Nonatherosclerotic vascular causes of acute abdominal pain

Background: To examine the epidemiology, treatments, and outcomes of acute symptomatic non-atherosclerotic mesenteric vascular disease. Methods: Subjects were reviewed over a six year period. Categories included embolism (EM), dissection (DI), and aneurysm (AN). Presentation, demographics, treatment and outcomes were compared. Results: 46 patients were identified (EM:20, AN:15, DI:11). Age at presentation differed (EM: 66.3, AN 62.4, DI 54.6, p <.05). EM more likely affected the superior mesenteric artery (EM80%, AN20%, DI45%, p =.002), DI hepatic artery (EM20%, AN13%, DI55%, p <.05), and AN mesenteric branches (EM5%, AN47%, DI0%; p =.001). EM more likely had history of arrhythmia (EM40%, AN7%, DI0%, p,0.05) and diarrhea (EM30%, AN7%, DI0%, p <.05). Treatment was most often surgical in EM (EM85%, AN33%, DI9%, p <.001), endovascular in AN (EM5%, AN40%, DI 9%, p <.02), and conservative in DI (EM15%, AN 33%, DI82%, p <.05). In hospital mortality was infrequent (EM10%, AN7%, DI0%, p = ns). Mean hospital length of stay differed by mechanism (EM13.6days, AN9.2, DI2.3, p =.005). Median follow up was 61 months. Survival at 1, 3 and 5 years for emboli was 75%, 70% and 59%, for aneurysms 93%, 86%, and 77%, and for dissections 100% at all time points (p =.043 log rank). Conclusions: Patients with EM, AN, and DI differ in age, anatomic distribution and method of treatment. The etiology significantly affects long term survival.