Clinical implications of chronic mesenteric ischemia in elderly and senile patients

Abstract

Aim.To evaluate the sensitivity and specificity of the clinical criteria for the diagnosis of chronic mesenteric ischemia in elderly and senile patients with mesenteric atherosclerosis.
 Materials and methods.The study included 142 patients (82 men and 60 women). The median age of patients is 66.0 [62.0; 72.0] years.
 Results.According to MDCT atherosclerotic lesions of the abdominal aorta and its unpaired visceral branches were diagnosed in 105 (73.9%) patients. A combination of atherosclerosis of the celiac trunk and the superior mesenteric artery with the presence of hemodynamically insignificant stenosis was revealed. Hemodynamically significant atherosclerotic narrowing of at least one mesenteric artery was present in 15% of cases. Among them, a single vascular lesion was found in 6 patients (4.2%), a combination of hemodynamically significant lesions of two arteries in 15 (11%) patients. Depending on the clinical manifestations, all patients are divided into two groups: the first group 30 (21.1%) patients with the presence of symptoms characteristic of chronic mesenteric ischemia (CMI). The second group consisted of 112 (78.8%) patients without a characteristic triad of symptoms. The clinical symptom complex of СMI, including postprandial abdominal pain, intestinal dysfunction and progressive weight loss, as a diagnostic criterion showed low sensitivity 13.3% and specificity 77.9%. At the same time, the sensitivity of such a clinical combination as a combination of atherosclerosis of the arteries of the lower extremities, weight loss and abdominal pain syndrome with a severity of more than 5.5 points, with respect to the detection of hemodynamically significant stenoses of two or more mesenteric arteries was sensitivity 86.7%, specificity 74.0%.

Atherosclerosis of unpaired visceral branches of the abdominal aorta (clinical and instrumental diagnostics)

“…Диапазон морфологических изменений, возникающих при ишемических поражениях органов пищеварения очень широк: от дистрофических изменений в органах и тканях до выраженных деструктивных поражений (эрозий и язвенных дефектов слизистой) и тяжелых осложнений типа некротических изменений, желудочно-кишечных кровотечений [10][11][12][13][14]. Прямых патоморфологических доказательств связи ишемии с наличием эрозивно-язвенного поражения желудка и луковицы двенадцатиперстной кишки, и развитием кровотечений, немного [15,16,17].…”