The Incidence of Chronic Mesenteric Ischemia in the Well-Defined Region of a Dutch Mesenteric Ischemia Expert Center.

Published on Aug 1, 2020in Clinical and translational gastroenterology3.968
· DOI :10.14309/CTG.0000000000000200
Luke G. Terlouw2
Estimated H-index: 2
,
Mandy Verbeten1
Estimated H-index: 1
+ 5 AuthorsJeroen J. Kolkman28
Estimated H-index: 28
Source
Abstract
INTRODUCTION: This study aimed to determine the incidence of chronic mesenteric ischemia (CMI) and to examine the influence of the etiological cause, location, and severity of a mesenteric artery stenosis on the probability of having CMI. METHODS: A prospective database, containing the details of all patients with suspected CMI referred to a renowned CMI expert center, was used. Patients residing within the expert centers’ well-defined region, between January 2014 and October 2019, were included. CMI was diagnosed when patients experienced sustained symptom improvement after treatment. RESULTS: This study included 358 patients, 75 had a ‡50% atherosclerotic stenosis of 1 vessel (CMI 16%), 96 of 2 or 3 vessels (CMI 81%), 81 celiac artery compression (CMI 25%), and 84 no stenosis (CMI 12%). In total, 138 patients were diagnosed with CMI, rendering a mean incidence of 9.2 (95% confidence interval [CI] 6.2–13.7) per 100,000 inhabitants. Atherosclerotic CMI was most common, with a mean incidence of 7.2 (95% CI 4.6–11.3), followed by median arcuate ligament syndrome 1.3 (95% CI 0.5–3.6) and chronic nonocclusive mesenteric ischemia 0.6 (95% CI 0.2–2.6). The incidence of CMI was highest in female patients (female patients 12.0 [95% CI 7.3–19.6] vs male patients 6.5 [95% CI 3.4–12.5]) and increased with age. CMI was more prevalent in the presence of a ‡70% atherosclerotic single-vessel stenosis of the superior mesenteric artery (40.6%) than the celiac artery (5.6%). DISCUSSION: The incidence of CMI is higher than previously believed and increases with age. Probability of CMI seems highest in suspected CMI patients with multivessel disease or a ‡70% atherosclerotic singlevessel superior mesenteric artery stenosis.
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Last. Marco J. Bruno (EUR: Erasmus University Rotterdam)H-Index: 23
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This This Dutch Mesenteric Ischemia Study group consists of: Ron Balm, Academic Medical Center, Amsterdam Gert Jan de Borst, University Medical Center Utrecht, Utrecht Juliette T Blauw, Medisch Spe...
17 CitationsSource
#1Louisa van de Loo van Dijk (Erasmus University Medical Center)H-Index: 1
#2Leon M G Moons (UU: Utrecht University)H-Index: 21
Last. Ellen V. Rouwet (Erasmus University Medical Center)H-Index: 20
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Abstract Objective An isolated stenosis of the celiac artery (CA) or the superior mesenteric artery (SMA) is frequently detected in patients with abdominal complaints. The dilemma is whether these patients suffer from chronic mesenteric ischemia (CMI) and whether they will benefit from revascularization. We evaluated the long-term clinical success rates for single CA or SMA revascularization in patients with gastrointestinal symptoms and confirmed mucosal ischemia. Methods This was a retrospecti...
10 CitationsSource
#1Fares Alahdab (Mayo Clinic)H-Index: 46
#2Remy Arwani (Ain Shams University)H-Index: 1
Last. M. Hassan Murad (Mayo Clinic)H-Index: 88
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Abstract Background Despite the enthusiasm for endovascular revascularization for chronic mesenteric ischemia (CMI), it is not clear if early benefits offset long-term patency rates. This systematic review aimed to provide an up-to-date comprehensive evidence synthesis evaluating the two approaches. Methods We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus through July 15, 2016, for studies that compared the endovascu...
28 CitationsSource
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Background: The aim was to study temporal changes in incidence, disease phenotype at diagnosis, and mortality of adult inflammatory bowel disease [IBD] patients in South Limburg, The Netherlands, diagnosed between 1991 and 2010. In addition, the 2010 IBD prevalence was estimated. Methods: A multi-faceted approach including hospital administrations, the national pathology registry [PALGA], and general practitioners led to the identification of 1162 patients with Crohn's disease [CD], 1663 with ul...
29 CitationsSource
#1Jihan Harki (EUR: Erasmus University Rotterdam)H-Index: 4
#2Yvonne VergouweH-Index: 34
Last. Eric T.T.L. TjwaH-Index: 13
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BACKGROUND: No golden diagnostic standard is available to diagnose chronic gastrointestinal ischemia (CGI). GOALS: We aimed to establish an accurate prediction model for CGI, based on clinical symptoms and radiologic evaluation of the amount of stenosis in the celiac artery (CA) and superior mesenteric artery (SMA) by means of computed tomography-angiography or magnetic resonance (MR)-angiography. STUDY: We prospectively included 436 consecutive patients with clinical suspicion of CGI in a terti...
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Abstract Acute mesenteric ischemia (AMI) is generally thought to be a rare disease, but in fact, it is more common cause of acute abdomen than appendicitis or ruptured abdominal aortic aneurysm in patients over 75 years of age. In occlusive AMI, surgical treatment without revascularization is associated with as high as 80% overall mortality. It has been shown that early diagnosis with contrast-enhanced computed tomography and revascularization can reduce the overall mortality in AMI by up to 50%...
55 CitationsSource
#1Erinn N. Kim (UCSF: University of California, San Francisco)H-Index: 2
#2Kathleen M. Lamb (Thomas Jefferson University)H-Index: 9
Last. Joshua EisenbergH-Index: 8
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Importance Median arcuate ligament (MAL) syndrome is a rare disease resulting from compression of the celiac axis by fibrous attachments of the diaphragmatic crura, the median arcuate ligament. Diagnostic workup and therapeutic intervention can be challenging. Objective To review the literature to define an algorithm for accurate diagnosis and successful treatment for patients with MAL syndrome. Evidence Review A search of PubMed (1995-September 28, 2015) was conducted, using the key terms media...
83 CitationsSource
#1Dominic P.J. Howard (University of Oxford)H-Index: 12
#2Amitava Banerjee (University of Oxford)H-Index: 58
Last. Peter M. Rothwell (University of Oxford)H-Index: 146
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Background Contemporary population-based data on age-specific incidence and outcome from acute abdominal aortic aneurysm (AAA) events are needed to understand the impact of risk factor modification and demographic change, and to inform AAA screening policy. Methods In a prospective population-based study (Oxfordshire, UK, 2002–2014), event rates, incidence, early case fatality and long-term outcome from all acute AAA events were determined, both overall and in relation to the four main risk fact...
50 CitationsSource
Objectives Both open surgery (OS) and endovascular surgery (ES) have been proposed for the treatment of symptomatic chronic mesenteric ischaemia (CMI). OS was considered the gold standard but ES is increasingly proposed as the first option. The aim was to report long-term outcomes associated with OS in patients suffering CMI in the modern era in order to help in choose between the two techniques. Materials and methods A retrospective single centre analysis of all consecutive digestive artery rev...
23 CitationsSource
#1Juan Carlos Jimenez (UCLA: University of California, Los Angeles)H-Index: 16
#2Michael P. Harlander-Locke (UCLA: University of California, Los Angeles)H-Index: 17
Last. Erik Dutson (UCLA: University of California, Los Angeles)H-Index: 28
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Background Median arcuate ligament syndrome (MALS) is a syndrome associated with chronic abdominal pain and radiographic evidence of celiac artery compression. We compared the evidence for both open and laparoscopic treatment of patients with MALS. Methods We reviewed the English-language literature between 1963 and 2012. Presenting symptoms, clinical improvement, operative details, and intraoperative and postoperative complications were noted. Results A total of 400 patients underwent surgical ...
86 CitationsSource
Cited By3
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#1Sergio MoralH-Index: 10
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Last. Arturo EvangelistaH-Index: 61
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#1Luke G. Terlouw (EUR: Erasmus University Rotterdam)H-Index: 2
Last. Marco J. Bruno (EUR: Erasmus University Rotterdam)H-Index: 67
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BACKGROUND The mesenteric artery calcium score (MACS) identifies patients with possible chronic mesenteric ischaemia (CMI) using standard computed tomography (CT) imaging. The MACS does not necessitate a dedicated computed tomography angiography (CTA) which is required for evaluation of mesenteric artery patency. This study aimed to test the use of a symptom and MACS based score chart to facilitate the selection of patients with a low probability of CMI, in whom further diagnostic workup can be ...
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#1Luke G. Terlouw (EUR: Erasmus University Rotterdam)H-Index: 2
Last. Adriaan Moelker (EUR: Erasmus University Rotterdam)H-Index: 27
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A practical screening tool for chronic mesenteric ischemia (CMI) could facilitate early recognition and reduce undertreatment and diagnostic delay. This study explored the ability to discriminate CMI from non-CMI patients with a mesenteric artery calcium score (MACS). This retrospective study included CTAs of consecutive patients with suspected CMI in a tertiary referral center between April 2016 and October 2019. A custom-built software module, using the Agatston definition, was developed and u...
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