Mesenteric Artery Disease

Mesenteric artery disease refers to conditions that affect the arteries supplying blood to the intestines — mainly the superior mesenteric artery (SMA), inferior mesenteric artery (IMA), and celiac artery. The most common form is chronic mesenteric ischemia, though acute forms exist [sudden occlusion of these vessels] and can be life-threatening.

🔹 Types of Mesenteric Artery Disease

1. Chronic Mesenteric Ischemia (CMI):
• Caused by atherosclerosis (plaque buildup) in the mesenteric arteries.
• Develops slowly over time.
• Usually involves at least two of the three main mesenteric arteries.
2. Acute Mesenteric Ischemia (AMI):
• Sudden blockage of blood flow (often from an embolus, thrombus, or low blood flow state).
• A medical emergency due to risk of bowel necrosis.

🔸 Symptoms

Chronic:

• Postprandial abdominal pain ("intestinal angina") — starts ~30 minutes after eating
• Unintentional weight loss
• Fear of eating due to pain (sitophobia)
• Diarrhea or constipation

Acute:

• Sudden, severe abdominal pain (often disproportionate to physical exam findings)
• Nausea, vomiting, possibly bloody stools
• Signs of sepsis or shock in late stages

🔹 Diagnosis

• CT angiography (CTA) – Gold standard
• Doppler ultrasound – Useful for screening
• MR angiography (MRA) or conventional angiography
• Lab tests may show elevated lactate in acute cases, but imaging is key

🔸 Treatment

Chronic:

• Revascularization (to restore blood flow):
• Angioplasty and stenting (minimally invasive)
• Bypass surgery (for more extensive disease or failed endovascular treatment)
• Lifestyle modifications and risk factor control:
• Smoking cessation
• Managing hypertension, hyperlipidemia, diabetes
• Antiplatelet therapy (e.g., aspirin)

Acute:

• Emergency surgery or endovascular intervention
• Anticoagulation (if embolic)
• Bowel resection if necrosis occurred
• Supportive care: fluids, antibiotics, monitoring for sepsis