Diagnosing Mesenteric Ischemia

NYU Langone doctors are experts in diagnosing mesenteric ischemia, a narrowing or blockage in the mesenteric arteries, which supply blood to the small and large intestines. 

The condition may be caused by atherosclerosis, a buildup of plaque—a hard, waxy substance made of fat, cholesterol, and calcium—in the arteries. Another cause is a blood clot, which cuts off blood supply to the mesenteric arteries and may be life threatening. 

Whether a person has atherosclerosis or a blood clot, the result is the same: Reduced blood flow deprives the intestines of oxygen, which can lead to gangrene, the death of intestinal tissue. 

In some people, mesenteric ischemia develops gradually, causing increasing abdominal pain after eating and unexplained weight loss. This is called chronic mesenteric ischemia. Most people, however, are diagnosed with acute mesenteric ischemia, in which symptoms arise suddenly and without warning. They include severe abdominal pain and cramping, diarrhea, nausea, and vomiting. 

Risk Factors 

Certain lifestyle habits, such as being sedentary and eating a diet high in fatty foods, can lead to mesenteric ischemia because they can cause plaque to accumulate in the arteries. In addition, smoking has been proven to harm blood vessels, causing them to narrow and increasing the risk for the condition.

People with chronic conditions that increase the risk for blood clots or narrowing of the arteries are also at increased risk for mesenteric ischemia. These include anti-phospholipid syndrome, coronary artery disease, diabetes, high blood pressure, low blood pressure, congestive heart failure, and arrhythmias, or irregular heartbeat. A tear in the aorta, called aortic dissection, also increases a person’s risk for the condition.

People who use drugs such as cocaine and methamphetamine are at increased risk for mesenteric ischemia. Talk to your doctor if you have any concerns about your risk factors.

Mesenteric ischemia is a serious condition that can worsen quickly. If you have symptoms, call 911 or go to the nearest emergency room immediately.

Diagnostic Tests

To diagnose mesenteric ischemia, cardiovascular specialists at NYU Langone conduct a physical exam and perform imaging tests. 

Arterial Doppler Ultrasound

A Doppler ultrasound is an imaging test that uses sound waves to produce detailed images of blood vessels and other structures inside the body. This test is used to measure blood flow and identify blockages in blood vessels.

A technician places a handheld instrument called a transducer against your skin to produce images of blood vessels on a computer monitor. The ultrasound is painless and may be completed in 30 to 60 minutes. 

CT Scan

A CT scan uses X-ray technology to produce cross-sectional images of the body. It can help identify problems with the arteries, such as aortic dissection, which is a tear in the aorta, the body’s largest artery.

Just before the scan, the doctor may give you a saline solution that contains a contrast material, or a dye, through a vein with intravenous (IV) infusion or an injection in the arm. The liquid travels through blood vessels and highlights any blockages in the arteries. 

A CT scan typically takes 30 to 45 minutes. It isn’t painful, but you may feel a warm sensation throughout your body if the contrast material is used. 

Magnetic Resonance Angiogram 

A magnetic resonance angiogram is a type of MRI scan that uses a contrast agent to provide clear images of blood flow in the arteries that lead to the intestines. In this test, a magnetic field and radio waves create computerized, three-dimensional images of the blood vessels and the intestines.

Before the test begins, a contrast dye is injected into a vein through a small catheter placed in the arm. This highlights any blockages in the arteries that lead to the large and small intestines.

Angiogram or Arteriogram

An angiogram is an X-ray that enables doctors to view your blood vessels. When the arteries are studied, it’s called an arteriogram. 

Angiogram and arteriogram are used because some treatments can be performed during the test. For example, if your doctor discovers a blood clot during the procedure, he or she may be able to dissolve it. The doctor may also perform an angioplasty with stenting to open a blocked artery, depending on the size and location of the blockage. 

To perform this test, your doctor applies a local anesthetic to the skin near the groin. He or she makes a small incision and inserts a thin, flexible tube called a catheter into the arteries that lead to the intestines. Next, the doctor injects a contrast dye into the catheter to highlight any narrowed or blocked blood vessels.

The procedure typically takes less than an hour or up to several hours, depending on what the test reveals. If the doctor doesn’t find a blockage that’s considered an emergency, you can go home. However, you may need to stay in the hospital for continued monitoring. 

Although an angiogram is not painful, you may feel some discomfort. You may also experience a feeling of pressure when the catheter is inserted and a sensation of warmth when the contrast agent is injected.