The Incidence of Chronic Mesenteric Ischemia in the Well-Defined Region of a Dutch Mesenteric Ischemia Expert Center

Abstract

INTRODUCTION: This study aimed to determine the incidence of chronic mesenteric ischemia (CMI) and to examine the influence of the etiological cause, location, and severity of a mesenteric artery stenosis on the probability of having CMI. METHODS: A prospective database, containing the details of all patients with suspected CMI referred to a renowned CMI expert center, was used. Patients residing within the expert centers' well-defined region, between January 2014 and October 2019, were included. CMI was diagnosed when patients experienced sustained symptom improvement after treatment. RESULTS: This study included 358 patients, 75 had a ≥50% atherosclerotic stenosis of 1 vessel (CMI 16%), 96 of 2 or 3 vessels (CMI 81%), 81 celiac artery compression (CMI 25%), and 84 no stenosis (CMI 12%). In total, 138 patients were diagnosed with CMI, rendering a mean incidence of 9.2 (95% confidence interval [CI] 6.2–13.7) per 100,000 inhabitants. Atherosclerotic CMI was most common, with a mean incidence of 7.2 (95% CI 4.6–11.3), followed by median arcuate ligament syndrome 1.3 (95% CI 0.5–3.6) and chronic nonocclusive mesenteric ischemia 0.6 (95% CI 0.2–2.6). The incidence of CMI was highest in female patients (female patients 12.0 [95% CI 7.3–19.6] vs male patients 6.5 [95% CI 3.4–12.5]) and increased with age. CMI was more prevalent in the presence of a ≥70% atherosclerotic single-vessel stenosis of the superior mesenteric artery (40.6%) than the celiac artery (5.6%). DISCUSSION: The incidence of CMI is higher than previously believed and increases with age. Probability of CMI seems highest in suspected CMI patients with multivessel disease or a ≥70% atherosclerotic single-vessel superior mesenteric artery stenosis.

Early risk stratification of patients with suspected chronic mesenteric ischaemia using a symptom and mesenteric artery calcium score based score chart

“…The prevalence of mesenteric artery stenosis is 6%–29% and increases with age to up to 67% in persons older than 80 years of age 2 . The incidence of CMI is substantial (9.2 per 100,000) and also increases with age (≥80 years 44.3 per 100,000) 4 . The difference in prevalence of mesenteric artery stenosis and incidence of CMI is at least partly explained by the compensatory capacity of the extensive collateral mesenteric circulation 5 .…”

Mesenteric artery calcium scoring: a potential screening method for chronic mesenteric ischemia

“…A sample size of 13 CTAs would suffice for assessment of the intraclass correlation coefficient (ICC), when comparing results of two observers, while using an alpha of 0.05 and a beta of 0.1 [ 18 ]. However, an atherosclerotic stenosis is observed in approximately 43–53% of patients [ 5 , 7 ]. The required sample size of 13 CTAs was tripled to 39 CTAs in order to include sufficient CTAs with calcified lesions, since interobserver variability is expected to be greater when scoring CTAs with calcifications.…”

“…European experts agree that CMI still remains an underdiagnosed and undertreated disease, which is mainly caused by a lack of knowledge and awareness among physicians [ 8 ]. This observation is supported by a substantial diagnostic delay of approximately 6 months after onset of complaints [ 5 , 9 ].…”

“…When left untreated, CMI has been reported to progress to acute mesenteric ischemia in 26–67% of patients [ 3 , 4 ]. A recent study reported an overall annual CMI incidence of 9.2 per 100,000 inhabitants [ 5 ]. As previously shown, this study also reported atherosclerotic CMI (7.3 per 100,000) to be the greatest contributor to the overall incidence [ 5 – 7 ].…”

“…A recent study reported an overall annual CMI incidence of 9.2 per 100,000 inhabitants [ 5 ]. As previously shown, this study also reported atherosclerotic CMI (7.3 per 100,000) to be the greatest contributor to the overall incidence [ 5 – 7 ]. The incidence of atherosclerotic CMI showed a rising trend over the study period, suggesting that atherosclerotic CMI is an upcoming health issue.…”