Diagnosis

Diagnosis at Mayo Clinic

Diagnosis of mesenteric ischemia begins with a description of your current symptoms, a medical history, physical exam and blood tests. Your doctor will ask you questions about your symptoms. You may also need an evaluation by a gastroenterologist.

As part of the diagnosis, doctors who specialize in the interpretation of medical images (radiologists) may perform tests to rule out other conditions and evaluate blood flow, including:

  • Doppler ultrasound. High-frequency sound waves help your doctor see images of your blood vessels.
  • CT scan/CT angiography. A CT scan uses X-rays to create detailed images of your arteries and of some organs. A CT angiogram (CTA) is a noninvasive way for doctors to see the details of your blood vessels, including narrowing and blockages.
  • Magnetic resonance angiography (MRA). Magnetic fields and radio waves produce detailed images of your blood vessels.
  • Mesenteric angiogram. A mesenteric angiogram is the standard test for evaluating blood flow and finding the blockage in the blood vessel. In this test, your doctor guides a thin, flexible tube (catheter) through the artery and inserts a dye to make the artery visible on an X-ray. Sometimes the doctor can treat the blocked arteries with a balloon angioplasty or stent during the angiogram.

Treatment

Treatment at Mayo Clinic

At Mayo Clinic, you and your doctor discuss treatment options for mesenteric ischemia. The most appropriate treatment depends on the severity of your symptoms, the cause and extent of your artery blockage, and your other medical conditions. Lifestyle changes such as switching to a healthy diet, exercising and stopping smoking are important parts of treatment.

Acute mesenteric ischemia is a medical emergency and requires immediate treatment.

Medication

If you have rapidly progressing (acute) mesenteric ischemia or blood clots in your intestinal veins (mesenteric venous thrombosis) you may need drugs to help prevent blood clots (anticoagulants).

Interventional procedures and surgery

Once your doctor determines that your stomach pain is caused by blocked intestinal arteries, you may need surgery. Doctors at Mayo Clinic perform conventional and minimally invasive procedures to improve blood flow to your intestines. Options include:

  • Angioplasty (with or without stenting). Angioplasty is a minimally invasive procedure that opens narrowed arteries. This procedure is also called endovascular revascularization. During an angioplasty, your doctor inserts a long, flexible tube (catheter) that has a balloon on its tip and when inflated will open the narrowed blood vessel.

    The surgeon usually places a small wire tube (stent) in your artery to keep it open. If you have a blood clot, your doctor may remove it during your angiogram.

  • Mesenteric artery bypass. A bypass creates an alternate route for blood to flow around the narrowed or blocked artery. Your surgeon sews a substitute blood vessel (graft) to a main artery to restore blood flow.
  • Mesenteric endarterectomy. In an endarterectomy, your doctor makes an incision in the large blood vessel that branches off your heart (aorta) to reach the mesenteric arteries and remove fat and cholesterol buildup (plaques) or the blood clot blocking the artery.

Specialists at Mayo Clinic generally recommend treatment for everyone with chronic mesenteric ischemia. Specific treatment depends on the extent of the blood vessel blockage and your overall health. Mayo Clinic's doctors' experience with mesenteric ischemia helps them tailor treatment to your condition.

Mesenteric ischemia care at Mayo Clinic

May 09, 2015
References
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  6. Golden, AK. Decision Support System. Mayo Clinic, Rochester, Minn. Feb. 18, 2015.
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  8. Kanamori KS. Outcomes of reoperative open or endovascular interventions to treat patients with failing open mesenteric reconstructions for mesenteric ischemia. Journal of Vascular Surgery. 2014;60:1612.
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