Mesenteric Ischemia

The mesenteric arteries supply blood to your large and small intestines. Ischemia occurs when your blood cannot flow through your arteries and your intestines do not receive the necessary oxygen.  This can be a life-threatening condition and may require prompt treatment.

Causes of Mesenteric ischemia
Mesenteric ischemia usually occurs when one or more of those arteries narrows or becomes blocked. When this blockage occurs, you can experience severe abdominal pain. Over time, often suddenly, the blockage may worsen and cause tissues in your intestine to die because they lack enough blood flow.

Mesenteric ischemia can be either chronic or acute.
Chronic means that you have had the condition and symptoms over a relatively long period of time. Acute means that the symptoms start abruptly and become very serious in a short period of time.

Chronic mesenteric ischemia can progress without warning to acute mesenteric ischemia, sometimes very quickly. Acute mesenteric ischemia is an emergency, and can be life-threatening.

Symptoms of Mesenteric Ischemia
Chronic mesenteric ischemia usually presents as:

• Severe pains in your abdomen 15 to 60 minutes after you eat.  The pain may last for as long as 60 to 90 minutes and then disappear.

Other symptoms may include:

• Diarrhea
• Nausea
• Vomiting
• Flatulence
• Constipation

Acute mesenteric ischemia usually presents as follows:

• Sudden, severe pain in the abdomen, which may be accompanied by:
  • Nausea
  • Vomiting

Risk Factors
Chronic mesenteric ischemia is usually caused by atherosclerosis and the risk factors are the same as for Peripheral Artery Disease. These include:

• History of smoking
• High cholesterol
• High blood pressure
• Diabetes
• Family history of hardening of the arteries

Acute mesenteric ischemia may be caused by atherosclerosis.  However, there are other causes which may include:

• Clot from the heart - this may occur with a condition called atrial fibrillation
• Congestive heart failure
• Aortic dissection, which is a tear in the aorta's inner layer
• Coagulation disorders
• Unusual disorders of the blood vessels such as fibromuscular dysplasia and arteritits

Mesenteric ischemia is a serious condition that may come on and worsen quickly. It is extremely important that you go to your physician or the emergency room if you experience any of the symptoms.

Diagnostic Testing 
Diagnostic testing for mesenteric ischemia usually includes one or more of the following:

• Angiogram
• Doppler ultrasound
• Blood test. When you have mesenteric ischemia, especially the acute variety, your white blood cells may be high. Blood tests may also show if acid in your blood is at high levels, a condition called acidosis. These findings may indicate the presence of serious bowel injury.
• Computed tomography (CT) scan

Treatment for Mesenteric Ischemia
The goal of treatment for mesenteric ischemia (both chronic and acute) is to re-open the artery to allow adequate blood flow to reach your intestine, so it can work properly. Because this must be accomplished before permanent damage is done to the bowel, your vascular surgeon may treat mesenteric ischemia as an emergency (for acute mesenteric ischemia) or as a scheduled procedure (usually for chronic mesenteric ischemia).

Treatment for chronic mesenteric ischemia

• Open surgery; usually this is as bypass surgery
• Angioplasty and stenting

Treatment for acute mesenteric ischemia
Treatment is usually open surgery. If the cause is a clot, then the surgeon will remove the clot from the artery in a procedure called a thromboembolectomy.  In some cases, the surgeon will need to perform a bypass.

Since the effectiveness, risk, and durability of each approach available for the treatment of mesenteric ischemia depends upon many issues, your vascular surgeon will advise you as to what procedure is the best for your particular situation.