Renal and Mesenteric Artery Disease Program

Overview: A Multidisciplinary Approach to Vascular Care

Our clinicians are leaders in the diagnosis and treatment of visceral vascular disease, the narrowing or blockage of arteries that supply blood to the intestines (mesenteric vascular disease) or the kidneys (renal vascular disease). We offer patients comprehensive care that includes a full range of medical, surgical and minimally invasive treatment options.

The Massachusetts General Fireman Vascular Center is one of the only vascular centers in the country with specialists in every area of vascular disease. Our Renal and Mesenteric Artery Disease Treatment Program brings together a team of clinicians from multiple disciplines to provide care from many perspectives, including:

• Vascular medicine and cardiology
• Vascular and endovascular surgery
• Vascular imaging and intervention
• Interventional radiology
• Nephrology and hypertension

We work together with the patient and referring physician to coordinate personalized treatment plans for all patients.

Diagnosis: Specialists Dedicated to Vascular Imaging

To accurately diagnose renal and mesenteric vascular disease, our team includes full-time specialists who are specifically trained to detect abnormalities in the vascular system and whose practice focuses specifically on vascular disease. These vascular imaging specialists are board certified in medicine, surgery, or radiology and fellowship trained with additional specialization in vascular care, including procedures to restore blood flow to these narrowed arteries.

Depending on the patient, we may use one or more techniques to diagnose visceral vascular disease, including:

• Duplex ultrasonography (ultrasound), a technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues and organs. Duplex ultrasonography is used to measure and assess the flow of blood
• Computed tomography angiography (CTA), which uses a combination of X-rays, contrast dye and computer technology to produce cross-sectional images of the body

• Magnetic resonance angiography (MRA), a noninvasive procedure that uses a combination of a large magnet, radiofrequencies and a computer to produce detailed images of organs and structures within the body

All of our diagnostic tests are also available at our convenient Waltham location.

Treatments and Prevention

Our approach to treating visceral vascular disease involves developing a personalized treatment plan for each patient that focuses on easing symptoms, managing hypertension (a possible complication of renal vascular disease) and restoring organ function.

Additionally, we collaborate with the Corrigan Minehan Heart Center and the divisions of Nephrology, Cardiology and Endocrinology to offer a Hypertension Program which specializes in the evaluation, diagnosis and management of patients with resistant or difficult to treat hypertension. Treatment is determined according to a patient’s symptoms, coexisting conditions and the severity of visceral vascular disease.

Medical and Preventive Treatments

Part of a world-class academic medical center, Fireman Vascular Center clinicians are leaders in their field. Our decades of experience researching and managing renal and mesenteric vascular disease allow us to recognize when to use medical, rather than interventional, therapies. Our clinicians often recommend medications and lifestyle changes to manage high cholesterol and high blood pressure – two conditions that may contribute to visceral vascular disease. For example, we have expert nephrologists who work closely with patients to control high blood pressure caused by the effects of renal vascular disease on the kidneys.

Our vascular specialists also guide patients through smoking cessation and other lifestyle changes and may refer them to cardiologists at the Corrigan Minehan Heart Center for related cardiac conditions. These dedicated physicians follow patients throughout their lives to ensure ongoing support and further treatment, if needed.

Advanced Interventional Techniques

Clinicians in the Renal and Mesenteric Artery Disease Treatment Program are national leaders in using endovascular and surgical therapies to treat patients with visceral vascular disease. Such interventional treatments include:

• Angioplasty and stenting: In this technique, a balloon-tipped catheter is threaded through the affected artery to expand it. A stent, which is a tiny metal-mesh tube, may be inserted to keep the artery open. Angioplasty and stenting is less invasive than open surgery and results in faster recovery times
• Trans-aortic endarterectomy: In this procedure, plaque is surgically removed from blocked mesenteric arteries
• Surgical bypass: This intervention re-routes blood flow around the diseased artery

National Leaders in Our Field

The Fireman Vascular Center has a long tradition of excellence in clinical care; and our clinicians are national leaders in the diagnosis and treatment of visceral vascular disease. All of our physicians are at the forefront of new research and serve on many national and international professional boards and societies, including:

• The Society for Vascular Surgery
• The Society of Interventional Radiology
• The American College of Cardiology
• The American Heart Association
• The Society for Vascular Medicine
• The Society for Cardiovascular Angiography and Intervention

Physicians within the Renal and Mesenteric Artery Disease Treatment Program are also committed to education: many of the physicians share their perspective with other medical professionals through national and internation conferences.

One Call Coordinates Care

Our dedicated access coordinator is available Monday through Friday from 8:30 am to 5:00 pm to take relevant information about your condition and symptoms and to make a timely appointment with the most appropriate specialist. Call 877-644-8346 to reach our nurse coordinator or request an appointment online.

We strive to see patients as soon as possible and assign every patient one clinician to organize care between members of our multidisciplinary team. From diagnosis to treatment and follow up, this physician guides patients through the treatment process.

Research and Clinical Trials

Physicians from the Renal and Mesenteric Artery Disease Treatment Program participate in national clinical studies evaluating new technologies and devices to treat mesenteric and renal vascular disease. This allows us to bring our patients promising new treatments as quickly as possible. Some of these studies include:

• ASPIRE-2. This landmark trial evaluated the use of stents in patients with renal vascular disease and was a determining factor in the FDA approval of renal stents
• A National Heart, Lung, and Blood Institute sponsored landmark study comparing the role of blood pressure medications to renal artery stent placement in combination with blood pressure medications in patients with high blood pressure and renal artery disease. Several members of the Fireman Vascular Center are on the National Steering Committee of this trial
• New devices. Physicians at the Fireman Vascular Center are currently investigating devices such as drug-eluting stents, drug-coated balloons and distal protection devices (filters) for the minimally invasive treatment of visceral vascular disease

Patients interested in participating in clinical trials can browse online for open trials.