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.
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Hypertension, atherosclerosis, and atrial fibrillation are predominant comorbidities in acute mesenteric ischemia.
“Hypertension, atherosclerosis, and atrial fibrillation have been identified as predominant comorbidities [5].”
From Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review (2024) · cites this paper as [5]
Most cases of acute mesenteric ischemia tend to be caused by occlusions in the superior mesenteric artery, followed by nonocclusive mesenteric ischemia.
“A recent study found that most cases of acute mesenteric ischemia tend to be caused by occlusions in the superior mesenteric artery, followed by nonocclusive mesenteric ischemia [5].”
From Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review (2024) · cites this paper as [5]
All subtypes of AMI ultimately lead to severe consequences and high mortality.
“Regardless of the specific approaches to diagnosis and management for different subtypes of AMI, all subtypes ultimately lead to severe consequences and high mortality [1, 2].”
From Incidence, diagnosis, management and outcome of acute mesenteric ischaemia: a prospective, multicentre observational study (AMESI Study) (2024) · cites this paper as [2]
The overall occurrence rate of confirmed AMI was lower than anticipated based on previous analyses.
“The overall occurrence rate of confirmed AMI was lower than anticipated based on previous analyses [1, 2].”
From Incidence, diagnosis, management and outcome of acute mesenteric ischaemia: a prospective, multicentre observational study (AMESI Study) (2024) · cites this paper as [2]
Different subtypes of AMI had different outcomes, which was expected and has also been reported in previous investigations.
“Different subtypes of AMI had different outcomes, which was expected and has also been reported in previous investigations [1, 2].”
From Incidence, diagnosis, management and outcome of acute mesenteric ischaemia: a prospective, multicentre observational study (AMESI Study) (2024) · cites this paper as [2]
In a systematic review and a recent population-based retrospective study, AMI was the primary diagnosis in approximately 5-7 patients per 10,000 hospital admissions.
“In a systematic review and a recent population-based retrospective study, AMI was the primary diagnosis in approximately 5–7 patients per 10,000 hospital admissions [1, 2], but the incidence is likely underestimated due to poor recognition, and the true worldwide incidence is not known.”
From Incidence, diagnosis, management and outcome of acute mesenteric ischaemia: a prospective, multicentre observational study (AMESI Study) (2024) · cites this paper as [2]
The true worldwide incidence of AMI is not known.
“In a systematic review and a recent population-based retrospective study, AMI was the primary diagnosis in approximately 5–7 patients per 10,000 hospital admissions [1, 2], but the incidence is likely underestimated due to poor recognition, and the true worldwide incidence is not known.”
From Incidence, diagnosis, management and outcome of acute mesenteric ischaemia: a prospective, multicentre observational study (AMESI Study) (2024) · cites this paper as [2]
Based on previous studies, the proportion of the least frequent form of AMI was estimated to be around 10% of all AMI cases.
“Based on previous studies [1, 2], it was estimated that the proportion of the least frequent form of AMI is around 10% of all AMI cases.”
From Incidence, diagnosis, management and outcome of acute mesenteric ischaemia: a prospective, multicentre observational study (AMESI Study) (2024) · cites this paper as [2]
The incidence of AMI is likely underestimated due to poor recognition.
“In a systematic review and a recent population-based retrospective study, AMI was the primary diagnosis in approximately 5–7 patients per 10,000 hospital admissions [1, 2], but the incidence is likely underestimated due to poor recognition, and the true worldwide incidence is not known.”
From Incidence, diagnosis, management and outcome of acute mesenteric ischaemia: a prospective, multicentre observational study (AMESI Study) (2024) · cites this paper as [2]
It was estimated that 0.06% (0.05-0.07) of all adult patients hospitalized in acute care hospitals have AMI.
“We estimated that 0.06% (0.05–0.07) of all adult patients hospitalized in acute care hospitals have AMI [1, 2].”
From Incidence, diagnosis, management and outcome of acute mesenteric ischaemia: a prospective, multicentre observational study (AMESI Study) (2024) · cites this paper as [2]
A greater delay to intervention seems to occur prior to hospital admission rather than in hospital, with median time of 24 h from beginning of symptoms until arrival to hospital.
“a greater delay to intervention seems to occur prior to hospital admission rather than in hospital, with median time of 24 h from beginning of symptoms until arrival to hospital (more than half with self-presentation), confirming the previous results of a retrospective study [2].”
From Incidence, diagnosis, management and outcome of acute mesenteric ischaemia: a prospective, multicentre observational study (AMESI Study) (2024) · cites this paper as [2]
The distribution of different subtypes of AMI was largely similar to literature data.
“The distribution of different subtypes of AMI was largely similar to literature data [1, 2]”
From Incidence, diagnosis, management and outcome of acute mesenteric ischaemia: a prospective, multicentre observational study (AMESI Study) (2024) · cites this paper as [2]
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References 21 · Cited by 56
- Authors
- Kase, K., Reintam Blaser, A., Tamme, K., Mändul, M., Forbes, A., Talving, P., & Murruste, M.
- Affiliations
- Tartu University Hospital (EE)
- Department of Anaesthesiology and Intensive Care Tartu University Hospital Tartu Estonia
- University of Tartu (EE)
- North Estonia Medical Centre (EE)
- Corresponding author
- Kase, Karri
- Venue
- World Journal of Surgery
- Publisher
- Wiley
- Published
- 2022-10-19
- Volume
- 47
- Issue
- 1
- Pages
- 173-181
- ISSN
- 0364-2313 (ISSN-L)
- 1432-2323
- OpenAlex
- W4306842660
- Cited by
- 56
- References
- 21
- Citations by year
- 2026: 17 · 2025: 17 · 2024: 15 · 2023: 6 · 2022: 1
- FWCI
- 9.32
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- World Journal of Surgery (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Sihtasutus Eesti Teadusagentuur (PRG1255)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Emergency Medicine › Appendicitis Diagnosis and Management
- Health Sciences › Medicine › Surgery › Intestinal and Peritoneal Adhesions
- Keywords
- acute mesenteric ischemia, incidence, mortality, superior mesenteric artery occlusion, nonocclusive mesenteric ischemia, inferior mesenteric artery occlusion, venous thrombosis, comorbidities, revascularization, bowel resection, end-of-life care, Estonia
- MeSH terms
- Aged, Female, Humans, Male, Retrospective Studies, Mesenteric Ischemia
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