Renal & Mesenteric Arterial Disease

Renal and mesenteric artery disease are conditions that develop when the arteries in the abdomen that supply either the kidneys or the intestines become narrow or blocked. If a blockage in the kidney arteries is severe, it can result in high blood pressure that is very tough to control with medications and can further damage the kidneys.

As with other arterial diseases, the condition is caused by a buildup of a fatty substance called plaque on the arterial walls. As plaque builds inside the artery walls, the arteries become hardened and narrowed in a condition called atherosclerosis, which affects up to 35% of all Americans. Patients with renal or mesenteric artery narrowing often have other related cardiovascular conditions.

RISK FACTORS AND SYMPTOMS

Risk factors for renal and mesenteric artery disease include smoking, the primary risk factor for all cardiovascular diseases, along with a family history of atherosclerosis, high blood pressure, diabetes, high cholesterol, advanced age, obesity and a sedentary lifestyle.

Renal Artery Disease

Renal artery disease can also develop as a result of fibromuscular dysplasia (FMD), a condition in which abnormal cells cause narrowing throughout certain arteries. Scar tissue that develops after injury to the kidneys can also cause narrowing. This condition can affect anyone but is most commonly seen in women aged 20 to 40.

High blood pressure that is tough to control is one of the key symptoms of renal artery disease. VIVAA can order an ultrasound of the kidney arteries to diagnose any blockage. If there is significant blockage, Dr. Sidhu will discuss the treatment plan with you depending on the findings.

Mesenteric Artery Disease

Similarly, if there is blockage in the arteries to the intestine (gut), you will experience abdominal pain every time you eat food and eventually may even be afraid to eat and start losing weight. It is called chronic mesenteric ischemia and it is important to discuss this problem if you are experiencing it.

The following imaging tests can help determine the location and the extent of any blockage:

• Duplex ultrasound
• Angiography
• Magnetic resonance angiography (MRA)
• CT angiography

There are two types of mesenteric artery disease:

• Long-term, chronic disease caused by atherosclerosis, more common in smokers and people who have hypertension and hyperlipidemia (high cholesterol)
• Sudden, acute disease caused by a blood clot that travels through the blood stream and blocks an artery. It is more common in people who have abnormal heart rhythms such as atrial fibrillation.

Both have similar symptoms, which can include in addition to stomach upset after eating:

• Diarrhea
• Sudden, severe abdominal pain
• Vomiting

TREATMENT FOR RENAL/MESENTERIC ARTERIAL STENOSIS

Early cases with no significant symptoms can be managed with lifestyle modifications like smoking cessation, regular exercise and management of related conditions such as diabetes, hypertension and cholesterol levels. Regular, follow-up care to monitor your condition is essential.

However, in many cases, a procedure may be required to relieve the narrowing in the artery and restore blood flow to the important organs.

Arterial stenosis resulting from renal artery disease may be treated using minimally invasive procedures such as angioplasty and stenting to improve blood supply. If the disease is very advanced, or if it occurs in an artery that is difficult to reach with a catheter, arterial bypass surgery may be necessary in order to restore blood flow. It is very important to bring blood pressure under good control and prevent further damage to the kidneys and other organs.

Mesenteric arterial blockage can be treated with minimally invasive mesenteric artery angioplasty/stenting or an open surgical bypass procedure. It is very important to diagnose and treat chronic mesenteric ischemia to prevent further weight loss, be pain-free and prevent the gut from losing complete blood flow.

Angioplasty and Stenting

Dr, Sidhu will discuss with you the severity of your condition and the possible options. Angioplasty and an accompanying stent are often used as the first option and especially in cases where patients would be poor candidates for open surgery. The techniques often work best when the diseased portion of the artery is relatively small and when the diseased artery is easily accessible via catheter. Only local anesthesia and intravenous sedation are required for angioplasty and stenting.

During angioplasty, a balloon-tipped catheter is inserted into an artery in the groin via a need puncture. This catheter is pushed through to the blockage point where the balloon is inflated to expand the opening in the artery, thus improving blood flow.

In some cases, angioplasty alone isn’t sufficient to open the artery. When necessary, a synthetic support structure similar to a spring, called a stent, is required. The stent is loaded onto the tip of the catheter and delivered to the point of blockage in the artery. After placement, the balloon inflates to expand the stent, which is left permanently in place to expand the artery and restore blood flow. Patients generally return home the day after the procedure.

Arterial Bypass Surgery

Arterial bypass surgery, using synthetic material or a natural vein taken from another part of the body is another option, particularly for blockages that are difficult to reach with a balloon catheter or if the disease is advanced. During the procedure, the diseased segment is exposed and the graft is attached above and below the segment. Blood supply is diverted through the graft and the diseased artery is left in place.

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