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Mesenteric angiography

Definition

Mesenteric angiography is a test used to look at the blood vessels that supply the stomach, small and large intestines, and other internal organs.

Angiography is an imaging test that uses x-rays and a special dye to see the insides of the arteries. Arteries are blood vessels that carry blood away from the heart.

How the Test is Performed

This test is done in a hospital. You will lie on an x-ray table. You may ask for medicine to help you relax (sedative) if you need it.

• During the test, your blood pressure, heart rate, and breathing will be checked.

• The health care provider will shave and clean the groin. A numbing medicine (anesthetic) is injected into the skin over an artery. A needle is inserted into an artery.

• A thin flexible tube called a catheter is passed through the needle. It is moved into the artery, and up through the main vessels of the belly area until it is properly placed into a mesenteric artery. The doctor (usually a radiologist with special training in this technique) uses x-rays as a guide. The doctor can see live images of the area on a TV-like monitor.

• Contrast dye is injected through this tube to see if there are any problems with the blood vessels. X-ray images are taken of the artery.

Certain treatments can be done during this procedure. These items are passed through the catheter to the area in the artery that needs treatment. These include:

• Dissolving a blood clot with medicine

• Opening a partially blocked artery with a balloon

• Placing a small tube called a stent into an artery to help hold it open

After the x-rays or treatments are finished, the catheter is removed. Pressure is applied to the puncture site for 20 to 45 minutes to stop the bleeding. After that time the area is checked and a tight bandage is applied. The leg where the needle was placed is most often kept straight for another 6 hours after the procedure. You should avoid strenuous activity, such as heavy lifting, for 24 to 48 hours.

How to Prepare for the Test

You should not eat or drink anything for 6 to 8 hours before the test.

You will be asked to wear a hospital gown and sign a consent form for the procedure. Remove jewelry from the area being imaged.

Tell your provider:

• If you are pregnant

• If you have ever had any allergic reactions to x-ray contrast material, shellfish, or iodine substances

• If you are allergic to any medicines

• Which medicines you are taking (including any herbal preparations)

• If you have ever had any bleeding problems

How the Test will Feel

You may feel a brief sting when the numbing medicine is given. You will feel a brief sharp pain and some pressure as the catheter is placed and moved into the artery. In most cases, you will feel only a sensation of pressure in the groin area.

As the dye is injected, you will feel a warm, flushing sensation. You may have tenderness and bruising at the site of the catheter insertion after the test.

Why the Test is Performed

This test is done:

• When there are symptoms of a narrowed or blocked blood vessel in the intestines

• To find the source of bleeding in the gastrointestinal tract

• To find the cause of ongoing abdominal pain and weight loss when no cause can be identified

• When other studies do not provide enough information about abnormal growths along the intestinal tract

• To look at blood vessel damage after an abdominal injury

A mesenteric angiogram may be performed after more sensitive nuclear medicine scans have identified active bleeding. The radiologist can then pinpoint and treat the source.

Normal Results

Results are normal if the examined arteries are normal in appearance.

What Abnormal Results Mean

A common abnormal finding is narrowing and hardening of the arteries that supply the large and small intestine. This can cause mesenteric ischemia in which the intestine does not receive enough blood to function normally. The problem occurs when fatty material (plaque) builds up on the walls of your arteries.

Abnormal results may also be due to bleeding in the small and large intestine. This may be caused by:

• Angiodysplasia of the colon

• Blood vessel rupture from injury

Other abnormal results may be due to:

• Blood clots

• Cirrhosis

• Tumors

Risks

There is some risk of the catheter damaging the artery or knocking loose a piece of the artery wall. This can reduce or block blood flow and lead to tissue death. This is a rare complication.

Other risks include:

• Allergic reaction to the contrast dye

• Damage to the blood vessel where the needle and catheter are inserted

• Excessive bleeding or a blood clot where the catheter is inserted, which can reduce blood flow to the leg

• Heart attack or stroke

• Hematoma, a collection of blood at the site of the needle puncture

• Infection

• Injury to the nerves at the needle puncture site

• Kidney damage from the dye

• Damage to the intestine if the blood supply is reduced

Considerations

To make a diagnosis, your doctor may also perform a computed tomography (CT) angiography or magnetic resonance angiography (MRA) before or in place of catheter angiography.

References

Mcquinn CW, Orion KC. Endovascular diagnostic technique. In: Sidawy AN, Perler BA, eds. Rutherford's Vascular Surgery and Endovascular Therapy. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 62.

Lo RC, Schermerhorn ML. Mesenteric arterial disease: epidemiology, pathophysiology, and clinical evaluation. In: Sidawy AN, Perler BA, eds. Rutherford's Vascular Surgery and Endovascular Therapy. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 62.

van den Bosch H, Westenberg JJM, de Roos A. Cardiovascular magnetic resonance angiography: carotids, aorta, and peripheral vessels. In: Manning WJ, Pennell DJ, eds. Cardiovascular Magnetic Resonance. 3rd ed. Philadelphia, PA: Elsevier; 2019:chap 44.

Review Date: 10/23/2024

Reviewed By: Deepak Sudheendra, MD, MHCI, RPVI, FSIR, Founder and CEO, 360 Vascular Institute, with an expertise in Vascular Interventional Radiology & Surgical Critical Care, Columbus, OH. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.