Renal / Mesenteric Artery Occlusive Disease
The renal arteries supply blood to your kidneys. If these vessels become narrowed or occluded, the result can be kidney failure or difficult to control high blood pressure. Several diagnostic tests can be used to determine if narrowing in these arteries are causing problems. A Duplex ultrasound study (sound wave study) can often image the vessels and determine any decrease in blood flow. Magnetic resonance angiography (MRA) which uses a magnetic fields effect on moving blood cells, can provide a road map of the vessels. A threedimensional computerized tomography (CT) reconstruction can also be very informative. However, the most precise mapping of the arteries is provided by a standard angiogram that may also allow treatment at the same setting. This, of course, requires a needle puncture of an artery, usually in the groin, through which a guidewire and then catheter can be placed for contrast dye injection into the proper artery (Figure 1).
Scanning of your kidneys using a very weak radioactive tracer and noting the effect certain drugs can have on the resulting image can help to determine if hypertension is caused by the renal artery narrowing (a nuclear medicine renal scan). Alternatively, sampling of blood from the renal veins can be checked for abnormally high levels of renin, a molecule which ultimately can cause high blood pressure (renal vein renin sampling).
The artery narrowing can be corrected by balloon angioplasty, stent placement, or open surgical bypass, depending on the location and extent of disease present.
The mesenteric arteries supply blood to the bowels and other abdominal organs. The most common complaints patients with narrowing or occlusion is these arteries note are unexplained weight loss, abdominal pain associated with eating, and bowel emptying (diarrhea or vomiting). The anatomic studies used to determine disease in the renal arteries (Duplex scanning, MRA, 3D CT (Figure 2), angiography) can also be used for the mesenteric arteries. Generally, for optimal anatomic clarity of all three mesenteric arteries, standard angiography is performed.
There are no serum blood studies or functional diagnostic studies that can confirm the anatomic diagnosis.
Treatment options include angioplasty, stenting, or open operative repair. The latter is most commonly performed, due to the length of narrowing or occlusion and overall long-term success.