Mesenteric & Renovascular Disease
What is mesenteric vascular disease?
The mesenteric arteries supply blood to the bowel in the abdomen and can be affected by several diseases that can compromise blood flow. Complications can arise as a result of blood clots from the heart, especially in patients with abnormal heart rhythms (atrial fibrillation), atherosclerosis or “hardening of the arteries” causing blockage of the arteries, aneurysm where the artery is weak and dilated, or a dissection where there is a tear in the vessel wall that can compromise blood flow.
Sudden blockage of the mesenteric arteries is a medical emergency that requires immediate attention. Patients may experience severe pain, diarrhoea and vomiting. Early recognition is important to avoid gangrene of the bowel requiring major surgery in order to remove the bowel. Patients diagnosed too late are unlikely to survive. Restoring blood flow to the bowel is a priority in these patients. It can be performed using either an open surgery approach or a minimally invasive endovascular procedure through the groin.
More gradual blockage of the artery over a period of months or years can cause pain associated with meals, weight loss and diarrhoea. The typical patient is a female smoker around the age of 60 years old and in contrast to patients with cancer, patients still feel hungry. The reason that the patient doesn’t eat, or eats only very small meals, relates to fear of the pain that comes after the meal. There are several alternative causes for abdominal pain and Dr Freeman can advise if you may benefit from treatment.
Ultrasound can be used to identify patients with blocked mesenteric arteries. Should this be thought to be the cause of a patients’ pain, and no other explanation has been identified despite extensive testing, treatment is aimed at restoring flow to the bowel. This can be achieved with a bypass. However, these days minimally invasive stenting (inserting a scaffold) where a scaffold is inserted to open the artery is preferred in most patients. After stenting patients need to be on aspirin and should quit smoking.
What is renovascular disease?
Atherosclerosis or “hardening of the arteries” narrowing the renal vessels that supply blood to the kidneys can cause significant complications including failure of the kidneys to the point that patients require dialysis, and high blood pressure that can be especially difficult to control. Ultrasound scanning can identify renal artery narrowing. Most patients can be managed with medication including aspirin and drugs to reduce cholesterol and blood pressure. Patients who smoke should stop.
A proportion of patients benefit from improving flow to the kidneys by way of a stent (a scaffold) that is delivered through the groin to open the artery. Not all patients are appropriate for stenting and additional tests are usually required to identify which patients will benefit. If a kidney has already completely failed, it will not recover with stenting. Patients have two kidneys, and some require stenting of both renal arteries. Dr Freeman is experienced in treating appropriately selected patients with renal stents.
The renal arteries can also be affected by an aneurysm where the wall is weakened and the artery dilates so that it is larger than normal. Renal artery aneurysms are rare and the risk of rupture is low when they are small. Most patients simply require surveillance with ultrasound. Larger aneurysms may warrant treatment which these days is usually through a minimally invasive endovascular procedure through the groin. Dr Freeman can discuss with you what the options are for treatment.
Sydney Vascular Ultrasound provides specialised vascular and venous diagnostic imaging in Burwood, Bankstown and Liverpool.