Atherosclerosis, or hardening of the arteries, is caused by the accumulation of a fatty substance called plaque on the inside of the walls of arteries. The condition affects up to 35% of Americans. Atherosclerosis can cause narrowing (also called stenosis) of any of the arteries throughout the body. When this narrowing occurs in the arteries supplying blood to the kidneys, it is called renal artery occlusive disease or stenosis. When the arteries supplying the intestines are affected, the condition is called mesenteric artery occlusive disease or stenosis. Narrowing of the kidney or intestinal arteries decreases the blood supply to these organs.
Renal/mesenteric artery narrowing is often present in conjunction with other conditions, such as carotid artery disease and heart disease. Risk factors include family history of atherosclerosis, high blood pressure, diabetes, high cholesterol, and advanced age, as well as factors such as a sedentary lifestyle and smoking. Smoking is the number one risk factor for cardiovascular diseases, including renal mesenteric artery occlusive disease.
Renal artery occlusive disease can also be caused by fibromuscular dysplasia, a condition usually afflicting young women between the ages of 20 and 40. Fibromuscular dysplasia involves the overgrowth of tissue inside the artery, causing occlusion. Occlusion can also be caused by scar tissue that develops after injury to the kidney.
Narrowing of the renal arteries can lead to high blood pressure that is very difficult to control. The condition can also lead to kidney failure.
Narrowing of the mesenteric arteries can lead to unexplained weight loss and severe abdominal pain that occurs upon eating.
One or more of the following imaging tests will be necessary to determine the location and the extent of the arterial narrowing (stenosis):
- Duplex Ultrasound
- Magnetic Resonance Angiography (MRA)
- CT Scan
Early cases of renal and mesenteric artery occlusion can be treated with lifestyle modifications like smoking cessation, regular exercise, and management of related conditions such as diabetes, high blood pressure, and cholesterol levels.
However, in many cases, a procedure may be required to relieve the narrowing in the artery and restore blood flow to the leg. The arterial stenosis may be treated using minimally invasive procedures such as angioplasty and stenting to improve blood supply or if the disease is very advanced, or if it occurs in an artery that is difficult to reach with a catheter, arterial bypass surgery may necessary in order to restore blood flow.
Minimally Invasive Procedures
Angioplasty and Stenting for Arterial Occlusive Disease
Because they are such simple procedures, angioplasty and stenting are often used in cases where patients would be poor candidates for open surgery. However, they are also being used more and more in all kinds of patients, as they are less invasive and have a quicker recovery time compared to open surgery. The techniques work best when the diseased portion of the artery is relatively small, and when the diseased artery is easily accessible with a catheter.
Angioplasty and stenting for occlusive (blocked) arteries are minimally invasive procedures that can be performed on blockages (occlusions) in the arteries of the kidneys (renal arteries), intestines (mesenteric arteries) and lower extremities (femoral, tibial arteries). Carotid angioplasty and stenting can also be performed. Angioplasty and stenting require only local anaesthesia and intravenous sedation (relaxing medications). During angioplasty, a balloon tipped catheter is inserted through an artery in the groin via a needle puncture. The catheter is pushed through the artery to the point of occlusion and the balloon is then inflated, to expand the opening in the artery. This procedure often improves the blood-flow through the artery.
Sometimes, however, angioplasty does not sufficiently open the artery and the use of a stent is also required. A stent is a synthetic support structure similar to a spring. It is similarly inserted to the point of occlusion in the artery loaded on the balloon tipped catheter. Once in place, it is expanded by inflating the balloon, and left permanently in the artery to provide a reinforced channel through which blood can flow.
Patients generally go home the day after the procedure.
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