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On Acute Thrombo-Embolic Occlusion of the Superior Mesenteric Artery
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Acute thrombo-embolic occlusion of the superior mesenteric artery (SMA) with intestinal infarction is a lethal disease, difficult to diagnose in time, with unknown incidence and cause-specific mortality. The aim of this thesis was to characterize the disease and to develop diagnostic methods.

Two laboratory studies were conducted on patients with suspected acute SMA occlusion. A pilot-study showed that the fibrinolytic marker D-dimer was elevated in six patients with the disease. In the subsequent study including 101 patients, D-dimer was the only elevated coagulation marker in nine patients with the disease. In a prospective study 24 patients (median age 84 years) were identified, of whom four were diagnosed at autopsy, despite an autopsy-rate of 10%. One-fourth were initially nursed in non-surgical wards. Length of the intestinal infarction was a predictor for death. An analysis of patients from the three studies showed that D-Dimer was elevated in all 16 tested patients with the disease.

Sixty patients with acute SMA occlusion underwent intestinal revascularisation and were registered in the Swedish Vascular Registry (SWEDVASC). One-year survival-rate was 40%. Previous vascular surgery was a negative risk-factor.

A population-based study was conducted in Malmö, based on an autopsy-rate of 87%. Among 270 patients with the disease, 2/3 were diagnosed only at autopsy and 1/2 were managed in non-surgical wards. The incidence was 8.6 per 100000 person years. The age-standardized incidence increased exponentially without gender differences. The diagnosis was the cause of death in 1.2% among octogenarians and beyond. Thrombotic occlusions were located proximally within the SMA and associated with extensive intestinal infarctions. Synchronous embolism, often multiple, occurred in 2/3 of the patients with embolic occlusions.

Conclusions: A normal D-dimer at presentation most likely excludes the diagnosis. Acute SMA occlusion was more frequent than previously estimated from clinical series. The patients were often nursed in non-surgical wards.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2004. , p. 67
Series
Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 0282-7476 ; 1337
Keywords [en]
Surgery, acute thrombo-embolic occlusion, superior mesenteric artery, intestinal infarction, D-Dimer, intestinal revascularisation, population-based study, incidence, autopsy
Keywords [sv]
Kirurgi
National Category
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-4147ISBN: 91-554-5926-9 (print)OAI: oai:DiVA.org:uu-4147DiVA, id: diva2:164341
Public defence
2004-05-08, Auditorium Minus, Museum Gustavianum, Uppsala, 13:00
Opponent
Supervisors
Available from: 2004-04-14 Created: 2004-04-14Bibliographically approved
List of papers
1. Preliminary study of D-dimer as a possible marker of acute bowel ischaemia
Open this publication in new window or tab >>Preliminary study of D-dimer as a possible marker of acute bowel ischaemia
2001 In: Br J Surg, Vol. 88, p. 385 - 388Article in journal (Refereed) Published
Identifiers
urn:nbn:se:uu:diva-91561 (URN)
Available from: 2004-04-14 Created: 2004-04-14Bibliographically approved
2. D-dimer testing in patients with suspected acute thromboembolic occlusion of the superior mesenteric artery
Open this publication in new window or tab >>D-dimer testing in patients with suspected acute thromboembolic occlusion of the superior mesenteric artery
2004 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 91, no 8, p. 991-994Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

There is no accurate non-invasive method available for the diagnosis of acute thromboembolic occlusion of the superior mesenteric artery (SMA). The aim of this study was to assess the diagnostic properties of the fibrinolytic marker D-dimer.

METHODS:

From September 2000 to April 2003 consecutive patients aged over 50 years admitted to hospital with acute abdominal pain were studied. Patients with possible acute SMA occlusion at presentation had blood samples taken within 24 h of the onset of the pain for analysis of D-dimer, plasma fibrinogen, activated partial thromboplastin time, prothrombin time and antithrombin. The value of D-dimer testing to diagnose SMA occlusion was assessed by means of likelihood ratios.

RESULTS:

Nine of 101 patients included had acute SMA occlusion. The median D-dimer concentration was 1.6 (range 0.4-5.6) mg/l, which was higher than that in 25 patients with inflammatory disease (P = 0.007) or in 14 patients with intestinal obstruction (P = 0.005). The combination of a D-dimer level greater than 1.5 mg/l, atrial fibrillation and female sex resulted in a likelihood ratio for acute SMA occlusion of 17.5, whereas no patient with a D-dimer concentration of 0.3 mg/l or less had acute SMA occlusion.

CONCLUSION:

D-dimer testing may be useful for the exclusion of patients with suspected acute SMA occlusion.

Keywords
Abdominal Pain/*etiology, Aged, Aged; 80 and over, Female, Fibrin Fibrinogen Degradation Products/*analysis, Humans, Male, Mesenteric Artery; Superior, Mesenteric Vascular Occlusion/*diagnosis, Middle Aged, Sensitivity and Specificity, Thromboembolism/*diagnosis
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-91562 (URN)10.1002/bjs.4645 (DOI)15286959 (PubMedID)
Available from: 2004-04-14 Created: 2004-04-14 Last updated: 2017-12-14Bibliographically approved
3. Acute thrombo-embolic occlusion of the superior mesenteric artery: A prospective study in a well defined population
Open this publication in new window or tab >>Acute thrombo-embolic occlusion of the superior mesenteric artery: A prospective study in a well defined population
2003 In: Eur J Vasc Endovasc Surg, Vol. 26, p. 179-183Article in journal (Refereed) Published
Identifiers
urn:nbn:se:uu:diva-91563 (URN)
Available from: 2004-04-14 Created: 2004-04-14Bibliographically approved
4. Revascularization of the superior mesenteric artery after acute thromboembolic occlusion
Open this publication in new window or tab >>Revascularization of the superior mesenteric artery after acute thromboembolic occlusion
Show others...
2002 In: Br J Surg, Vol. 89, p. 923-927Article in journal (Refereed) Published
Identifiers
urn:nbn:se:uu:diva-91564 (URN)
Available from: 2004-04-14 Created: 2004-04-14Bibliographically approved
5. Incidence of acute thrombo-embolic occlusion of the superior mesenteric artery - a population-based study
Open this publication in new window or tab >>Incidence of acute thrombo-embolic occlusion of the superior mesenteric artery - a population-based study
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2004 In: Eur J Vasc Endovasc Surg, Vol. 27, p. 145 - 150Article in journal (Refereed) Published
Identifiers
urn:nbn:se:uu:diva-91565 (URN)
Available from: 2004-04-14 Created: 2004-04-14Bibliographically approved
6. Autopsy findings in 213 patients with fatal acute thrombo-embolic occlusion of the superior mesenteric artery
Open this publication in new window or tab >>Autopsy findings in 213 patients with fatal acute thrombo-embolic occlusion of the superior mesenteric artery
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(English)Article in journal (Refereed) Submitted
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-91566 (URN)
Available from: 2004-04-14 Created: 2004-04-14 Last updated: 2013-08-14Bibliographically approved

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