Renal & Mesenteric Artery Disease

What are Renal & Mesenteric Artery Diseases?

Renal artery disease is the narrowing of the arteries that carry blood to the kidneys and mesenteric artery disease is the narrowing of the arteries that carry blood to the intestines. A build-up of a fatty substance called plaque can harden and narrow the arteries through a process called atherosclerosis. Atherosclerosis—also called stenosis—can cause the narrowing of any arteries throughout the body. As atherosclerosis affects the whole body, people with renal or mesenteric artery disease often have other cardiovascular conditions such as carotid artery disease, peripheral artery disease, and heart disease.

At NewYork-Presbyterian, our vascular specialists are dedicated to the care of patients with renal and mesenteric artery disease. With the vast resources and latest technologies available at our two renowned medical centers – NewYork-Presbyterian/Columbia University Irving Medical Center and NewYork-Presbyterian/Weill Cornell Medical Center—our vascular experts are here to provide you with advanced and compassionate care.

Signs & Symptoms

In renal artery disease, reduced blood flow to the kidneys causes progressive kidney failure or difficult-to-control high blood pressure. In mesenteric artery disease, reduced blood flow to the intestines can cause weight loss and severe pain with eating.

Risk Factors

The risk factors for renal and mesenteric artery disease are the same risk factors as for all cardiovascular diseases. These include:

Smoking is the number one risk factor for all cardiovascular disease
High blood pressure
Diabetes
High cholesterol
Advanced age (over 50)
No longer having menstrual periods (postmenopausal)
Obesity (being 30 percent over your ideal body weight)
Personal or family history of atherosclerosis
Sedentary lifestyle

Renal artery disease can also develop as a result of fibromuscular dysplasia (FMD), a condition in which abnormal cells cause narrowing throughout certain arteries, particularly those that supply the kidneys with blood. FMD can also affect the carotid arteries and arteries in the pelvis. This condition can affect anyone but is often seen in women between the ages of 20 and 40.

Diagnosis

To diagnose renal or mesenteric artery disease, our vascular specialists begin with an assessment and consultation, which will include reviewing your medical history and obtaining any necessary imaging and blood tests.
Our vascular specialists use one or more of the following imaging tests to determine the location and the extent of the arterial stenosis:

Duplex ultrasound - This test uses ultrasound, high-frequency sound waves, to detect stenosis or narrowing of the arteries

Angiography - This test uses an injection of contrast material into your blood vessels to help to diagnose and evaluate blood vessel disease or related conditions, such as aneurysms or blockages

Magnetic resonance angiography (MRA) - This procedure uses large magnets, radio frequencies, and a computer to produce detailed images

CT Scan - This test uses X-ray scanning to view cross-section images of the body

Renography - A specialized radiology procedure used to assess the function and structure of the kidneys. Renography is a type of nuclear radiology procedure. This means that a tiny amount of a radioactive substance is used during the procedure to assist in the examination of the kidneys.

Treatment

The main goals for the treatment of renal and mesenteric artery disease are to control the symptoms and to prevent future complications. Treatments range from lifestyle modification to minimally invasive therapies to surgery. Our vascular specialists will work with your primary physician to provide comprehensive, individualized vascular care and communicate regularly about your long-term vascular health.

Lifestyle modification

Patients whose symptoms are mild to moderate can often manage their disease by making lifestyle changes such as quitting smoking, getting regular exercise, improving diet, and working with their doctors to take care of related conditions, such as diabetes, high blood pressure, and high cholesterol.

Medical therapy

Doctors may also prescribe medications to improve blood flow, such as antiplatelet agents (blood thinners) and medications that relax the blood vessel walls. Medications are also used to treat underlying conditions such as diabetes, hypertension, and high cholesterol.

Minimally invasive approaches

Vascular specialists often use minimally invasive procedures such as angioplasty and stenting to relieve the narrowing in the blood vessels and improve blood supply to the kidneys and intestines.
Because they are less invasive 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 lower risk 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

During angioplasty, vascular specialists use a special catheter that has a small balloon at the end, which can be inflated and deflated. The deflated balloon catheter is inserted through an artery in the groin or the wrist and guided to the narrowed segment of the artery. When the catheter reaches the blockage, the balloon is inflated to widen the narrowed artery.

Stenting

In some cases, it may be necessary to place a stent. A stent is a small tube that holds open the artery at the site of the blockage. The stent is collapsed around a balloon when it is placed on the tip of the catheter and inserted into the body. Once the catheter reaches the blockage, the doctor expands the stent by inflating the balloon. The stent is left permanently in the artery to provide a reinforced channel through which blood can flow. Some stents (drug-eluting stents) are coated with a medication that helps prevent the formation of scar tissue.

Surgery

If renal or mesenteric artery disease is very advanced, or if blockages develop in an artery that is difficult to reach with a catheter, arterial bypass surgery may be necessary to restore blood flow.

Arterial bypass surgery

To surgically correct the decreased blood flow through the artery, doctors place a bypass graft made of synthetic material or a natural vein taken from another part of the body. During the procedure, the surgeon will make an incision to expose the diseased segment of the artery, and then attach one end of a bypass graft to a point above the blockage and the other end to a point below it. The blood supply is then diverted through the graft, around the blockage, to bypass the diseased section of the artery. The diseased artery is left in place.

Prevention

Renal and mesenteric artery disease is preventable with strategies that stop narrowing of the arteries in people who are at risk. Our vascular specialists can determine your risk by gathering information such as your age, weight, medical history, medications and lifestyle factors. You can take steps to prevent renal and mesenteric artery disease, or prevent it from getting worse, with the following steps:

Stop smoking, including staying away from secondhand smoke
Healthy eating including reduced fat, cholesterol, and sugar, and increased fruits, vegetables, whole grains, and healthy protein (lean meats, fish, and soy)
Treatment of high cholesterol with diet, exercise, and medications
Losing weight if overweight
Limiting the amount of alcohol you drink
Taking medicine to reduce your risk for blood clots
Regular exercise
Control of blood sugar levels
Control of blood pressure

Why Choose Us

Special programs and services for hypertension

Narrowing of the renal arteries can lead to hypertension (high blood pressure) that's difficult to control. We offer two renowned hypertension programs at NewYork-Presbyterian:

NewYork-Presbyterian/Weill Cornell's Hypertension Center, part of the Division of Nephrology & Hypertension, provides state-of-the-art care to patients afflicted with kidney disease and/or high blood pressure. The Hypertension Center is the only center in the greater metropolitan area devoted exclusively to the care of patients with blood pressure and kidney circulation disorders.
The Hypertension Center at NewYork-Presbyterian/Columbia University Medical Center was the first multidisciplinary center for treating hypertension in the New York metropolitan area. It has been designated by the American Heart Association as a Comprehensive Hypertension Center, which recognizes institutions that meet or exceed standards for the research-based treatment of hypertension.

Expertise in vascular care

NewYork-Presbyterian is a leader in the field of vascular care, with a long tradition of expertise, innovation, and leadership. Our vascular specialists are board certified in vascular or endovascular medicine, cardiovascular disease, and interventional cardiology. They have expertise in diagnosing and treating abnormalities of the vascular/circulation system, including renal and mesenteric arteries, offering the highest level of specialized care and advanced therapies. Our vascular specialists are internationally known for the treatment of these conditions using minimally invasive therapies.

Individualized and holistic care

At NewYork-Presbyterian, our vascular specialists offer individualized and holistic care, tailoring your treatment to your medical history, lifestyle, and wellness goals. Our goal is to understand your condition and then treat it in a way that improves your lifestyle and prevents future vascular problems. We will work closely with our patients and referring physicians to coordinate a personalized treatment plan for every patient. We are especially skilled in diagnostic imaging, vascular medicine, and minimally invasive procedures that allow for shorter and less painful recovery times. We provide the highest level of service, starting with the initial visit through follow-up and recovery.

Multidisciplinary team approach

Vascular conditions can affect many areas of the body and may require input from other specialists. Our top-notch team collaborates with other world-renowned experts at NewYork-Presbyterian--which may include vascular and endovascular specialists, surgeons, cardiologists, nephrologists, and other specialists--ensuring that you receive the comprehensive care that you need.