title: Symptomatic mesenteric atherosclerotic disease-lessons learned from the diagnostic workup.
abstract: OBJECTIVE
  This study aims to analyze the diagnostic workup in patients referred for endovascular mesenteric revascularization for symptomatic mesenteric atherosclerotic disease.
  
  
  METHODS
  Fifty-five patients were identified between 2006 and 2011. Median follow-up time was 24 months.
  
  
  RESULTS
  Median age was 71 years, 67 % were women. Forty patients had acute on chronic mesenteric ischemia, eight had acute mesenteric ischemia, and seven had chronic mesenteric ischemia. Other manifestations of atherosclerotic disease were present in 71 %. Body mass index (BMI) <20 kg/m(2) was found in 37 %. Endoscopy diagnosed duodenitis (38 %; 13/34) and colitis in the right colon (57 %;12/21). All ulcers tested for Helicobacter pylori were negative (n = 17). Patients received proton pump inhibitor, antibiotic, and cortisone therapy during diagnostic workup in 73, 42, and 29 % of the cases, respectively. Previous hospitalization for the same complaints had occurred in 78 %. CT angiography showed occlusion (n = 30) and high-grade stenosis (n = 25) of the superior mesenteric artery (SMA). Forty-eight patients were treated with stenting of the SMA. The BMI increased in both women (p = 0.001) and men (p = 0.03) after endovascular therapy. The in-hospital mortality rate was 18 %.
  
  
  CONCLUSIONS
  Patients with abdominal pain, known atherosclerotic disease, right-sided colitis or H. pylori-negative duodenitis should undergo CT angiography immediately to be able to identify symptomatic mesenteric atherosclerotic disease.
authors: Vascular Center, Malmö, Skåne University Hospital, 205 02, Malmö, Sweden.
authors: Steinarr
authors: S
authors: Björnsson
authors: Timothy
authors: T
authors: Resch
authors: Stefan
authors: S
authors: Acosta
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D050197:Atherosclerosis / Q000175:diagnosis* / Q000628:therapy; D015415:Biomarkers / Q000032:analysis; D015992:Body Mass Index; D015897:Comorbidity; D003348:Cortisone / Q000627:therapeutic use; D004724:Endoscopy; D057510:Endovascular Procedures; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D017052:Hospital Mortality; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007511:Ischemia / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D065666:Mesenteric Ischemia; D008875:Middle Aged; D016016:Proportional Hazards Models; D018709:Statistics, Nonparametric; D015607:Stents; D014057:Tomography, X-Ray Computed; D014652:Vascular Diseases / Q000175:diagnosis* / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D005938:Glucocorticoids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D003348:Cortisone