What is Abdominal Angina (Chronic Mesenteric Ischemia)?
Abdominal angina is a condition where you experience pain after eating. This pain is because the blood supply to the colon can’t increase as much as needed. This situation is somewhat similar to intermittent claudication, a condition where blood flow to your legs is reduced, or angina pectoris, a chest pain that occurs when there isn’t enough blood flow to the heart.
What Causes Abdominal Angina (Chronic Mesenteric Ischemia)?
Intestinal ischemia happens when the digestive system doesn’t get enough oxygen. This is typically due to reduced blood flow because of narrowed blood vessels in the mesentery, a fold of tissue in the abdomen that attaches the intestines to the wall of the abdomen. The most usual cause of this issue is abdominal angina, which is often linked to hardening of the arteries, a condition known as atherosclerosis.
It usually affects where the mesenteric vessels branch off in the body. In many cases, the superior mesenteric artery, a major artery supplying blood to the intestines, gets blocked and causes symptoms in the belly. Activities like smoking and having high levels of blood fat increase the risk of experiencing atherosclerosis in the superior mesenteric artery.
Risk Factors and Frequency for Abdominal Angina (Chronic Mesenteric Ischemia)
Abdominal angina is a rare condition with a high risk of death. It’s more commonly observed in females and older people. However, it can be hard to diagnose because it often shows vague symptoms, meaning it rarely comes to medical attention. Although it tends to affect people aged 60 and over, it’s been known to occur in younger individuals too. With a ratio of around 3 to 1, females are more likely to have this condition than males. It’s not clear which population groups are most at risk, due to the small number of cases. Abdominal angina is not frequently reported outside the United States.
Signs and Symptoms of Abdominal Angina (Chronic Mesenteric Ischemia)
Abdominal angina is a condition where there is severe abdominal pain usually experienced after eating a meal. Despite the intensity of the pain, physical exams often show no clear signs of illness. Commonly, after a few hours, the pain starts to lessen. The severity of this condition can lead some people to develop a fear of eating, resulting in weight loss. It’s important to know if the person has a history of smoking, claudication (limping), or high blood cholesterol levels. During a physical check-up, significant weight loss might be clearly observed. The abdomen typically feels soft and shows no signs of inflammation. Some patients may have a detectable abdominal sound, known as a bruit. Other signs of peripheral vascular disease, such as weak leg pulses, might also be found. Usually, a digital rectal exam will not show any signs of internal bleeding.
Testing for Abdominal Angina (Chronic Mesenteric Ischemia)
While routine blood and laboratory tests may not be useful in diagnosing mesenteric ischemia, a condition that affects blood flow to the intestines, they’re still important for ruling out serious illnesses like colon and stomach cancer. Additionally, ultrasound is generally not effective in detecting this condition.
The best way to diagnose mesenteric ischemia is through a procedure known as an angiogram, which gives a detailed look at the blood vessels. However, nowadays, CT angiography, which combines a CT scan with an angiogram, has become the preferred method. This is because it’s just as accurate as an angiogram and can provide more detailed images.
It’s also crucial to remember that individuals with mesenteric ischemia typically have a history of atherosclerosis, meaning they have a buildup of plaques in their arteries. Because of this, doctors should also check for signs of heart and peripheral vascular disease, which are other conditions affected by atherosclerosis. For heavy smokers, arterial blood gas and pulmonary function tests are often needed, especially if surgery is being considered.
Treatment Options for Abdominal Angina (Chronic Mesenteric Ischemia)
Abdominal angina, a type of stomach pain caused by reduced blood flow to the intestines, is usually treated through a process called mesenteric revascularization. This involves surgery to remove whatever is obstructing the blood flow. Often this involves the celiac artery, the superior mesenteric artery, and the inferior mesenteric artery, and at least two of these vessels must be made clear using a procedure called angioplasty and a technique known as stenting. If the vessel is still narrow after angioplasty, a stent (a tiny tube) is placed into the vessel to keep it open.
While the benefits of this procedure can be significant, potential complications include bruising in the groin, leg blood supply issues, dissection (tearing) or rupture of the mesenteric artery, and break-off and travel of hardened patches in the arteries.
If it’s not possible to perform this kind of procedure, alternative surgical options are available: the artery could be opened up either along its length (longitudinal arteriotomy) or at a right angle to it (transverse arteriotomy). In other cases, a bypass around the blockage is created; this can be done in either direction (antegrade or retrograde).
There’s some controversy over the best material to use for this bypass. An artificial graft is one possibility, but some experts advise using the patient’s own reversed saphenous vein (a vein from the leg). This kind of procedure can be challenging, especially for less experienced surgeons, as the vessel used for bypass is usually very small, and it can be narrowed if stitched too aggressively. Revision surgeries after initial attempts aren’t uncommon due to technical difficulties, and the use of magnifying tools during the operation is highly recommended.
During the surgery, the patient should be closely monitored for heart issues. Some surgeons like to check the success of the operation with a portable Doppler device, which uses ultrasound to measure blood flow.
Regarding general medical care, it’s crucial that patients quit smoking. Also, any high blood lipid (fat) levels should be addressed. A consultation with a heart specialist and a vascular surgeon is recommended. In some cases, despite significant weight loss in patients, the use of parenteral nutrition (feeding a person intravenously, bypassing the usual process of eating and digestion) is a contentious issue. While some surgeons use it before surgery in selected patients, it’s still unclear whether it actually provides benefits or reduces complications. After the operation, patients are usually able to eat a normal diet without restrictions.
What else can Abdominal Angina (Chronic Mesenteric Ischemia) be?
- Long-term inflammation of the pancreas (Chronic pancreatitis)
- Abdominal cancer (Intra-abdominal malignancy)
- Long-term gallbladder inflammation (Chronic cholecystitis)
- Ulcers in the stomach or upper part of the small intestine (Peptic ulcer disease)
Possible Complications When Diagnosed with Abdominal Angina (Chronic Mesenteric Ischemia)
There are several complications that could happen such as:
- Losing weight
- Issues with blood supply to the intestine (ischemic bowel)
- Bleeding
- Infection
- Death of bowel tissue (bowel infarction)
- Extended period of no bowel movements (prolonged ileus)
- Infection in the graft (a surgically transplanted organ or tissue)
