Epidemiology of Acute Mesenteric Ischemia: A Population‐Based Investigation

Abstract

Background There is a lack of population‐based studies on acute mesenteric ischemia (AMI). We have therefore performed a nationwide epidemiological study in Estonia, addressing incidence, demographics, interventions and mortality of AMI. Methods A retrospective population‐based review was conducted of all adult cases of AMI accrued from the digital Estonian Health Insurance Fund and Causes of Death Registry for 2016–2020 based on international classification of diseases (ICD‐10) diagnostic codes and procedure codes (NOMESCO). Results Overall, 577 cases of AMI were identified—an annual incidence of 8.7 per 100,000. The median age was 79 (range 32–104) and 57% were female. Predominating comorbidities included hypertensive disease (81%), atherosclerosis (67%), and atrial fibrillation (52%). The majority of cases (60%) were caused by superior mesenteric artery occlusion (thrombosis 54%, embolism 12%, and unclear 34%). Inferior mesenteric artery occlusion occurred in 7%, non‐occlusive mesenteric ischemia in 7%, venous thrombosis in 4%, whereas the type remained unclear in 21% of cases. 40% of patients received intervention (revascularization and/or intestinal resection) and 13% active non‐operative treatment. In 21% an exploratory laparotomy or laparoscopy revealed unsalvageable bowel prompting end‐of‐life care, which was the only management in a further 25% of cases. Conclusions The population‐based annual incidence of AMI in Estonia was 8.7 per 100,000 during the study period. The overall hospital mortality and 1 year mortality were 64% and 74%, respectively. In the 53% of patients who received active treatment hospital mortality was 32% and 1 year all‐cause mortality was 51%. Trial registration ClinicalTrials.gov Identifier NCT04867499.

Trends in population-based incidence and mortality of acute superior mesenteric artery occlusion

“…The present population-based study was compared to other population-based reports [3,[8][9][10]15] (Table 2). The highest incidence and mortality rate reported stems from Malmö in a report covering a time period from 1970 to 1982, including an autopsy rate of 87% in the population.…”

“…If not treated adequately, this may lead to intestinal necrosis and peritonitis [1]. The most common cause of AMI is an acute thromboembolic occlusion of the superior mesenteric artery (SMA) [1][2][3]. Other reasons include non-occlusive mesenteric ischaemia (NOMI) and superior mesenteric vein thrombosis [1,2].…”

Acute mesenteric ischaemia

“…This also applies for patients with renal insufficiency, as the benefits of a fast and accurate diagnosis will generally outweigh the risks of contrast-induced nephropathy [22]. However, in available studies patients with AMI often received only venous phase contrast-computed tomography (the commonest imaging mode for the abdomen when there is no suspicion of AMI) [5,19].…”

“…Epidemiology and outcome of AMI, based on available evidence [2–5,8,10–19], is presented in Table 1.…”

“…Most of the studies currently available on AMI are retrospective single-center studies that usually collected patients over several years or even decades. In a recent retrospective investigation in Estonia from 2016-2020, the population-based annual incidence of AMI was 8.7/100 000 (95% CI: 8.0-9.5), and AMI comprised 0.07% of all adult hospital admissions [5].…”