Nonatherosclerotic vascular causes of acute abdominal pain - 25/04/18
, Alla Yarmosh, Timothy K. Liem, Enjae Jung, Amir F. Azarbal, Cherrie Z. Abraham, Erica L. Mitchell, Gregory L. MonetaAbstract |
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.
El texto completo de este artículo está disponible en PDF.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. |
Esquema
Vol 215 - N° 5
P. 838-841 - mai 2018 Regresar al número
Artículo precedente
- Discussion of “Evaluation of a novel thoracic entry device versus needle decompression in a tension pneumothorax swine model”
- Frederic J. Cole
- Discussion of “Nonatherosclerotic vascular causes of acute abdominal pain”
- James P. Dolan
Bienvenido a EM-consulte, la referencia de los profesionales de la salud.
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