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Renal and mesenteric occlusive disease

Definition

Renal and mesenteric occlusive disease is a buildup of plaque in your arteries leading to the kidneys and/or the intestines.

Alternate Names

Kidney artery disease, renovascular hypertension; intestinal artery disease, acute or chronic mesenteric ischemia

Causes, incidence and risk factors

The risk factors for renal and mesenteric occlusive disease are similar to those for other arterial plaques, such as those found in the heart arteries (coronary disease), carotid arteries or lower extremity arteries (peripheral arterial disease) and include smoking, genetic history of arterial plaques, hypertension and hypercholesterolemia (high cholesterol).

Types

Renal and mesenteric occlusive disease often occur together, but can occur in isolated arteries.

Signs and symptoms

Most often, patients with blockages in the kidney or intestinal arteries do not experience symptoms until late in the disease process. Symptoms of renal artery occlusive disease may include high blood pressure that is difficult to treat with routine medications or chronic renal insufficiency (decreased kidney function).

Mesenteric occlusive disease may cause abdominal pain that occurs with eating, diarrhea after eating (which sometimes may contain blood), chronic lack of appetite and associated weight loss.

Tests

The first test for both conditions is typically an arterial duplex, which is a special ultrasound used to visualize the vessels and determine if any blockages may be present. The findings of this study are a good screening test, but are often not conclusive and may warrant a CT scan with contrast (CT Arteriogram) of the abdomen, or a catheter-based arteriogram, which is performed in the operating room using a catheter in the femoral (groin artery) or brachial (arm artery).

Treatments

Angioplasty and stenting

Surgeons perform angioplasty by inserting a catheter with a balloon on the end into the appropriate artery. The cylindrical-shaped balloon is inflated inside the artery at the point where plaque has narrowed the artery. After a few seconds, the balloon is deflated. Angioplasty is typically followed by placement of a stent, because angioplasty alone has been proven to be ineffective for long-term prevention of recurrent blockage in the artery.

A stent is a small tube made of metal mesh. After placement of the stent in the artery, the stent holds the vessel open. Although stenting often provides an excellent result on imaging and improvement in symptoms, the durability of the procedure relies heavily on the patient’s genetics and their ability to decrease their risk factors for mesenteric and renal artery disease after the procedure. Screening after stent placement is an absolute necessity, and is usually done with arterial duplex at intervals determined by your surgeon.

In the event that re-blockage of the artery occurs after stenting, a repeat angioplasty or even placement of another stent may be performed. However, sometimes the repeat blockage must be treated by open bypass.

Open bypass

In a bypass operation, surgeons use a cloth tube called Dacron, or a portion of a vein from another part of the body to create a detour around the diseased section of the artery.

Just as with stenting, post-operative monitoring is imperative and your surgeon will determine at what intervals you will undergo duplex for monitoring of your bypass.

Expectations (prognosis)

The timing and type of treatment of renal and mesenteric occlusive disease is complex and considerations of whether to proceed with treatment involve many factors including the degree of blockage, presence or absence of symptoms and the presence of other medical problems. Your surgeon will discuss with you the risks and benefits of treatment and the data that exists regarding the outcomes of these procedures. In general, the complication rates for mesenteric and renal stenting or bypass are low, and depend heavily on the patient’s other medical problems and the complexity of the disease.

The most important factors in improving long-term prognosis involve decreasing the risk factors associated with mesenteric and renal occlusive disease.  All patients with these conditions should immediately stop smoking, and should be on several medications that are known to decrease overall cardiovascular complications before and after treatment of arterial blockages. These medications include: a statin medication (even if your cholesterol is not high), medications to adequately treat high blood pressure (including a beta-blocker and/or a drug called an ACE Inhibitor) and an anti-platelet drug (such as aspirin, Aggrenox or Plavix).

If you are an active smoker, please discuss quitting with your surgeon, as this is the most serious risk factor associated with renal and mesenteric occlusive disease. The vascular surgeons at UF Health have an active smoking cessation program, and are experts at helping patients successfully quit.

When to call your health care provider

If you are experiencing unexplained weight loss with loss of appetite, diarrhea and abdominal pain after eating, you should consult your physician immediately.

Prevention

Prevention of renal and mesenteric occlusive disease involves decreasing the risk factors associated with this problem. These risk factors include smoking, high blood pressure, and high cholesterol. Patients with these conditions, or any atherosclerotic plaques such as peripheral arterial disease, cerebrovascular occlusive disease or coronary artery disease, should be on medications to lower their cholesterol (even if the cholesterol level is not abnormally high), and should be on an adequate medication regimen to normalize their blood pressure. They should also take a daily aspirin or other anti-platelet drug.

Most importantly, if you are an active smoker, this is the biggest risk factor for these conditions and you should seek assistance to quit as soon as possible. The vascular surgeons at UF Health are experts in smoking cessation, and have an active program for helping patients quit.