Atherosclerosis of the visceral arteries

Thrombosis in the visceral arteries is the most common cause of acute mesenteric ischemia. It typically occurs in areas of atherosclerotic narrowing. Atherosclerosis of splanchnic blood vessels also causes chronic mesenteric ischemia. In the present study, the occurrence of atherosclerosis in the celiac and mesenteric arteries was evaluated in an unselected Finnish autopsy series of 120 patients. Thirty-five patients (29%) had stenosis in the first few centimetres of mesenteric arteries. In 18 cases (15%) at least two mesenteric arteries were stenotic. The celiac artery was the most common site of mesenteric artery stenosis. More distally, only hemodynamically insignificant signs of macroscopic atherosclerosis, fatty streaks or fibrous plaques, observed. The occurrence of mesenteric artery stenosis was strongly associated with aging. Sixty-seven per cent of the subjects aged 80 or more presented with mesenteric artery stenosis, whereas the rate was 6% among those aged less than 40 years. Despite sometimes extensive stenotic alterations in the mesenteric arteries, only one patient in our study had bowel necrosis at autopsy. We conclude that atherosclerosis of mesenteric arteries commonly affects individuals of advanced age. As a part of general arteriosclerotic process of the circulatory system, mesenteric artery atherosclerosis is strongly associated with atherosclerosis in coronary arteries. In addition, there was an association between atherosclerosis in mesenteric arteries and cerebral arteries in the skull base. Thus, a characteristic triad of postprandial abdominal pain, food aversion, and weight loss in an elderly patient with other manifestations of arteriosclerosis should suggest a possibility of the visceral arterial insufficiency.