Epidemiology of Mesenteric Vascular Disease: Clinical Implications
Section snippets
Incidence of Atherosclerosis in the Mesenteric Arteries
ATHEROSCLEROSIS OF THE mesenteric arteries is often a manifestation of a generalized atherosclerosis. The incidence increases with age and the prevalence among 65-year-old subjects in Europe and North America is approximately 20%.1 Patients who have undergone an aortobifemoral bypass due to occlusive disease of the iliac arteries have concomitant atherosclerosis of the mesenteric arteries in approximately 70%.2 In case of stenosis or occlusion of the mesenteric arteries, collateral arterial
Distribution of Etiologies among Patients with Acute Mesenteric Ischemia
Overall incidence rate of acute mesenteric ischemia between 1970 and 1982, diagnosed at either autopsy or operation, in the population of Malmö was estimated at 12.9 (95% confidence interval, 11.6-14.1)/100,000 person-years. Autopsy rate was 87%. In all, 402 patients were diagnosed; 270 (67.2%) with acute SMA occlusion, 63 (15.7%) with mesenteric venous thrombosis, 62 (15.4%) with nonocclusive mesenteric ischemia (NOMI), and 7 (1.7%) with indeterminate etiology (Fig 1).5 The epidemiological
Trends in Incidence and Discovery of Acute SMA Occlusion
Almost none of the published case series on acute SMA occlusion are population-based. Most patients in these series are diagnosed at operation and the autopsy frequency is unknown (Table 1). The most thorough epidemiological study has been conducted on the population of Malmö: Overall incidence of acute SMA occlusion in Malmö between 1970 and 1982 was estimated at 8.6/100,000 person-years,6 and this estimate has not been demonstrated to increase since then, even though the proportion of elderly
Trends in Mortality of Acute SMA Occlusion
Overall cause-specific mortality was 6.0/1000 deaths in 1970 to 1982 and the in-hospital mortality rate was 93%.6 These mortality estimates have decreased since then as have the autopsy rates to 24%. From 2004 to end of study, in-hospital mortality rate was 58%. The subset of patients undergoing a multidetector row CT with intravenous contrast enhancement had a lowered in-hospital mortality rate of 36% (P = .002).5
Acute Thrombotic versus Embolic Occlusion of the SMA
In an autopsy study consisting of 213 patients with acute SMA occlusion, the embolus/thrombus ratio was 1.4.7 Thrombotic occlusions were located more proximally than embolic occlusions, intestinal infarction was more extensive and thrombotic occlusions were associated with old brain infarction, aortic wall thrombosis, and disseminated cancer. Thrombosis or severe atherosclerotic changes of the celiac trunk were present in 33% of those with thrombosis in the SMA. The proportion of patients with
NOMI
NOMI, with or without stenosis of the mesenteric arteries, may be very difficult to distinguish from thromboembolic occlusion of the SMA without mesenteric angiography or autopsy because these conditions have common risk factors. In an autopsy series where the cause of death was intestinal infarction, patients with an open but stenotic SMA (n = 25) were found to be older than those without a stenosis (n = 37), and they had more often a concomitant stenosis of the celiac trunk.10 Synchronous
Incidence
Estimated overall incidences of mesenteric venous thrombosis (MVT) in Malmö 1970 to 198211 and 2000 to 200612 were similar, 2.7/100,000 person-years in 2000 to 2006, with equal incidences in both genders. The highest incidence in both men (12.0/100,000 person-years) and women (10.8/100,000 person-years) was in the age category 70 to 79 years. The mode of establishing the diagnosis of MVT changed over time, during recent years a diagnosis with CT became more prevalent. Between 2000 and 2003, the
References (24)
- et al.
AGA technical review on intestinal ischemiaAmerican Gastrointestinal Association
Gastroenterology
(2000) - et al.
Incidence of acute thromboembolic occlusion of the superior mesenteric artery—A population-based study
Eur J Vasc Endovasc Surg
(2004) - et al.
Superior mesenteric artery embolism: Eighty-two cases
Ann Vasc Surg
(1990) - et al.
Mesenteric venous thrombosis with transmural intestinal infarction: A population-based study
J Vasc Surg
(2005) - et al.
Mesenteric venous thrombosis: A changing clinical entity
J Vasc Surg
(2001) - et al.
Acute mesenteric venous thrombosis: Case for nonoperative management
J Vasc Surg
(2001) - et al.
Ruptured abdominal aortic aneurysm: A population-based study
J Vasc Surg
(1993) - et al.
Acute occlusive mesenteric ischemiaSurgical management and outcomes
Ann Vasc Surg
(2003) - et al.
Contemporary management of acute mesenteric ischemia: Factors associated with survival
J Vasc Surg
(2002) - et al.
Significant disease of the celiac and superior mesenteric arteries in asymptomatic patients: Predictive value of Doppler sonography
AJR Am J Roentgenol
(1993)
Mesenteric ischaemia: A multidisciplinary approach
Br J Surg
Mid-term outcome of endovascular revascularization for chronic mesenteric ischemia
Br J Surg
Cited by (212)
Dexmedetomidine against intestinal ischemia/reperfusion injury: A systematic review and meta-analysis of preclinical studies
2023, European Journal of PharmacologySuperior mesenteric artery thrombosis with concomitant pancreaticoduodenal artery pseudoaneurysm in a 60-year-old male patient — A case report
2023, International Journal of Surgery Case ReportsMultivariate analysis of intestinal necrosis in acute superior mesenteric artery embolism: a single institution experience
2023, Annals of Vascular Surgery - Brief Reports and InnovationsAcute management of mesenteric emergencies: Tailoring the solution to the problem
2023, Seminars in Vascular Surgery