Nonatherosclerotic vascular causes of acute abdominal pain - 25/04/18

Doi : 10.1016/j.amjsurg.2017.12.019

Gregory J. Landry ^⁎ , Alla Yarmosh, Timothy K. Liem, Enjae Jung, Amir F. Azarbal, Cherrie Z. Abraham, Erica L. Mitchell, Gregory L. Moneta
Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, OP11, Portland, OR 97239-3098, USA

^∗Corresponding author.

Abstract

Background

To examine the epidemiology, treatments, and outcomes of acute symptomatic non-atherosclerotic mesenteric vascular disease.

Methods

Subjects were reviewed over a six year period. Categories included embolism (EM), dissection (DI), and aneurysm (AN). Presentation, demographics, treatment and outcomes were compared.

Results

46 patients were identified (EM:20, AN:15, DI:11). Age at presentation differed (EM: 66.3, AN 62.4, DI 54.6, p < .05). EM more likely affected the superior mesenteric artery (EM80%, AN20%, DI45%, p = .002), DI hepatic artery (EM20%, AN13%, DI55%, p < .05), and AN mesenteric branches (EM5%, AN47%, DI0%; p = .001). EM more likely had history of arrhythmia (EM40%, AN7%, DI0%, p,0.05) and diarrhea (EM30%, AN7%, DI0%, p < .05). Treatment was most often surgical in EM (EM85%, AN33%, DI9%, p < .001), endovascular in AN (EM5%, AN40%, DI 9%, p < .02), and conservative in DI (EM15%, AN 33%, DI82%, p < .05). In hospital mortality was infrequent (EM10%, AN7%, DI0%, p = ns). Mean hospital length of stay differed by mechanism (EM13.6days, AN9.2, DI2.3, p = .005). Median follow up was 61 months. Survival at 1, 3 and 5 years for emboli was 75%, 70% and 59%, for aneurysms 93%, 86%, and 77%, and for dissections 100% at all time points (p = .043 log rank).

Conclusions

Patients with EM, AN, and DI differ in age, anatomic distribution and method of treatment. The etiology significantly affects long term survival.

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Highlights

•	Acute abdominal pain can be caused arterial emboli, aneurysms and dissections.
•	Emboli are more often associated with arrhythmias and dissections occur in younger patientsn.
•	Emboli are common in the superior mesentericartery, aneurysms in mesenteric branches and dissection in the celiac artery.
•	Long term survival is best for dissections, worst for emboli.

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