to Dr. Begos
who was selected again as one of of Boston’s top doctors by Boston Magazine in 2015
CSA Vein Center
receives accreditation by the IAC:
CSA is the first vein practice in Northeast Massachusetts to be fully accredited as a Certified Vein Center by the IAC (Intersocietal Accreditation Commission).
Mesenteric ischemia refers to the lack of blood flow to one or more of the
mesenteric arteries (arteries that supply the intestines) causing pain and
possibly placing the affected portion of the intestine in jeopardy of dying. The
cause is often sudden thrombosis (occlusion from blood clot formation) at a
chronic stenosis (narrowing) that develops from progressively worsening
atherosclerotic (cholesterol) plaque build-up within that artery.
Other possible causes are embolization and dissection. Embolization is when
thrombus (blood clot) or plaque from higher up in the aorta or heart breaks
loose and lodges itself into a mesenteric artery further downstream.
Dissection is when the inner wall of an artery tears and blood flows between
2 layers of the artery wall in 2 lumens (channels) known as the ‘false’
lumen (newly created channel within the wall of the artery), and the ‘true’
lumen (the proper lumen that has always existed). The ‘false’ lumen can
often cause collapse and occlusion of the ‘true’ lumen and thus lack of
blood flow to the associated portion of the intestine. One final cause may
be chronic stenosis itself, which causes only limited blood flow to the
intestines and a more chronic form of the condition.
The symptoms that can occur with mesenteric ischemia include sudden and
severe abdominal pain, which is usually associated with acute thrombosis of
chronic stenosis/disease, embolization, or dissection, and abdominal pain
after eating that leads to weight loss, which is usually associated with
Complications from mesenteric ischemia include severe weight loss from
avoidance of eating due to the associated pain, and infarction (injury or
death) of the affected intestine, which often requires surgery to remove
that portion of the intestine.
Diagnosis of mesenteric ischemia requires a thorough history and physical
exam by a vascular surgeon and an imaging study such as a computed
tomography (CT) scan, magnetic resonance imaging (MRI) study, or arteriogram
(injection of contrast dye into the arteries).
Treatment of mesenteric ischemia requires a procedure, sometimes
emergent, to restore blood flow to the affected portion of the intestine.
This may include a minimally invasive (endovascular) treatment with
thrombolysis (removal of thrombus with medicine through a catheter),
thrombectomy (mechanical disruption and removal of thrombus through a
catheter), and possibly also balloon angioplasty and/or stenting. If the
patient or circumstances do not allow for this technique, then it requires
open surgical removal of thrombus or embolus and subsequent open surgical
treatment of the cause.