Abdominal atherosclerosis is not a risk factor of nonocclusive mesenteric ischemia among critically ill patients: a propensity matching study

Abstract

Background Although risk factors of occlusive acute mesenteric ischemia are well known, triggering factors of nonocclusive mesenteric ischemia (NOMI) remain unclear. Alongside to the known risk factors for NOMI, the role of atherosclerosis is not fully elucidated. The purpose of our study was to evaluate whether abdominal atherosclerosis is a risk factor for NOMI. Methods From January 2018 to December 2021, all consecutive patients admitted to the intensive care unit who underwent contrast-enhanced CT for suspicion of NOMI were evaluated for inclusion. Clinical and biological data at the time of the CT scan were retrospectively extracted from medical charts and reviewed by a single radiologist. The cohorts were matched by a 1:1 propensity score based on the patient clinical, biological data, and abdominal CT features associated with NOMI. Noncontrast CT acquisitions were used to calculate calcium scores of the abdominal aorta, celiac trunk, superior mesenteric artery (SMA), and common iliac artery according to the Agatston method. Analyses were performed before and after propensity score matching. Results Among the 165 critically ill patients included, 59 (36%) had NOMI. Before matching analysis, the SMA and total abdominal Agatston calcium scores were not different between patients without and with NOMI (52.00 [IQR = 0, 473] vs. 137.00 [IQR = 0, 259], P = 0.857, respectively, and 7253 [IQR = 1220, 21738] versus 5802 [IQR = 2075, 15,084]; P = 0.723). The results were similar after matching 38 patients with NOMI and 38 without: 153 [IQR = 0, 665] versus 85 [IQR = 0, 240] (P = 0.312) for the SMA calcium score, and 7915 [IQR = 1812, 21561] versus 4139 [IQR = 1440, 9858] (P = 0.170) for the total abdominal Agatston calcium score. Conclusion Our results suggest that atherosclerosis is not a risk factor for NOMI in critically ill patients.

Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review

“…Furthermore, critically ill patients with non-obstructive mesenteric ischemia prescribed vasoconstricting agents can increase superior mesenteric artery vasoconstriction, potentially contributing to organ infarcts [ 17 ]. Interestingly, the role of atherosclerosis as a risk factor for nonocclusive mesenteric ischemia has been debated in the literature [ 18 ].…”

Diagnostic Role of MDCT in Acute Mesenteric Ischemia

“…Nonocclusive mesenteric ischemia (NOMI) is an intestinal hypoperfusion in the absence of arterial or venous thromboembolism [2] accounting for up to 20% of cases of AMI [9,54] and atherosclerosis is not considered a risk factor [55]. The real incidence may be underestimated because this condition occurs in critically ill patients with predisposing conditions such as heart failure, major trauma, the use of vasopressors, and cardiogenic or septic shock (Figure 6) [2,36,56], NOMI should be considered in the differential diagnosis in these patients because imaging findings may be subtle, and the distribution of affected bowel may be discontinuous or involve multiple vascular territories [56].…”

Diagnostic Role of Multi-Detector Computed Tomography in Acute Mesenteric Ischemia

“…Nonocclusive mesenteric ischemia (NOMI) is an intestinal hypoperfusion in the absence of arterial or venous thromboembolism [ 2 ] accounting for up to 20% of cases of AMI [ 9 , 58 ], and atherosclerosis is not considered a risk factor [ 59 ]. The real incidence may be underestimated because this condition occurs in critically ill patients with predisposing conditions such as heart failure, major trauma, the use of vasopressors, and cardiogenic or septic shock ( Figure 6 ) [ 2 , 42 , 60 ].…”