patients with CMI are fearful of eating to avoid the pain. It can also result in a severe acute interruption of blood-flow to the intestines. Without proper flow, the intestines may begin to die and potentially perforate. This condition requires prompt diagnosis and emergency treatment.
At South Charlotte general and Vascular Surgery, our vascular surgeons are able to treat the blockage of the arteries in the office in our accredited angiography suite and help you avoid the more serious complications of the condition if left untreated.
Risk Factors
Mesenteric ischemia usually occurs in persons older than 60. Key risk factors are the same risk factors for patients who have heart disease, stroke or PAD and include smoking, high cholesterol, high blood pressure, and diabetes mellitus.
Symptoms
With chronic mesenteric ischemia, the symptoms may mimic other intestinal conditions, and it is not uncommon for symptoms to go on for on 6-12 months before the correct diagnosis is actually made.
Chronic mesenteric ischemia:
- Severe dull or sharp pain in the abdomen above the belly button occurring within an hour of eating, lasting for 60 to 90 minutes, and recurring after each meal.
- Weight loss (patients cut back on eating due to the pain)
- Diarrhea after eating
- Nausea and Vomiting
Many symptoms of chronic mesenteric ischemia are frequently present in other conditions, therefore detailed tests must be performed to obtain a definitive diagnosis of mesenteric ischemia.
Acute mesenteric ischemia
In some patients, the blockage progresses over time but there may come a point where the artery becomes quickly and completely blocked by a blood clot. Patient will then experience a sudden and severe pain in the abdomen that cannot be alleviated with narcotic pain medications, nausea, or vomiting. They may be riddled in pain although their initial exam may be initially untelling. The pain is out of proportion to the exam, and it may take a physician in the ER who is familiar with the presentation to suspect it and initiate prompt consultation with the vascular surgeon.
Causes:
Mesenteric ischemia may result from any of the following causes although hardening of the arteries (atherosclerosis) is by far the most common:
- Atherosclerosis
- Aortic dissection: A tear in the aorta's inner layer.
- Blood Clots: A clot or embolus travels to or forms in one of the mesenteric arteries and blocks blood flow. Such clots are more common in patients with heart disease an irregular heartbeat.
- Congestive heart failure
- Low blood pressure
- Occlusion or blockage of the veins in the bowel
- Fibromuscular dysplasia and arteritis: inflammation of the arteries
Diagnostic Tests
- Blood Tests: With mesenteric ischemia, especially the acute type, the white blood cells may be elevated. Tests may also show if the acid level in the blood is high, a condition called acidosis. This may indicate serious bowel injury.
- Doppler Ultrasound: Doppler ultrasound uses high-frequency sound waves which bounce off blood vessels. This test is designed to measure blood flow and may reveal which arteries are blocked.
- CT Angiogram Scan: A CTA scan (Computed tomography) creates detailed images from x-rays of slices of the body. It can reveal problems with the large and small arteries, such as aortic dissection, and abdominal organs.
- Magnetic Resonance Angiogram (MRA) Scan: An MRA scan creates rich images of blood vessels using magnetic images of slices of the body. This method cannot be used, however, when a person has metal implants, such as a pacemaker or artificial hip.
- Angiogram: An angiogram uses x-rays and a special dye that is injected in your veins or arteries to view the body's blood vessels through a catheter introduced via your groin or arm. A treatment through the catheter may also be started during the angiogram.
The goal of treatment is to reopen the blocked arteries to restore adequate blood flow to the intestines. Depending on whether your symptoms are chronic or acute, your vascular surgeon may recommend one of the following treatments:
Treatment for Chronic Mesenteric Ischemia:
- Trans-aortic endarterectomy: This is a procedure often used to treat chronic mesenteric ischemia. The surgery is designed to remove the plaque blocking the mesenteric artery. A vascular surgeon makes a surgical cut in the abdomen, or side, and removes the plaque from the inner lining of the blocked mesenteric artery.
- Bypass Surgery: In bypass surgery, the vascular surgeon will create a new route for blood flow using either a vein from another part of the body (bypass graft) or a tube made from synthetic material. This creates a new path for blood to flow to the intestines.
- Angioplasty and Stenting: In this procedure (often performed by pour vascular specialists at the time of the angiogram) a small balloon is inflated inside the narrowed artery. After widening the artery with angioplasty, our vascular specialist may insert a stent, a metallic mesh tube that supports the artery's walls and keeps the blood vessels from collapsing again. Our state-of-the-art facility allows our surgeons to treat your condition in the comfort and safety of our in-office angiography suite.
Treatment for Acute Mesenteric Ischemia:
Patients often presents to the ER and an emergency procedure is often required because severe intestinal damage can develop over a short time. Blood clot-dissolving medications may be injected into blood vessels, frequently at the time of the angiogram. If not successful, the vascular surgeon will have to remove the clot surgically, especially where intestinal damage is present. In patients presenting with acute mesenteric ischemia, some parts of the intestine may need to be removed. It may require a second operation two days later to make sure that the intestines have recovered, and no additional treatment is needed.
At South Charlotte General and Vascular Surgery, our vascular specialists are committed to your vascular health. Please call us or book an appointment online here to inquire about the condition if you have these symptoms of mesenteric ischemia or any of the associated vascular conditions.
