Blockages of Arteries To The GI System
The gastro-intestinal system in the abdomen comprises the stomach, small intestine, large intestine, liver, gall bladder and pancreas. These organs are supplied by three main arteries namely Celiac, Superior Mesenteric and Inferior Mesenteric arteries. At our institution angiogram reports are maintained in a database. This database was queried to obtain a list of patients who underwent mesenteric angiograms. The initial part of this report addresses the angiographic features reported.
Analysis of 1263 patients who underwent mesenteric angiograms at our institution are presented. A majority of patients underwent single procedures, approximately half of the patients required intervention (angioplasty and stent placement) to their mesenteric arteries. A random sample of 200 patients drawn from those who underwent angiograms allowed us to assess clinical features. Data from 4 patients was not usable due to incomplete information and the final analysis included 196 patients. Patient demographics were similar amongst those who did and did not undergo stent placement. It was difficult to ascertain presence of abdominal pain from retrospective chart review, however a greater proportion of patients who underwent stent placment had presence of abdominal pain documented in the chart. Amongst those who underwent ultrasound to interrogate the mesenteric vessels and had usable data; presence of celiac disease was not diagnosed in a great majority. Based on our analysis we therefore propose that a careful history be taken amongst those PAD patients who are to undergo angiography with particular attention to abdominal pain, weight loss, bloating and early satiety. Care should be taken amongst those who have such symptoms to selectively image the mesenteric vessels.
Overall Numbers As a broad overview there were 1263 angiograms, of these 1042 underwent single procedures, 597 or 47 % did not require intervention, 415 or 33 % required Inferior Mesenteric Artery intervention, 130 or 10 % required Celiac intervention, 60 or 5 % required superior mesenteric artery intervention, the remainder required multiple interventions. Amongst those with multiple interventions the distribution was as follows. Superior Mesenteric and Inferior Mesenteric intervention amongst 27, Celiac and Inferior Mesenteric intervention amongst 17 and Celiac and Superior Mesenteric intervention amongst 9 patients.
Summary of Angiogram Table (n=1263)
## Celiac 0.1029295329 ## Celiac, IMA 0.0134600158 ## Celiac, SMA 0.0031670625 ## diagnostic 0.0007917656 ## Diagnostic 0.4726840855 ## IMA 0.3285827395 ## IMA, SMA 0.0015835313 ## IMA, SMA, Celiac 0.0007917656 ## SMA 0.0475059382 ## SMA, Celiac 0.0039588282 ## SMA,IMA 0.0015835313 ## SMA, IMA 0.0213776722 ## Type 0.0007917656
Clinical Features ## Claudication Leg.Discomfort Limb.Fatigue Limb.Weakness Cold.Feet ## No : 49 No : 90 No :107 No :168 No :123 ## Yes:147 Yes:106 Yes: 89 Yes: 28 Yes: 73 ## LE.Skin.Changes LE.ulcers Distal.Pulses.Diminished ## : 0 : 0 : 0 ## 0.385786802: 0 0.02030456853: 0 0.8730964467: 0 ## 76 : 0 4 : 0 172 : 0 ## No :120 No :192 No : 24 ## Yes : 76 Yes : 4 Yes :172 ## Exercise.adviced Smoking.cessation Dietary.advice Lipid.Lowering.agent ## No :192 No : 3 No :191 No : 49 ## Yes: 4 Yes : 0 Yes: 5 Yes:147 ## NA's:193 ## Anti.platelet.therapy..Aspirin..plavix.etc. ## No : 22 ## Yes:174
Analysis of patients with significant mesenteric disease to those without
There was no difference between those who had blockages that need stent versus those who do not need a stent with regards to their risk factor profile. Risk factos assessed inclued family history, high cholesterol (hyperlipidemia), high blood pressure (hypertension), diabetes. Amongst those who did not get a stent 9% were current smokers in comparison to 16% current smokers amongst those who required stent placement.
Symptoms amongst those who required stents compared to those who didn't
Patients who needed stents had significantly more abdominal pain in comparison to those who didn't need stents. Chart reviewers noted difficulty in abstracting presence or absence of abdominal pain from retrospective chart review.
Medical therapy amongst those who did and didn't need stents
Our data shows that patients who underwent stents had appropriate anti-platelet therapy. Chart review failed to show adequate documentation of dietary advice and smoking cessation.
Review of literature on PubMed shows small case reports compromise most of the literature. In this analysis we are by no means trying to dispute any of the findings in the literature, we are merely trying to report clincial features of a large angiographic series. Although charts were not reviewed on all the patients from the angiogram list, a random sample of 196 patients should be quite representative and is a good sample size. We reccomend a careful history taking and amongst apropriate patients with severe advanced PAD and clincial features of mesenteric ischemia who are to undergo angiography for their PAD we reccomend care be taken to carefully visualize their mesenteric vessels. Further with advancing age amongst our diabetic patients we reccomend caregivers to remember mesenteric ischemia as a possible cause of abdominal pain amongst those at risk.