Epidemiology of mesenteric vascular disease: clinical implications.
TL;DR: In-hospital mortality is highest for NOMI, lower for acute SMA occlusion, and lowest, around 20%, for MVT, whereas patients with embolus had a higher frequency of acute myocardial infarction, and had cardiac thrombi and synchronous emboli in 68% of the patients.
About: This article is published in Seminars in Vascular Surgery.The article was published on 2010-03-01. It has received 232 citations till now. The article focuses on the topics: Superior mesenteric artery & Embolus.
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TL;DR: This study demonstrates that ferroptosis is closely associated with intestinal I/R injury, and that ACSL4 has a critical role in this lethal process, and suggests a unique and effective mechanistic approach for intestinal I-R injury prevention and treatment.
Abstract: Ferroptosis is a recently identified form of regulated cell death defined by the iron-dependent accumulation of lipid reactive oxygen species. Ferroptosis has been studied in various diseases such as cancer, Parkinson’s disease, and stroke. However, the exact function and mechanism of ferroptosis in ischemia/reperfusion (I/R) injury, especially in the intestine, remains unknown. Considering the unique conditions required for ferroptosis, we hypothesize that ischemia promotes ferroptosis immediately after intestinal reperfusion. In contrast to conventional strategies employed in I/R studies, we focused on the ischemic phase. Here we verified ferroptosis by assessing proferroptotic changes after ischemia along with protein and lipid peroxidation levels during reperfusion. The inhibition of ferroptosis by liproxstatin-1 ameliorated I/R-induced intestinal injury. Acyl-CoA synthetase long-chain family member 4 (ACSL4), which is a key enzyme that regulates lipid composition, has been shown to contribute to the execution of ferroptosis, but its role in I/R needs clarification. In the present study, we used rosiglitazone (ROSI) and siRNA to inhibit ischemia/hypoxia-induced ACSL4 in vivo and in vitro. The results demonstrated that ACSL4 inhibition before reperfusion protected against ferroptosis and cell death. Further investigation revealed that special protein 1 (Sp1) was a crucial transcription factor that increased ACSL4 transcription by binding to the ACSL4 promoter region. Collectively, this study demonstrates that ferroptosis is closely associated with intestinal I/R injury, and that ACSL4 has a critical role in this lethal process. Sp1 is an important factor in promoting ACSL4 expression. These results suggest a unique and effective mechanistic approach for intestinal I/R injury prevention and treatment.
417 citations
TL;DR: These guidelines are dedicated to Paola De Rango, University of Perugia, Italy, who participated very actively in the process of developing these guidelines, in particular the important chapters on chronic arterial and venous mesenteric ischaemia.
329 citations
TL;DR: New guidelines for the management of acute mesenteric ischaemia are presented to provide recommendations for practice that will lead to improved outcomes for patients.
Abstract: Acute mesenteric ischaemia (AMI) accounts for about 1:1000 acute hospital admissions. Untreated, AMI will cause mesenteric infarction, intestinal necrosis, an overwhelming inflammatory response and death. Early intervention can halt and reverse this process leading to a full recovery, but the diagnosis of AMI is difficult and failure to recognize AMI before intestinal necrosis has developed is responsible for the high mortality of the disease. Early diagnosis and prompt treatment are the goals of modern therapy, but there are no randomized controlled trials to guide treatment and the published literature contains a high ratio of reviews to original data. Much of that data comes from case reports and often small, retrospective series with no clearly defined treatment criteria. A study group of the European Society for Trauma and Emergency Surgery (ESTES) was formed in 2013 with the aim of developing guidelines for the management of AMI. A comprehensive literature search was performed using the Medical Subject Heading (MeSH) thesaurus keywords “mesenteric ischaemia”, “bowel ischaemia” and “bowel infarction”. The bibliographies of relevant articles were screened for additional publications. After an initial systematic review of the literature by the whole group, a steering group formulated questions using a modified Delphi process. The evidence was then reviewed to answer these questions, and recommendations formulated and agreed by the whole group. The resultant recommendations are presented in this paper. The aim of these guidelines is to provide recommendations for practice that will lead to improved outcomes for patients.
220 citations
Cites background from "Epidemiology of mesenteric vascular..."
...The incidence increases exponentially with age and there appears to be an equal incidence in men and women after adjusting for age and gender in the population [5]....
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...Although mortality rates have declined over the past 50 years [5, 26] they remain unacceptably high at 50–69 % [6, 27–29]....
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...In studies comparing the four aetiological types of AMI, VAMI has the lowest mortality (11– 30 %) [5, 22, 30]....
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TL;DR: This review provides novel insight into the basic mechanisms of damaged intestinal microcirculation and covers therapeutic targets to attenuate intestinal I/R injury.
Abstract: Intestinal ischemia and reperfusion (I/R) is a challenging and life-threatening clinical problem with diverse causes. The delay in diagnosis and treatment contributes to the continued high in-hospital mortality rate. Experimental research during the last decades could demonstrate that microcirculatory dysfunctions are determinants for the manifestation and propagation of intestinal I/R injury. Key features are nutritive perfusion failure, inflammatory cell response, mediator surge and breakdown of the epithelial barrier function with bacterial translocation, and development of a systemic inflammatory response. This review provides novel insight into the basic mechanisms of damaged intestinal microcirculation and covers therapeutic targets to attenuate intestinal I/R injury. The opportunity now exists to apply this insight into the translation of experimental data to clinical trial-based research. Understanding the basic events triggered by intestinal I/R may offer new diagnostic and therapeutic options in order to achieve improved outcome of patients with intestinal I/R injury.
207 citations
Cites background from "Epidemiology of mesenteric vascular..."
...Acute mesenteric ischemia is not an isolated clinical entity but comprises a complex of diseases, including mesenteric arterial embolism, mesenteric venous thrombosis, and non-occlusive mesenteric ischemia [1, 4]....
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...Moreover, patients with history of congestive heart failure, cardiac arrhythmias, atherosclerosis, hypovolemia, or hypotension and sepsis, as well as patients with recent surgery, deep venous thromboses, arterial embolism, or collagen disease are all at risk of intestinal ischemia [1, 4]....
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01 Mar 2013
TL;DR: The pathogenesis of thrombosis of mesenteric veins, the diagnosis and differentiation from arterial ischemia, the emergence of the JAK2 (Janus kinase 2) sequence variation as a marker ofThrombophilia and myelodysplastic neoplasms, and new anticoagulants are discussed.
Abstract: The prevalence of mesenteric venous thrombosis has increased over the past 2 decades with the routine use of contrast-enhanced computed tomography (CT) in patients presenting with abdominal pain and those with portal hypertension. Concurrent with increasing recognition, routine and frequent use of anticoagulation has reduced the need for surgical intervention and improved outcome in these patients. Acute thrombosis often presents with abdominal pain, whereas chronic disease manifests either as an incidental finding on CT or with features of portal hypertension. Contrast-enhanced CT diagnoses about 90% of cases. The presence of collateral circulation and cavernoma around a chronically thrombosed vein differentiates chronic from acute disease. The superior mesenteric vein is often involved, whereas involvement of the inferior mesenteric vein is rare. Associated portal venous thrombosis can be seen if the disease originates in the major veins instead of the small vena rectae. Thrombophilia and local abdominal inflammatory conditions are common causes. Management is aimed at preventing bowel infarction and recurrent thrombosis. Anticoagulation, the mainstay of management, has also been safely used in patients with cirrhosis and portal hypertension. This review discusses the pathogenesis of thrombosis of mesenteric veins, the diagnosis and differentiation from arterial ischemia, the emergence of the JAK2 (Janus kinase 2) sequence variation as a marker of thrombophilia and myelodysplastic neoplasms, and new anticoagulants. Algorithms for the management of acute and chronic mesenteric venous thrombosis are provided to help readers understand and remember the approach to the management of acute and chronic mesenteric venous thrombosis.
180 citations
References
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536 citations
TL;DR: The contemporary management of AMI with revascularization with open surgical techniques, resection of nonviable bowel, and liberal use of second-look procedures results in the early survival of two thirds of the patients with embolism and thrombosis.
369 citations
TL;DR: The incidence of aneurysm rupture in the city of Malmö, Sweden from 1971 to 1986 was not low compared with other Scandinavian studies, but was low in comparison with studies from the United Kingdom.
365 citations
TL;DR: Epidemiological reports on risk and prognostic factors in patients with mesenteric venous thrombosis (MVT) are scarce and need to be reviewed for consistency.
Abstract: BACKGROUND:: Epidemiological reports on risk and prognostic factors in patients with mesenteric venous thrombosis (MVT) are scarce METHODS:: Patients with MVT were identified through the inpatient and autopsy registry between 2000 and 2006 at Malmo University Hospital RESULTS:: Fifty-one patients had MVT, diagnosed at autopsy in six The highest incidence (113 per 100 000 person-years) was in the age category 70-79 years Activated protein C resistance was present in 13 of 29 patients tested D-dimer at admission was raised in all five patients tested Multidetector row computed tomography (CT) in the portal venous phase was diagnostic in all 20 patients investigated, of whom 19 were managed conservatively The median length of resected bowel in 12 patients who had surgery was 06 (range 01-22) m The overall 30-day mortality rate was 20 per cent; intestinal infarction (P = 0046), treatment on a non-surgical ward (P = 0001) and CT not done (P = 0022) were associated with increased mortality Cancer was independently associated with long-term mortality: hazard ratio 403, 95 per cent confidence interval 103 to 1585; P = 0046 CONCLUSION:: Portal venous phase CT appeared sensitive in diagnosing MVT As activated protein C resistance was a strong risk factor, lifelong anticoagulation should be considered Copyright (c) 2008 British Journal of Surgery Society Ltd Published by John Wiley & Sons, Ltd
245 citations
TL;DR: There is a wide range (5–50 per 100 000) in the reported annual incidence of acute pancreatitis, and the predominant aetiology varies in different reports.
Abstract: BACKGROUND:
There is a wide range (5-50 per 100 000) in the reported annual incidence of acute pancreatitis. Furthermore, the predominant aetiology varies in different reports. This study was undertaken to establish the current incidence, aetiology and associated mortality rate in a defined population.
METHODS:
A retrospective study of all cases of acute pancreatitis admitted over a 10-year period to a single institution was performed. In addition the autopsy and forensic materials were reviewed.
RESULTS:
Altogether 883 attacks of acute pancreatitis were recorded, of which 547 were first attacks. The annual incidence of first attacks was 23.4 per 100 000. Including relapses, the incidence was 38.2 per 100 000. Biliary disease was the main aetiological factor in first attacks whereas alcohol was the predominant factor when relapses were included. The mean annual mortality rate for acute pancreatitis in the population was 1.3 per 100 000. Of 31 patients who died from acute pancreatitis only 15 were diagnosed before death. For recurrent disease the mortality rate was 0.3 per cent. In 12 patients the pancreatitis was associated with pancreatic carcinoma.
CONCLUSION:
It is important to differentiate between first attacks and relapses, since both incidence and aetiology figures are influenced by this, and it is important to include autopsy and forensic material in population-based mortality studies.
240 citations