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Invest in your intestines: Learning the effects of mesenteric ischemia

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Omar P. Haqqani, MD
Midland Daily News
January 22, 2017

In some cases, vascular disease not only affects how many of our bodily processes take place, but can also affect how we live our lives, making normal activities difficult to do. In the case of mesenteric ischemia, it can result in pain and difficulty eating.

Breaking down mesenteric ischemia, as a condition, is as simple as looking at each half of the disease’s namesake. The body’s mesentery is a fold of membrane tissue, attached to the intestinal tract by means of the back wall of the peritoneal cavity.

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This tissue allows for the mesenteric organs, including the stomach, intestines, liver, and colon, to be supplied with oxygenated blood from the arteries, and carry oxygen-poor blood back to the heart through the veins.

Mesenteric ischemia occurs when the decreased blood flow to these organs results in either narrowing of the arteries or blockages. Mesenteric ischemia can be either acute or chronic.

Acute mesenteric ischemia happens when a sudden blockage of blood flow occurs in the arteries, resulting in permanent arterial damage in the intestines. AMI is considered an emergency situation requiring immediate medical attention.

Chronic mesenteric ischemia, however, is a gradual process that grows over time through narrowing in one or more of the mesenteric arteries. An early means of detecting chronic mesenteric ischemia is experiencing pain 15 to 60 minutes after eating, as well as bowel movement frequency changes, bloating, vomiting, and nausea.

In some cases, mesenteric ischemia also occurs when blood isn’t able to leave the intestines, resulting in the development of blood clots in the veins. Mesenteric venous thrombosis is a condition that occurs when blood backs up in the intestines, resulting in swelling and bleeding.

Many risk factors can result in the development of either mesenteric ischemia, or mesenteric venous thrombosis.

In the case of mesenteric ischemia, the condition can be brought on through multiple conditions and instances, such as atherosclerosis, high blood pressure, illegal drug use, blood clotting issues, or impaired blood flow from low blood pressure related to shock, heart failure, or kidney failure.

Mesenteric venous thrombosis, on the other hand, is most commonly caused by abdominal infection or trauma, bowel diseases, such as Crohn’s disease, diverticulitis, or ulcerative colitis, or disorders that make a patient more prone to blood clots.

Both of these conditions can be diagnosed through one of three simple tests. In order to help expedite the diagnosis, your medical doctor or vascular surgeon will inquire about any past history of smoking or heart disease, and symptoms you’ve recently experienced.

In some cases, a blood test may be able to diagnose mesenteric ischemia, as a sudden increase in white blood cell count is often an indicator of this condition. In other instances, Doppler ultrasound or CT angiogram tests may be able to identify the early stages of the disease.

In a more invasive, but preferred option, a diagnostic angiogram is the most reliable method for diagnosis. In this process, a long, thin tube is inserted into the groin or arm and passed through an artery leading to the aorta. Any blockages that exist in the arteries are then detected by a dye that is injected into the blood.

If either mesenteric ischemia or mesenteric venous thrombosis is diagnosed, there are multiple methods of treatment for all forms of the conditions.

Treatment for acute mesenteric ischemia must be administered quickly, as diagnosis is usually attained in an emergency state. Narcotic pain medication is initially given, followed by thrombolytic therapy, where a clot-dissolving drug is injected into the artery.

In severe instances of clotting, surgical removal of the clot and, sometimes, part of the intestine may be removed due to damage caused by lack of blood flow.

Chronic mesenteric ischemia can be also be treated, but through different means. Treatment starts with pain medication, followed by both a balloon angioplasty and stent to remove the clot, or a bypass surgery to create a detour for the clot to travel away from the narrowed or blocked section of the affected artery.

Treatment for mesenteric venous thrombosis, on the other hand, begins with a 3-6 month regimen of blood thinners, followed by possible surgery if the bowel shows increasing signs of damage.

Though the effects of mesenteric ischemia are severe, and can result in detrimental effects on how we’re able to live our daily lives, it’s important for patients to understand the methods of how this condition is diagnosed and treated to be able to fight back against the disease with full force.

Dr. Omar P. Haqqani is the Chief of Vascular and Endovascular Surgery at Vascular Health Clinics in Midland.

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