Arterial occlusive disease in the abdominal region

What is arterial occlusive disease in the abdominal region?

Arterial occlusive disease often affects the vessels of the legs, heart or brain. However, in very rare cases, constrictions can also form in the intestinal and renal vessels (renal artery stenosis / mesenteric artery stenosis). What arterial occlusive diseases have in common is that deposits usually form on the artery walls, the so-called plaques. Due to this hardening of the arteries(arteriosclerosis), the vessel becomes increasingly constricted, hardens and thus becomes less elastic. The blood flow in the affected region is increasingly restricted. Eventually, the vessel may close partially or even completely. In the affected region, the organ, which is normally supplied by these arteries, receives too little blood – and therefore too little oxygen and nutrients. As a result, it no longer works as it should.

Narrowed renal arteries (renal artery stenosis)

The body generally has two kidneys, each of which is supplied with oxygen- and nutrient-rich blood via at least one renal artery. Renal artery stenosis is the name given to the clinical picture when a kidney is no longer properly supplied with blood (ischemia) due to vasoconstriction. And that has consequences. This is because the kidneys play a key role in regulating blood pressure by releasing certain hormones. If the renal artery is narrowed, the kidney releases hormones that increase blood pressure. And this high blood pressure can in turn cause damage, particularly to the heart, or even be the cause of a stroke. In addition, the kidney tissue itself is damaged and the organ’s detoxification function continues to decline. If the renal artery becomes completely blocked, for example by a blood clot (thrombus), the result is a kidney infarction. This leads to an immediate loss of kidney function in the affected kidney. The bottleneck or blockage in the vessel must therefore be eliminated quickly. In the long term, it is important to treat high blood pressure in order to prevent secondary damage.

Constricted intestinal artery (mesenteric artery stenosis)

If an intestinal artery is narrowed, the intestine no longer receives enough blood for its digestive work. Although the body has ways of supplying the undersupplied sections of the intestine with blood again over time via bypass circuits, those affected can still suffer from pain after eating and weight loss (angina intestinalis).

Arterial occlusive disease in the abdominal region: causes

There are various possible causes of renal artery stenosis. The most important are:

• Calcification of the arteries (arteriosclerosis) in older people: Calcium, fats and other substances are deposited in the arterial wall. It thickens and less blood passes through.
• Thickening of the connective tissue in the arterial wall that is not caused by inflammation (fibromuscular dysplasia): It causes renal artery stenosis, particularly in younger people (especially women).
• Less common: wall damage within the vessel leading to the formation of two spaces (dissection) and vascular inflammation, such as Takayasu arteritis.

Of course, arteriosclerosis can also affect the intestinal arteries and lead to constrictions or blockages.

Symptoms: Arterial occlusive disease in the abdominal region causes pain

In many cases, the consequence of renal artery stenosis is high blood pressure (hypertension). High blood pressure often goes unnoticed for a long time because it causes little or no discomfort. Renal artery stenosis as the cause of high blood pressure:

• Headaches, especially in the morning after getting up
• Dizziness
• Palpitations
• Irritability, nervousness
• Nausea
• Visual disturbances
• Hypertensive crisis: sudden spikes in blood pressure, accumulation of water in the lungs (pulmonary edema)
• High blood pressure in adolescents and young adults
• Sudden onset of severe high blood pressure in older adults

If several intestinal vessels are constricted, those affected often experience the following symptoms:

• Abdominal pain during and after eating: This is when digestion starts and the intestines do not receive enough blood to work normally. The abdominal pain can vary in intensity and duration. Those affected usually eat less to alleviate their symptoms.
• Nausea, vomiting
• Diarrhea, flatulence
• Unintentional weight loss due to restricted food intake

Diagnosis of arterial occlusive disease in the abdominal region

Diagnosis always begins with a discussion with your doctor about your medical history, the anamnesis. Among other things, the following questions are asked:

• What exactly are your symptoms?
• When did the symptoms first occur and how intense are they?
• When do the symptoms occur, do they occur after certain (fatty) foods?
• Do you have any known illnesses? For example, high blood pressure, heart, kidney or intestinal diseases? Is there a known vascular disease of the legs?
• Do you take medication regularly? If yes: Which ones and since when?

This is followed by a physical examination, during which we palpate the abdominal region for changes. For example, we check whether you feel pain when pressure is applied and where exactly it is located. We also listen to the abdomen with a stethoscope. Conspicuous noises can be detected in this way. A blood pressure measurement and blood test also provide us with important information about the cause of the symptoms.

Imaging procedures are also used in the diagnosis of arterial occlusive disease in the abdominal region. Some examples:

• Color-coded duplex sonography: This is a special ultrasound examination. The method can map the vessels themselves, deposits, constrictions and the speed of blood flow. With the help of color coding, the blood flow can also be displayed in color. Increases in flow velocity indicate constrictions.
• Possibly Computed tomographyAn X-ray examination with a contrast medium, which images the body “slice by slice” and creates detailed, three-dimensional images of the interior.
• Possibly Magnetic resonance imaging (MRI = magnetic resonance imaging or magnetic resonance angiography (MRA): Radiologists use strong magnetic fields and a contrast medium to create high-resolution images of the inside of the body.
• Angiography: This allows the arteries to be visualized with the aid of X-rays and contrast medium.

In the case of narrowed intestinal arteries, further examinations are sometimes used, for example a colonoscopy and gastroscopy, stool examination or an abdominal ultrasound. However, these examinations often provide inconspicuous results.

Arterial occlusive disease in the abdominal region: prevention, early detection, prognosis

A common cause of narrowing of the renal arteries is arteriosclerosis. It also sometimes plays a role in constricted intestinal arteries. You can prevent vascular calcification to a certain extent by minimizing or eliminating the risk factors. Some tips:

• Let diseases such as high blood pressurehigh blood pressure, high blood lipid levels (cholesterol) or diabetes mellitus. There are measures that address your lifestyle, as well as effective medication.
• Refrain from smoking. Try to wean yourself off cigarettes and other smoking products. If you can’t do it alone: seek professional support to help you stop smoking (stop smoking advice).
• Only drink alcohol in moderation and take regular alcohol breaks.
• Make sure you eat a healthy diet: eat plenty of fresh fruit and vegetables, wholegrain products and pulses. Only eat meat in moderation. It is best to choose vegetable fats and oils (linseed, rapeseed, olive or sunflower oil) – they contain healthy unsaturated fatty acids.
• If you suffer from overweight orobesity: Try to lose a few kilos. Your blood vessels also benefit from this.
• Move as much as possible in your everyday life. Any kind of exercise counts, even housework such as cleaning or vacuuming or weeding the garden. Take the stairs instead of the elevator.
• Exercise: Experts recommend endurance sports such as swimming, cycling, hiking or Nordic walking – for 30 minutes a day, preferably every day of the week.
• Reduce stress: Stress can also damage your blood vessels. Learn a relaxation method such as autogenic training or progressive muscle relaxation according to Jacobson. Yoga, Tai Chi or Qigong can also effectively dispel stress. Take regular breaks in your daily routine and do something good for yourself to relax: for example, read, go to the cinema or theater, meet up with friends or listen to music.

If you follow some of these tips, you can protect your blood vessels. However, you cannot do anything about some risk factors yourself, such as genes or age.

Progression and prognosis of arterial occlusive disease in the abdominal region

The course and prognosis of renal artery stenosis or narrowed intestinal vessels are good if you seek medical advice at an early stage so that the disease can be detected and treated in good time. Without treatment, the disease progresses and can cause damage throughout the body – not just in the kidneys and intestines. If the arteries in the kidneys or intestines become completely blocked, there is a risk of serious consequential damage. The organs no longer function due to the lack of blood flow – kidney infarction and intestinal infarction can be dangerous consequences.

If you make sure that your risk factors are well controlled (stop smoking completely, treat high blood pressure, blood lipids and diabetes), you can also make an important contribution to keeping your arteries healthy for a long time.

Arterial occlusive disease in the abdominal region: treatment with balloon/stent or open surgery

The treatment depends on how many and how severely the intestinal vessels or renal arteries are narrowed and how severe the symptoms are.

We can treat narrowed intestinal vessels and renal arteries using various methods that are individually tailored to you. The most important therapies are