Mesenteric Ischemia and Thrombosis

The mesenteric arteries and veins are little-known but important vessels that carry blood to and from your large and small intestines. If these blood vessels become narrowed or blocked, blood cannot flow through them as easily and your intestines become deprived of necessary oxygen. A prolonged lack of oxygen can cause tissue in your intestines to die.

Mesenteric vascular disease is a type of vascular disease commonly caused by long-term plaque build-up or a blood clot that blocks the vessel. It can also occur in people who have other medical conditions, including aortic dissection, congestive heart failure, fibromuscular dysplasia and narrowed or blocked veins in the bowel.

Scripps vascular surgeons provide thorough diagnosis and repair of several different forms of mesenteric vascular disease, including the following long-term and sudden medical conditions:

• Chronic mesenteric ischemia occurs when one or more of the mesenteric arteries is narrowed or blocked, depriving the intestines of oxygen. People with chronic mesenteric ischemia have experienced symptoms over a relatively long period of time.
• Acute mesenteric ischemia is a sudden blockage of one or more of the mesenteric arteries, which prevents blood and oxygen from reaching the intestines. Symptoms begin suddenly and progress rapidly, often requiring emergency treatment.
• Mesenteric venous thrombosis occurs when a blood clot blocks one of the mesenteric veins that carry blood away from the intestine. This causes blood to stop circulating in the intestine, and the resulting lack of oxygen leads to tissue death.
• Visceral artery aneurysms occur when one of the arteries that supply blood to the spleen, kidneys, liver or intestines begins to bulge and potentially burst. Scripps vascular surgeons provide conventional and minimally invasive repair of any visceral artery aneurysm, including splenic artery aneurysms and renal artery aneurysms. 
• Visceral artery dissections occur when there is a rip or tear in a visceral artery wall. The visceral arteries carry blood to the spleen, kidneys, liver or intestines. Scripps physicians are trained to diagnose and treat different forms of visceral artery dissection, including superior mesenteric arterial (SMA) dissection and renal artery dissection.

People with mesenteric vascular disease typically experience pain and other symptoms in their abdomen. Depending on your particular medical condition, these symptoms may gradually get worse over time, or they may come on suddenly and quickly worsen:

• Intense pain in your abdomen that occurs between 15 and 60 minutes after eating. While the pain typically goes away after 60-90 minutes, it usually returns after each meal.
• Weight loss
• Diarrhea
• Nausea and/or vomiting
• Flatulence
• Constipation

Risk factors for mesenteric disease include:

• Family history of vascular disease
• Age (60 and older)
• Tobacco use
• High blood pressure
• High cholesterol

Scripps physicians can diagnose mesenteric disease using one or more of the following tests:

• Doppler ultrasound, an imaging study that evaluates blood flow through a blood vessel
• Mesenteric angiogram, a special imaging procedure that uses X-ray and a special dye to help doctors see inside the mesenteric arteries, which carry blood to the small and large intestines
• Magnetic resonance angiography (MRA), a type of MRI that is used to look at blood vessels and the way blood is flowing through them
• Computed tomography (CT) scan, a painless, noninvasive way to see inside the body using X-ray imaging
• Computed tomography angiography (CTA), a procedure where contrast dye is placed intravenously (IV) and then used by the CT scanner to create the images of blood vessels

Our vascular surgeons perform the following open surgical and endovascular approaches for treating mesenteric vascular disease.

• Angioplasty and stenting is an endovascular procedure that uses a balloon-tipped catheter to first inflate a narrowed mesenteric artery or vein, and then place a tiny mesh cylinder called a stent to keep the blood vessel permanently propped open.
• Trans-aortic endarterectomy is a surgical procedure in which plaque is removed from a mesenteric artery, so it is no longer narrowed or blocked.
• Arterial bypass surgery allows a vascular surgeon to create a detour around the narrowed or blocked portion of a mesenteric artery. This “bypass,” made from one of your own veins or from synthetic material, allows blood to reroute around the blockage and flow into the intestines.
• Thrombolysis is used to dissolve a blood clot by injecting clot-busting medication directly into the blocked mesenteric vein.

Scripps Health offers comprehensive endovascular and vascular treatment in San Diego at the following locations:

• Scripps Clinic Carmel Valley
• Scripps Clinic John R. Anderson V Medical Pavilion
• Prebys Cardiovascular Institute
• Scripps Green Hospital
• Scripps Memorial Hospital Encinitas
• Scripps Memorial Hospital La Jolla
• Scripps Mercy Hospital San Diego