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Preliminary study of D-dimer as a possible marker of acute bowel ischaemia
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
2001 In: Br J Surg, Vol. 88, 385 - 388 p.Article in journal (Refereed) Published
Place, publisher, year, edition, pages
2001. Vol. 88, 385 - 388 p.
Identifiers
URN: urn:nbn:se:uu:diva-91561OAI: oai:DiVA.org:uu-91561DiVA: diva2:164335
Available from: 2004-04-14 Created: 2004-04-14Bibliographically approved
In thesis
1. On Acute Thrombo-Embolic Occlusion of the Superior Mesenteric Artery
Open this publication in new window or tab >>On Acute Thrombo-Embolic Occlusion of the Superior Mesenteric Artery
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. 67 p.
Series
Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 0282-7476 ; 1337
Keyword
Surgery, acute thrombo-embolic occlusion, superior mesenteric artery, intestinal infarction, D-Dimer, intestinal revascularisation, population-based study, incidence, autopsy, Kirurgi
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-4147 (URN)91-554-5926-9 (ISBN)
Public defence
2004-05-08, Auditorium Minus, Museum Gustavianum, Uppsala, 13:00
Opponent
Supervisors
Available from: 2004-04-14 Created: 2004-04-14Bibliographically approved

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