| The mesenteric arteries are the three major | | | | the screening test performed, an angiogram is |
| arteries that supply blood to the stomach, small | | | | usually necessary to determine the best |
| intestine, and large intestine. The word | | | | treatment for chronic mesenteric ischemia. Our |
| “ischemia” means decrease in oxygen | | | | preferred screening test is duplex sonography, |
| supply. Mesenteric ischemia is a condition in which | | | | which employs sound waves to obtain pictures of |
| the mesenteric arteries do not deliver enough | | | | the intestinal arteries. |
| blood and oxygen to the small and large intestines. | | | | Prevention |
| This makes it difficult for the intestines to digest | | | | Prevention includes following lifestyles changes |
| food and can cause segments of the intestine to | | | | that reduce your risk for atherosclerotic disease. |
| die. | | | | This includes: |
| Causes | | | | · Stop smoking |
| Mesenteric artery ischemia is often seen in those | | | | · Follow a healthy diet |
| with hardening of the arteries elsewhere in the | | | | · Exercise |
| body, such as that associated with coronary | | | | Treatment |
| artery disease or peripheral vascular disease. The | | | | Chronic mesenteric ischemia is usually treated with |
| condition is more common in smokers and in | | | | surgery. The narrow or blocked portion of the |
| patients with high cholesterol. | | | | arteries may be removed and the arteries are |
| Mesenteric ischemia may also be caused by a | | | | then reconnected to the aorta. Or, the blocked |
| blood clot (embolus) that moves through the | | | | part of the artery may be bypassed, with a piece |
| blood and suddenly blocks one of the mesenteric | | | | of vein or a plastic tube. Acute mesenteric |
| arteries. The clots usually come from the heart or | | | | ischemia is treated with emergency surgery. It is |
| the aorta. These clots are more commonly seen | | | | extremely important to restore the blood supply |
| in patients with heart arrhythmias such as atrial | | | | to the intestine as quickly as possible by removing |
| fibrillation. | | | | the blockage from the artery. Portions of the |
| Signs and Symptoms | | | | intestine may have to be removed if the lack of |
| Chronic mesenteric ischemia caused by | | | | blood has caused any of the tissue to die. |
| atherosclerosis is commonly associated with | | | | Nonocclusive mesenteric ischemia is treated |
| chronic abdominal pain after eating, and | | | | medically, while acute and chronic ischemia is |
| occasionally, diarrhea. Acute mesenteric ischemia | | | | correctable with surgery. The first step in treating |
| due to an embolus is frequently associated with | | | | nonocclusive ischemia is identifying the underlying |
| sudden onset severe abdominal pain, vomiting, and | | | | cause and, once found, correcting it. For instance, |
| diarrhea. | | | | if a patient is found to have vasospastic disease, |
| Diagnosis | | | | direct injection of papaverine into the SMA may |
| Angiography is the gold standard for diagnosis of | | | | resolve the vasospasm. If resolution with |
| this condition. An angiogram is a test where dye is | | | | papaverine occurs, start an infusion of 30-60 mg |
| injected into the blood vessels of the intestines to | | | | h. |
| look for narrow areas. The dye is usually injected | | | | Angioplasty |
| through a catheter placed into an artery in the | | | | A baloon is threaded through the artery and is |
| groin. The dye can cause allergic reactions or | | | | inflated at the location of the blockage to restore |
| damage to the kidneys, but these are rare. | | | | blood flow. |
| Because of the risks of angiograms, chronic | | | | Vasodilator medication |
| mesenteric ischemia may be evaluated by other | | | | Medicines that dilate the arteries, such as |
| less invasive screening tests first. Regardless of | | | | papaverine, is given intravenously to open the clot. |