When people think about atherosclerosis, they often think about a heart disease or strokes. In reality, atherosclerosis and ischemia can develop anywhere in the body. This includes the blood vessels that supply blood to the abdominal organs. When this happens it is called mesenteric artery disease or mesenteric ischemia.
Definition of Mesenteric Artery Disease and Mesenteric Ischemia
Mesenteric artery disease is a narrowing, usually due to atherosclerosis, of the blood supply to the abdominal organs. Mesenteric ischemia is a term that describes a lack of blood flow to abdominal organs. However, there are multiple types and causes of mesenteric ischemia.
Anatomy of Mesenteric Artery Disease
There are three mesenteric blood vessels feed the abdominal organs. The celiac artery supplies the stomach, liver, spleen and some of the small intestine. The superior mesenteric artery supplies blood to the intestines from the end of the duodenum through approximately half of the colon. There is also the inferior mesenteric artery that supplies blood to the last half of the colon. If these vessels develop atherosclerosis or become occluded mesenteric ischemia can occur.
Causes of Mesenteric Artery Disease and Mesenteric Ischemia
The causes of mesenteric artery disease are largely similar to atherosclerosis in other areas of the body. People with high blood pressure, diabetes, and atherosclerosis of other vessels are at higher risk for developing mesenteric artery disease. Smoking is also a risk factor. Mesenteric ischemia can be due to severe atherosclerosis of multiple mesenteric vessels. Alternatively, a clot can block off the mesenteric arteries causing acute mesenteric ischemia to develop. This is a medical emergency.
Symptoms of Mesenteric Artery Disease
There are two forms of mesenteric ischemia. Acute mesenteric ischemia occurs over minutes to hours and requires immediate attention. Chronic mesenteric ischemia can occur over months to years.
Symptoms of acute mesenteric ischemia:
- Acute abdominal pain
- Pain appears out of proportion with the findings on physical exam
If the clinical exam is largely benign but the patient is in severe pain, this could indicate mesenteric ischemia.
Symptoms of chronic mesenteric ischemia:
- Pain shortly after eating
- Severe weight loss
- Fear of eating due to the pain associated with it
Diagnosis of Mesenteric Ischemia
The diagnosis is made using a combination of clinical symptoms and imaging. If the symptoms suggest mesenteric ischemia, an ultrasound is usually the first test. If an ultrasound is unavailable or there is a concern for bowel death, computed tomography can show the extent of arterial disease as well as show any evidence of bowel ischemia.
Prevention of Mesenteric Artery Disease
Mesenteric ischemia has many of the same risk factors as heart disease. Patients should see their physician regularly to maintain adequate blood pressure and check that cholesterol levels are within appropriate limits. Patients with atrial fibrillation should ensure they stay on appropriate blood thinners and check medication levels as directed. Patients should not smoke.
Am I At Risk?
Patients with elevated cholesterol levels, heart disease, diabetes, elevated blood pressure, and those on chronic anticoagulation are all at risk of mesenteric ischemia.
Treatment of Mesenteric Artery Disease
The treatment of acute mesenteric disease is an emergency. Both endovascular like stenting and open procedures like open thrombectomies and bypasses can be used for treatment of mesenteric ischemia. In addition, those patients with acute mesenteric ischemia may need to resect any dead bowel. For chronic mesenteric ischemia, these patients can often be treated with endovascular stent placement.