Mesenteric arteriography

Alternative names
Abdominal arteriogram; Arteriogram - abdomen

Definition
Mesenteric arteriography is a type of X-ray examination of the the vessels that provide blood to the organs of the abdomen (including the small and large bowel).

How the test is performed

This test is done in a hospital. You will be asked to lie on an X-ray table. The groin area is cleansed, a local anesthetic is given, and a needle is inserted into the artery. The catheter (a long, narrow, flexible tube) is inserted through the needle and into the artery. It is then threaded through the main vessels of the abdomen and chest until it is properly placed into a mesenteric artery.

This procedure is monitored by a fluoroscope (an X-ray machine that projects the images on a TV monitor). The contrast medium is then injected into vessel via the catheter, and the X-ray pictures are taken. The catheter is kept open by flushing it periodically with a saline solution containing heparin, which will keep the blood in the catheter from clotting. Your pulse, blood pressure, and breathing are monitored during the procedure. After the X-rays are taken, the needle and catheter are withdrawn.

Pressure is immediately applied to the puncture site for 10 to 15 minutes to stop the bleeding. After that time the area is checked and a tight bandage is applied. The leg should be kept straight for an additional 4 hours after the procedure.

How to prepare for the test

Your food and fluids will be restricted 8 hours before the test is done. Inform the health care provider if you are pregnant and if you have any bleeding problems. Report any allergic reactions to X-ray contrast material or iodine substance and any other allergic reactions you have had. You must sign an informed consent form. You will be given a hospital gown to wear and asked to remove all jewelry. You may be given a sedative or pain pill before the procedure.

Infants and children:
The physical and psychological preparation you can provide for this or any test or procedure depends on your child’s age, interests, previous experiences, and level of trust. For specific information regarding how you can prepare your child, see the following topics as they correspond to your child’s age:

How the test will feel
The X-ray table is hard and cold; you may ask for a blanket or pillow. There is a sting when the anesthetic is given. This does not numb the artery, so there will be brief sharp pain as the catheter is inserted. There is a feeling of pressure as the catheter is advanced. As the dye is injected there is a warm, flushing sensation. Tenderness and bruising at the site of the injection may occur after the test.

Why the test is performed

The arteriography is done after an endoscopy (a procedure using an illuminating instrument to examine the internal organ) cannot locate the source of bleeding in the intestinal system or other studies prove inadequate in evaluating neoplasms (abnormal growths). It may also be used to evaluate vessel damage after an abdominal trauma.

If a site of active bleeding is identified, metallic coils or special chemicals and foams can be placed into the feeding (source) artery, in order to occlude it and prevent further bleeding. Similarly, vessels feeding cancers may be blocked to help reduce tumor size prior to surgery and Chemotherapy or radiotherapy.

What abnormal results mean

The study may reveal bleeding in the upper or lower GI (gastrointestinal) system, abnormal cells, vessel rupture from injury, and Cirrhosis.

Additional conditions under which the test may be performed include angiodysplasia of the colon.

What the risks are


There is the possibility of significant risk. A reaction to the contrast medium can occur. There is some risk of the catheter damaging the artery or knocking loose a piece of the artery wall which can cause tissue ischemia (reduced blood flow) or infarction (blockage of flow with eventual tissue death). This is rare, however.

If attempts are made to occlude actively bleeding arteries, there is a risk of embolizing other unintended vessels, possibly causing organ failure and death. A clot or bleeding at the puncture site may result in a partial blockage of the flow of blood to the leg.

There is low radiation exposure with a mesenteric arteriogram. X-rays are monitored and regulated to provide the minimum amount of radiation exposure needed to produce the image. Most experts feel that the risk of X-rays is smaller than other risks taken every day. Pregnant women and children are more sensitive to the risks of X-rays.

Special considerations

Mesenteric arteriograms may be performed after more sensitive nuclear medicine bleeding scans have identified active bleeding. The radiologist can then search in the region of bleeding to identify, and then embolize (occlude) the source.

Johns Hopkins patient information

Last revised: December 4, 2012
by Janet G. Derge, M.D.

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