Overall survival of patients with Chronic Mesenteric Ischemia

Wong, C.K. (Chung Kwan) (2016) Overall survival of patients with Chronic Mesenteric Ischemia. thesis, Medicine.

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Abstract

Background: Chronic Mesenteric Ischemia (CMI) is uncommon in daily practice. It is mainly caused by progressive atherosclerotic stenosis. The clinical presentation is typically postprandial pain and weight loss caused by fear for eating. In Medisch Spectrum Twente (MST), diagnostics are standardized and consists of 1) clinical history, 2) vascular imaging and 3) functional test (tonometry). MST is a nation-wide referral center for diagnostics and treatment of patients suspected with mesenteric ischemia. The workup is carried out by a specialized workgroup consisting of a vascular surgeon, radiologist and gastroenterologist. All relevant clinical data are registered since the working group was founded in 1997. Several differences have been observed between patients with 1-vessel and multi-vessel disease. Patients with multi-vessel disease have complaints that fits with ischemia while this is less in patients with 1-vessel disease. The clinical experience suggests that survival is much worse in multi-vessel disease. However, evidence of survival in CMI patients and differences of this between 1-vessel and multi-vessel are lacking. Understanding the clinical course in terms of survival is important in order to decide whether preventing stenting is indicated in patients with multi-vessel disease. The aim of this study was to investigate the survival in patients with 1-vessel and multi-vessel CMI. Causes and predictive factors of death were also investigated. Methods: All relevant data were acquired from the ischemia database and derived from the medical records when needed. Patients were checked whether they were alive in the Netherlands municipal personal records database. General practitioners or other physicians where contacted for causes of death when needed. For analysis, groups were classified as: 1-vessel (C1), 2-vessel (C2) and 3-vessel (C3) CMI. Survival analysis is performed with the Kaplan-Meier estimate. Differences between these groups in clinical presentation and comorbidities were tested with χ2-test. Results: A total of 3192 were referred within the period of January 1997 - August 2016. CMI was diagnosed in 791 patients. The distribution of these were 23.8% C1, 53.6% C2 and 22.6% C3. The mean age (range) in C1, C2 and C3 was 63 (18-90), 67 (29-93) and 69 (41-92) respectively. Patients with 3-vessel CMI had the most smokers, hypercholesterolemia, diabetes, hypertension and weight loss. Survival analysis showed a 5-year survival of 81% for C1, 64% for C2 and 60% for C3 (p < 0.001). The hazard ratio for death was 1.59 for C2 vs. C1 (p = 0.004) and 2.14 for C3 vs. C1 (p < 0.001). The independent predictive factors on survival were age, smoking and peripheral artery disease. After correcting for these, the mortality of C2 and C3 were still higher though the significance of the difference failed to sustain. In all the patients who died, 12% was due to mesenteric ischemia and all of them had 2- or 3-vessel CMI. Conclusion: one-vessel CMI had a better survival compared to multi-vessel CMI. This is in part associated with age and comorbidities. Smoking was the greatest predictive factor of death (HR 1.71). None of the patients with 1-vessel CMI died of mesenteric ischemia.

Item Type:	Thesis (Thesis)
Supervisor name:	Kolkman, Prof. dr. J.J. and gastro-enterologist and Department of gastro-enterology, Medisch Spectrum Twente
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:52
Last Modified:	25 Jun 2020 10:52
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1263

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