Epidemiology of Mesenteric Vascular Disease: Clinical Implications
Epidemiology of Mesenteric Vascular Disease: Clinical Implications
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DOI：
10.1053/j.semvascsurg.2009.12.001
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发表时间：
2010-03-01
影响因子：
2.5
通讯作者：
Acosta, Stefan
中科院分区：
文献类型：
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作者：
Acosta, Stefan
在1970年至1982年期间，瑞典马尔莫人群中尸检或手术诊断的急性肠系膜缺血的总发病率估计为12.9/100，000人-年。尸检率为87%。急性上级肠系膜动脉（SMA）闭塞（栓子/血栓比= 1.4）、肠系膜静脉血栓形成（MVT）和非闭塞性肠系膜缺血（NOMI）分别约为68%、16%和16%。发现急性SMA闭塞比破裂的腹主动脉瘤更常见。发病率随着年龄的增长呈指数级增长，在调整人口的年龄和性别后，男女发病率平均分布。血栓性闭塞比栓塞性闭塞位于更近端，肠梗死更广泛，而栓塞患者急性心肌梗死的发生率更高，48%的患者有心脏血栓，68%的患者有同步栓塞。据报道，在急性血栓性闭塞发作之前，有慢性肠系膜缺血固有症状的患者比例为73%。心力衰竭、房颤病史和近期手术均与致死性NOMI相关。MVT由血栓形成倾向、直接损伤或局部静脉充血或淤滞引起。多探测器行计算机断层扫描，静脉造影剂增强和动脉期成像怀疑急性SMA闭塞和静脉期成像MVT已成为首选的诊断方法。NOMI的住院死亡率最高，急性SMA闭塞的住院死亡率较低，MVT的住院死亡率最低，约为20%。Semin Vasc Surg 23：4-8（C）2010 Elsevier Inc. All rights reserved.
The overall incidence rate of acute mesenteric ischemia between 1970 and 1982, diagnosed at either autopsy or operation, in the population of Malmo, Sweden was estimated at 12.9/100,000 person-years. Autopsy rate was 87%. Acute superior mesenteric artery (SMA) occlusion (embolus/thrombus ratio = 1.4), mesenteric venous thrombosis (MVT), and nonocclusive mesenteric ischemia (NOMI) were found in approximately 68%, 16%, and 16%, respectively. Acute SMA occlusion was found to be more common than ruptured abdominal aortic aneurysms. The incidence increased exponentially with age, equally distributed among men and women after adjusting for age and gender in the population. Thrombotic occlusions were located more proximally than embolic occlusions and intestinal infarction was more extensive, whereas patients with embolus had a higher frequency of acute myocardial infarction, and had cardiac thrombi in 48% and synchronous emboli in 68% of the patients. The proportion of patients with symptoms inherent with chronic mesenteric ischemia prior to onset of acute thrombotic occlusion has been reported to occur in 73%. Cardiac failure, history of atrial fibrillation, and recent surgery have all been associated with fatal NOMI. MVT is either caused by thrombophilia, direct injury, or local venous congestion or stasis. Multidetector row computed tomography with intravenous contrast enhancement and imaging in the arterial phase for suspicion of acute SMA occlusion and imaging in the venous phase for MVT has become the diagnostic method of choice. In-hospital mortality is highest for NOMI, lower for acute SMA occlusion, and lowest, around 20%, for MVT. Semin Vasc Surg 23:4-8 (C) 2010 Elsevier Inc. All rights reserved.