Mesenteric ischemia causes
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Feham Tariq, MD [2]
Overview
Narrowing of the arteries that supply blood to the intestine causes mesenteric ischemia. The arteries that supply blood to the intestines run directly from the aorta. Mesenteric ischemia is often seen in people who have hardening of the arteries in other parts of the body (for example, those with coronary artery disease or peripheral vascular disease). The condition is more common in smokers and in patients with high blood pressure or blood cholesterol. Mesenteric ischemia may also be caused by an embolus that suddenly blocks one of the mesenteric arteries. The emboli usually come from the heart or aorta. These clots are more commonly seen in patients with arrhythmias, such as atrial fibrillation.
Causes
Mesenteric ischemia can be broadly classified into four categories:[1][2][3][4][5]
Venous thrombosis is more frequently seen in women and arterial thrombosis is more commonly seen in men.[6]
| Classification based on etiology | |||
|---|---|---|---|
| Etiology | Cause | Incidence | Examples |
| Occlusive causes | Aterial embolism | 50-70% |
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| Arterial thrombosis | 15-25% |
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| Venous thrombosis | 5% |
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| Non-Occlusive causes | Non-occlusive ischemia | 20-30% |
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- Acute mesenteric arterial embolism: Attributes to 50% cases of mesenteric ischemia.[7][8]
- Mesenteric embolus can oringinate from the left atrium, associated with cardiac arrythmias such as atrial fibrillation.
- Recent myocardial infarction resulting in segmental wall motion abnormality leading to poor ejaction fraction and embolus formation.
- Infective endocarditis: vegetations on the cardiac valves resulting in turbulence in blood flow predisposing to formation of emboli into the blood stream.
- Acute mesenteric arterial thrombosis:
- 25% cases of mesenteric ischemia result from mesenteric arterial thrombosis.
- Most likely due to underlying atherosclerosis(plaque formation) leading to stenosis.
- An underlying plaque(fatty streak) in the superior mesenteric artery leads to critical stenosis over the years forming collaterals.
References
- ↑ Reinus JF, Brandt LJ, Boley SJ (1990). "Ischemic diseases of the bowel". Gastroenterol Clin North Am. 19 (2): 319–43. PMID 2194948.
- ↑ Di Fabio F, Obrand D, Satin R, Gordon PH (2009). "Intra-abdominal venous and arterial thromboembolism in inflammatory bowel disease". Dis Colon Rectum. 52 (2): 336–42. doi:10.1007/DCR.0b013e31819a235d. PMID 19279432.
- ↑ Ha C, Magowan S, Accortt NA, Chen J, Stone CD (2009). "Risk of arterial thrombotic events in inflammatory bowel disease". Am J Gastroenterol. 104 (6): 1445–51. doi:10.1038/ajg.2009.81. PMID 19491858.
- ↑ Stone JR, Wilkins LR (2015). "Acute mesenteric ischemia". Tech Vasc Interv Radiol. 18 (1): 24–30. doi:10.1053/j.tvir.2014.12.004. PMID 25814200.
- ↑ Acosta S, Ogren M, Sternby NH, Bergqvist D, Björck M (2006). "Fatal nonocclusive mesenteric ischaemia: population-based incidence and risk factors". J Intern Med. 259 (3): 305–13. doi:10.1111/j.1365-2796.2006.01613.x. PMID 16476108.
- ↑ Endean ED, Barnes SL, Kwolek CJ, Minion DJ, Schwarcz TH, Mentzer RM (2001). "Surgical management of thrombotic acute intestinal ischemia". Ann Surg. 233 (6): 801–8. PMC 1421323. PMID 11407335.
- ↑ Acosta S (2015). "Mesenteric ischemia". Curr Opin Crit Care. 21 (2): 171–8. doi:10.1097/MCC.0000000000000189. PMID 25689121.
- ↑ Acosta S, Ogren M, Sternby NH, Bergqvist D, Björck M (2005). "Clinical implications for the management of acute thromboembolic occlusion of the superior mesenteric artery: autopsy findings in 213 patients". Ann Surg. 241 (3): 516–22. PMC 1356992. PMID 15729076.