Symptomatic Mesenteric Atherosclerotic Disease—Lessons Learned from the Diagnostic Workup

Abstract

ObjectiveThis study aims to analyze the diagnostic workup in patients referred for endovascular mesenteric revascularization for symptomatic mesenteric atherosclerotic disease. Material and MethodsFifty-five patients were identified between 2006 and 2011. Median follow-up time was 24 months. ResultsMedian age was 71 years, 67 % were women. Forty patients had acute on chronic mesenteric ischemia, eight had acute mesenteric ischemia, and seven had chronic mesenteric ischemia. Other manifestations of atherosclerotic disease were present in 71 %. Body mass index (BMI) <20 kg/m2 was found in 37 %. Endoscopy diagnosed duodenitis (38 %; 13/34) and colitis in the right colon (57 %;12/21). All ulcers tested for Helicobacter pylori were negative (n = 17). Patients received proton pump inhibitor, antibiotic, and cortisone therapy during diagnostic workup in 73, 42, and 29 % of the cases, respectively. Previous hospitalization for the same complaints had occurred in 78 %. CT angiography showed occlusion (n = 30) and high-grade stenosis (n = 25) of the superior mesenteric artery (SMA). Forty-eight patients were treated with stenting of the SMA. The BMI increased in both women (p = 0.001) and men (p = 0.03) after endovascular therapy. The in-hospital mortality rate was 18 %. ConclusionPatients with abdominal pain, known atherosclerotic disease, right-sided colitis or H. pylori-negative duodenitis should undergo CT angiography immediately to be able to identify symptomatic mesenteric atherosclerotic disease.