Nonatherosclerotic vascular causes of acute abdominal pain

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Abstract

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.

Original languageEnglish (US)
JournalAmerican Journal of Surgery
DOIs
StateAccepted/In press - Jan 1 2018

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Acute Pain
Embolism
Abdominal Pain
Aneurysm
Blood Vessels
Dissection
Length of Stay
Superior Mesenteric Artery
Survival
Hepatic Artery
Age Distribution
Hospital Mortality
Vascular Diseases
Cardiac Arrhythmias
Diarrhea
Epidemiology
Demography
Therapeutics

ASJC Scopus subject areas

  • Surgery

Cite this

@article{4ba0764de62843a69fd85ae18e4a9379,
title = "Nonatherosclerotic vascular causes of acute abdominal pain",
abstract = "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.",
author = "Gregory Landry and Alla Yarmosh and Timothy Liem and Enjae Jung and Amir Azarbal and Cherrie Abraham and Erica Mitchell and Moneta, {Gregory (Greg)}",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.amjsurg.2017.12.019",
language = "English (US)",
journal = "American Journal of Surgery",
issn = "0002-9610",
publisher = "Elsevier Inc.",

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TY - JOUR

T1 - Nonatherosclerotic vascular causes of acute abdominal pain

AU - Landry, Gregory

AU - Yarmosh, Alla

AU - Liem, Timothy

AU - Jung, Enjae

AU - Azarbal, Amir

AU - Abraham, Cherrie

AU - Mitchell, Erica

AU - Moneta, Gregory (Greg)

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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.

AB - 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.

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U2 - 10.1016/j.amjsurg.2017.12.019

DO - 10.1016/j.amjsurg.2017.12.019

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