Renal & Mesenteric Arterial Disease

Renal and mesenteric artery disease are conditions that develop when kidney or intestinal arteries supplying blood to the region 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 types of vascular disease, the condition is caused by a buildup of a fatty substance called plaque on the artery walls. As plaque builds inside them, 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, including carotid artery disease, peripheral artery disease, and heart disease.

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. Postmenopausal women are also more likely to develop renal and mesenteric artery disease.

Renal Artery Occlusive Disease

Renal artery disease can also develop due to fibromuscular dysplasia (FMD), a condition in which abnormal cells cause narrowing throughout specific 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, which is tough to control, is one of the key symptoms of renal artery disease. Dr. Sidhu can order an ultrasound of the kidney arteries to diagnose any blockage. If the test shows significant blockage, he will discuss a treatment plan with you, depending on the findings.

Mesenteric Artery Disease

Similarly, in mesenteric artery disease, reduced blood flow to the intestines may cause severe abdominal pain every time you eat. Eventually, patients become afraid to eat and begin to

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 bloodstream and blocks an artery. It is more common in people who have abnormal heart rhythms such as atrial fibrillation.

Both have similar symptoms, including stomach upset after eating, along with the following:

• 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 the 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 blood vessels and restore blood flow to essential organs.

Arterial stenosis resulting from renal artery disease may be treated using minimally invasive procedures such as angioplasty and renal artery stent placement to improve blood supply. If the disease is quite advanced, or if it occurs in an artery difficult to reach with a catheter, arterial bypass surgery may be necessary to restore blood flow. Bringing blood pressure under control and preventing further damage to the kidneys and other organs is vital.

Mesenteric arterial blockage can be treated with minimally invasive mesenteric artery angioplasty/stenting or an open surgical bypass procedure. It is imperative 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 the severity of your condition and the possible options. Angioplasty and an accompanying stent are often used as the first option, especially in cases where patients have a significant risk factor for open surgery. The techniques often work best when the diseased portion of the artery is relatively small and easily accessible via a 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, left permanently 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 remains in place.

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