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    Mesenteric artery ischemia

    Mesenteric vascular disease; Ischemic colitis

    Mesenteric artery ischemia occurs when there is a narrowing or blockage of one or more of the three mesenteric arteries, the major arteries that supply the small and large intestines.

    Causes

    Narrowing of the arteries that supply blood to the intestine causes mesenteric ischemia. The arteries that supply blood tothe intestinesrun directly from the aorta, the main artery from the heart.

    Mesenteric artery ischemia is often seen in people who have hardening of the arteries in other parts of the body (for example, those with coronary artery disease or peripheral vascular disease). The condition is more common in smokers and in patients with high blood pressure or blood cholesterol.

    Mesenteric ischemia may also be caused by a blood clot (embolus) that moves through the blood and suddenly blocks one of the mesenteric arteries. The clots usually come from the heart oraorta. These clots are more commonly seen in patients with abnormal heart rhythms (arrhythmias), such as atrial fibrillation.

    Symptoms

    Symptoms of long-term (chronic) mesenteric artery ischemia caused by hardening of the arteries (atherosclerosis):

    • Abdominal pain after eating
    • Diarrhea

    Symptoms of sudden (acute) mesenteric artery ischemia due to a traveling blood clot:

    • Diarrhea
    • Sudden severe abdominal pain
    • Vomiting

    Exams and Tests

    In acute mesenteric ischemia, blood tests may show a higher than normal white blood cellcount and changes in the blood acid level. There may be bleeding in the GI tract.

    A Doppler ultrasound orCT scan may show problems with the blood vessels and the intestine.

    A mesenteric angiogram is a test that involves injecting a special dye into your bloodstream to highlight the arteries of the intestine. Then x-rays are taken of the area. This can show the location of the blockage in the artery.

    Treatment

    Acute mesenteric artery ischemia is an emergency. If a blood clot is causing it, you may need to take medicines to dissolve the clot (thrombolytics) andwiden the mesenteric arteries (vasodilators). Surgery may be needed to treat mesenteric ischemia. In some cases, the surgeon must also create a bypass around the blockage.

    Surgery for chronic mesenteric artery ischemia involves removing the blockage and reconnecting the arteries to the aorta. A bypass around the blockage is another procedure. It is usually done with a plastic tube graft.

    An alternative to surgery is a stent. It may be inserted to enlarge the blockagein the mesenteric artery or deliver medicine directly to the affected area. This is a new technique and it should only be done by experienced health care providers. The outcome is usually better with surgery.

    Outlook (Prognosis)

    In the case of chronic mesenteric ischemia, the outlook after a successful surgery is good. However, if appropriate lifestyle changes (such as a healthy diet and exercise) are not made, any problems with hardening of the arteries will generally get worse over time.

    Persons with acute mesenteric ischemia usually do poorly, since death of the intestine often occurs before surgery is done. However, when diagnosed and treated right away, patients with acute mesenteric ischemia can be treated successfully.

    Possible Complications

    Tissue death from lack of blood flow (infarction) in the intestines is the most serious complication of mesenteric artery ischemia. Surgery may be needed to remove the dead portion.

    When to Contact a Medical Professional

    Call your health care provider if you have:

    • Changes in bowel habits
    • Fever
    • Nausea
    • Severe abdominal pain
    • Vomiting

    Prevention

    The following lifestyle changescan reduce your risk for narrowing of the arteries:

    • Exercise
    • Follow a healthy diet
    • Get treatment for a heart arrhythmia
    • Keep your blood cholesterol under control
    • Keep your blood pressure under control
    • Stop smoking

    To prevent acute mesenteric artery ischemia, also control any heart rhythm problems that may cause the blood to clot.

    References

    Hauser SC. Vascular diseases of the gastrointestinal tract. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 145.

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                Tests for Mesenteric artery ischemia

                Review Date: 2/18/2012

                Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

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