Atherosclerosis is associated with poorer outcome in non-occlusive mesenteric ischemia

Abstract

To evaluate whether abdominal atherosclerosis was associated with poorer outcome in a single-centre cohort of patients suffering from nonocclusive mesenteric ischemia (NOMI). Methods: From January 2009 to December 2019, 121 consecutive patients from the critical care unit who underwent laparotomy for suspected NOMI and with available unenhanced and contrast-enhanced CT were included. Clinical and biological data at the time of the CT scan were retrospectively extracted from medical charts and reviewed by a single radiologist. Unenhanced CT acquisitions were used to calculate calcium scores of the abdominal aorta, celiac trunk, superior mesenteric artery (SMA) and common iliac arteries according to the Agatston method. Univariate and multivariate analysis were performed. Results: Among the 121 patients with NOMI and calcium score calculation, only 4 patients had no aortic calcifications (3 %) and 32 had no superior mesenteric artery calcification (26 %). 35 patients (29 %) died within 24 h after the abdominal CT scan. Univariate analysis showed that a total abdominal calcium score greater than 15 000 (last quartile) was significantly associated with death within 24 h (14 (40 %) vs 17 (20 %) patients, p = 0.035). By multivariate analysis, a total abdominal calcium score greater than 15 000 was an independent risk factor for death (HR = 1.94,, p = 0.044). Regarding separate calcium scores, only a SMA calcium score greater than 50 was a risk factor for death (HR 2.46,, p = 0.019). Conclusion:Our results show that abdominal atherosclerosis, especially in the SMA, is associated with poorer outcome in NOMI.

Mesenteric Ischemia After Cardiac Surgery in Dialysis Patients: An Overlooked Risk Factor

“…Association of calcification score with postoperative NOMI: Although the SMA scores were not different, this study showed that the CA and CA + SMA scores were significantly higher in the NOMI group. By contrast, Juif et al reported that abdominal atherosclerosis, especially in the SMA, is associated with poorer outcomes in NOMI [Juif 2021]. Majority of the blood flow for the mesentery is supplied by the SMA; thus, our findings should carefully be interpreted.…”

“…Evaluation method of CA/SMA orifice calcification: We used a CT-based scoring system, examined the calcification of the orifices of abdominal blood vessels (CA and SMA), and applied a three-level ordinal scale. By contrast, Juif et al measured calcifications of the aorta, CA, SMA, and iliac artery in NOMI using the Agatston method, which generally is used in the quantitative assessment of coronary artery calcification [Juif 2021;Agatston 1990]. Moreover, Terlouw et al reported abdominal artery calcification scoring using the Agatston definition for chronic mesenteric ischemia.…”

“…Furthermore, CT-based calcification scoring was performed by surgeons, and the evaluation was based on an interval scale. The results might have been different if the analysis had been performed using a well-established method to quantify calcification, such as the Agatston definition [Juif 2021;]. Nevertheless, we consider that the methods for preoperative risk assessment should be simple and easy to use in daily clinical practice.…”

“…Generally, vascular calcification, including aortic calcification, is highly prevalent in hemodialysis patients, and mineral metabolism disorders have been reported as risk factors for vascular calcification [Chertow 2004;Davies 2001;Taniwaki 2005]. Moreover, severe atherosclerosis with calcification at the celiac artery (CA) and the superior mesenteric artery (SMA) was a known risk factor for developing NOMI [Guillaume 2017;Acosta 2006;Juif 2021]. Few studies have focused on the relationship between mesenteric artery calcium and chronic mesenteric ischemia in non-cardiac surgical patients ; however, patients undergoing cardiac surgery would have different risk profiles from those of the general population.…”

Abdominal atherosclerosis is not a risk factor of nonocclusive mesenteric ischemia among critically ill patients: a propensity matching study

“…CT also allow quantification of atheroma by detecting vascular calcifications which has been extensively studied in the coronary arteries [ 17 , 18 ] by the Agatston method. However, quantification of calcification is not only possible on coronary arteries but on all arteries, and thus on arteries that supply blood to the gut [ 19 ].…”