A simple but useful method of screening for mesenteric ischemia secondary to acute aortic dissection.
BACKGROUND
In spite of recent improvements in treatment for acute aortic dissection, mesenteric ischemia secondary to aortic dissection is still challenging. We propose a simple screening method to detect mesenteric ischemia secondary to acute aortic dissection.


METHODS
From 1991 to 2002, 245 patients with acute aortic dissection were admitted to our hospital. Nine (3.7%) of those were complicated with mesenteric ischemia. The clinical records of those 9 patients were retrospectively analyzed. The ratios of the diameter of the superior mesenteric vein (SMV) to that of the superior mesenteric artery (SMA) were calculated in patients with mesenteric ischemia (group M) and in patients without mesenteric ischemia (group C). Blood test data, including results of arterial blood gas analysis, in the 2 groups were also compared.


RESULTS
The SMV/SMA ratios in groups M and C were 1.16 +/- 0.33 and 1.78 +/- 0.29, respectively (P=.003). A cutoff value of the SMV/SMA ratio was 1.5 (sensitivity, 88.9%; specificity, 88.9%) with an odds ratio of 64.0. Although there were differences between the 2 groups in glutamate oxaloacetate transaminase, lactate dehydrogenase, creatine phosphate kinase, pH, and lactate values, the measurement of lactate was especially useful (P=.002).


CONCLUSIONS
The combination of the SMV/SMA ratio and lactate concentration is a useful screening method to detect mesenteric ischemia secondary to acute aortic dissection.
Kurimoto
Yoshihiko
Y
Department of Traumatology and Critical Care Medicine, Sapporo Medical University, Sapporo, Japan.
Morishita
Kiyofumi
K
Fukada
Johji
J
Kawaharada
Nobuyoshi
N
Komatsu
Kanshi
K
Yama
Naoya
N
Asai
Yasufumi
Y
Abe
Tomio
T
D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000000981:diagnostic imaging*; D001014:Aortic Aneurysm / Q000150:complications / Q000000981:diagnostic imaging*; D001837:Body Weights and Measures; D005260:Female; D006801:Humans; D007511:Ischemia / Q000097:blood / Q000000981:diagnostic imaging* / Q000209:etiology; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008403:Mass Screening / Q000379:methods; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging; D008642:Mesenteric Veins / Q000000981:diagnostic imaging; D008643:Mesentery / Q000098:blood supply*; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
D019344:Lactic Acid