Mesenteric Ischemia

Mesenteric ischemia occurs when there is low blood flow to the intestines or bowel caused by a blockage of the arteries that supply the small and large intestine with blood flow.

There are three mesenteric arteries that supply blood flow from the heart to the small and large intestines. Mesenteric artery stenosis (MAS) occurs when there is a narrowing or blockage in one or more of these arteries. It may also be caused by a blood clot that moves through the bloodstream, blocking the mesenteric arteries, this is commonly found in individuals who possess abnormal heart rhythms.

Mesenteric ischemia may occur in patients with:

• A long history of smoking
• Atrial fibrillation (a fast and irregular heart beat)
• Recent heart attack

Other risk factors include:

• High cholesterol
• Hypertension (high blood pressure)
• Lack of physical exercise
• Family history of vascular disease (in particular, peripheral vascular disease or carotid artery disease)

Signs of Mesenteric Artery Stenosis:
Symptoms of chronic mesenteric artery stenosis (build up of plaque over time that hardens the arteries include):

• Abdominal pain after eating
• Fear of eating
• Diarrhea
• Weight loss

Symptoms of sudden mesentery artery stenosis (due to a traveling blood clot):

• Sudden severe abdominal pain
• Vomiting
• Lack of appetite

Diagnosis:

Diagnosis is usually based on a patient's history, symptoms, and physical examination. Blood tests that may be helpful include white blood cell ( WBC) count and lactic acid levels.

Imaging tests that may show narrowing or blockage in the mesenteric arteries include:

• Duplex ultrasound
• CT Scan
• Mesenteric Angiogram

Treatment:

Chronic Mesenteric Ischemia:

• Mesenteric angioplasty and stenting
  • This involves opening the narrowed artery using a balloon and inserting a stent (metal scaffolding) to keep it open. This is done through a small groin puncture and usually involves overnight hospitalization.
• Mesenteric artery bypass
  • This involves a large open surgery using artificial bypass graft material or your own vein to carry blood around the blocked areas in the arteries. This may involve a hospital stay of several days.

Acute Mesenteric Ischemia:

• This is a surgical emergency -- if not promptly treated, it may result in death.
  • Treatments include:
    • Open surgery thrombectomy (removing the clot through an open operation)
    • Thrombolysis (performing an angiogram and using clot busting drugs to break up the clot).
      • This is seldom done in patients.

**There is no medical treatment, per se, for mesenteric ischemia. However, tobacco cessation, healthy dietary habits, exercise, and drug therapy (antiplatelet drugs such as aspirin and cholesterol lowering agents) can help to slow the progression of disease and reduce the risk of recurrence.