Abdominal Artery Ischaemia and Occlusion
Print Friendly, PDF & Email

Also known as Ischaemic Bowel or Mesenteric Ischaemia, abdominal artery ischaemia can be the result of many pathologies and can be acute or chronic.

It most commonly presents as severe abdominal pain in an elderly patient.

Epidemiology

Common causes

  • Atherosclerosis
  • Embolism
  • Dissection
  • External compression by mass lesions
  • Fibromuscular dysplasia – non-artherosclerotic, non-inflammatory arterial changes

Common sites of occlusion

  • Splanchnic arteries
    • Superior mesenteric
    • Coeliac arteries – often occurs chronically in women
    • Renal arteries
  • Bifurcation of the aorta

Signs and symptoms

Acute

  • This is an emergency and can be life threatening!
  • Severe, diffuse abdominal pain
  • Rarely involves the liver or spleen
  • Renal artery occlusion:

Chronic

  • Is often asymptomatic, unless both the superior mesenteric and coeliac arteries are occluded, due to large collateral circulation between these two arterial systems
  • Intestinal Angina is the most common symptom. This is a cramping pain typically felt 20-60 minutes after eating. Can be relieved by sublingual GTN.
  • Patients often lose weight as they develop a fear of eating
  • Abdominal bruit may be heard
  • Other signs include nausea, vomiting, diarrhoea, constipation and dark stools
  • Renal artery occlusion:

Diagnosis

In suspected ischaemic bowel CT angiogram is the investigation of choice. On an abdominal CT, often dilated bowel with thickened bowel wall is suggestive. A CT angio may be identify the location of any occlusion. The advantage of CT angiogram over standard angiogram is the ability to diagnose other abdominal pathologies.

Ischaemic bowel on CT
Ischaemic bowel on CT. Note the dilated bowel loops and thickened bowel wall, as indicated by the arrow.

Chronic Mesenteric Ischaemia

  • Based mainly on clinical findings
  • Angiography may be useful
  • In severe cases, bypass surgery can be beneficial, but outcomes vary
  • Angioplasty is also sometimes helpful both with and without stenting
  • Some patients may be put on preventative measures and anti-platelet agents

Acute Mesenteric Ischaemia

  • Surgical emergency
  • Usually diagnosed with CT of the abdomen – sometimes CT angio is also required and is able to determine the location of the occlusion. There is often co-existing small bowel obstruction which can make diagnosis easier
  • Requires thrombolysis or percutaneous intervention to prevent gut necrosis
  • If gut necrosis is already present (and it often is) then surgery is required to remove the affected bowel.
  • Outcomes are poor, particularly if >4-6hours after onset

Related Articles

Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) currently works as a GP Registrar and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

Leave a Reply