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The Incidence of Chronic Mesenteric Ischemia in the Well-Defined Region of a Dutch Mesenteric Ischemia Expert Center
Open accessAbstract
INTRODUCTION: This study aimed to determine the incidence of chronic mesenteric ischemia (CMI) and to examine the influence of the etiological cause, location, and severity of a mesenteric artery stenosis on the probability of having CMI. METHODS: A prospective database, containing the details of all patients with suspected CMI referred to a renowned CMI expert center, was used. Patients residing within the expert centers' well-defined region, between January 2014 and October 2019, were included. CMI was diagnosed when patients experienced sustained symptom improvement after treatment. RESULTS: This study included 358 patients, 75 had a ≥50% atherosclerotic stenosis of 1 vessel (CMI 16%), 96 of 2 or 3 vessels (CMI 81%), 81 celiac artery compression (CMI 25%), and 84 no stenosis (CMI 12%). In total, 138 patients were diagnosed with CMI, rendering a mean incidence of 9.2 (95% confidence interval [CI] 6.2–13.7) per 100,000 inhabitants. Atherosclerotic CMI was most common, with a mean incidence of 7.2 (95% CI 4.6–11.3), followed by median arcuate ligament syndrome 1.3 (95% CI 0.5–3.6) and chronic nonocclusive mesenteric ischemia 0.6 (95% CI 0.2–2.6). The incidence of CMI was highest in female patients (female patients 12.0 [95% CI 7.3–19.6] vs male patients 6.5 [95% CI 3.4–12.5]) and increased with age. CMI was more prevalent in the presence of a ≥70% atherosclerotic single-vessel stenosis of the superior mesenteric artery (40.6%) than the celiac artery (5.6%). DISCUSSION: The incidence of CMI is higher than previously believed and increases with age. Probability of CMI seems highest in suspected CMI patients with multivessel disease or a ≥70% atherosclerotic single-vessel superior mesenteric artery stenosis.
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Up to 40% of atherosclerotic CMI is caused by a severe single vessel >70% SMA stenosis and 5.6% by a single vessel CA stenosis.
“Up to 40% of atherosclerotic CMI is caused by a severe single vessel > 70%SMAstenosis and 5.6% by a single vessel CA stenosis.”
From Editor's Choice - European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Guidelines on the Management of Diseases of the Mesenteric and Renal Arteries and Veins. (2025) · cites this paper as [10]
The Results and Discussion (page numbers not provided) give 40.6% and 5.6% as the proportions of symptomatic patients with severe single-vessel SMA and CA stenosis, respectively, who had CMI—not the proportions of atherosclerotic CMI caused by those stenoses. The Results also report only 12 CMI diagnoses among 75 patients with any single-vessel atherosclerotic stenosis, versus 93 among patients with two or three stenoses. (LLM, conf=0.87)
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Experimental — accuracy not yet measuredA >70% stenosis seems appropriate in patients with single vessel disease, considering that isolated 50-70% stenosis was associated with a 0-10% probability of CMI.
“Terlouw et al. suggested that a > 70% stenosis seems appropriate in patients with single vessel disease, considering that isolated 50 e 70% stenosis was associated with a 0 e 10% probability of CMI. 10”
From Editor's Choice - European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Guidelines on the Management of Diseases of the Mesenteric and Renal Arteries and Veins. (2025) · cites this paper as [10]
The Discussion recommends a ≥70% cutoff for single-vessel disease and reports CMI probabilities of 0% and 10% for isolated intermediate CA and SMA stenoses, respectively. The citing sentence says >70%, which excludes stenosis at exactly 70% and is therefore a slightly different threshold. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThe second most common cause of single vessel MAOD is external compression of the CA by the median arcuate ligament that crosses over the aorta at the level of the first lumbar vertebral body, above the CA origin.
“The second most common cause of single vessel MAOD is external compression of the CA by the median arcuate ligament that crosses over the aorta at the level of the first lumbar vertebral body, above the CA origin (Fig. 2).”
From Editor's Choice - European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Guidelines on the Management of Diseases of the Mesenteric and Renal Arteries and Veins. (2025) · cites this paper as [10]
The Introduction identifies celiac artery compression as a cause of occlusive chronic mesenteric ischemia, and the Results report median arcuate ligament syndrome as the second most common form of chronic mesenteric ischemia in this cohort. The paper does not establish that ligament compression is the second most common cause of single-vessel mesenteric artery occlusive disease, nor does it describe the ligament’s position relative to the first lumbar vertebra and celiac artery origin (pages not provided). (LLM, conf=0.84)
Experimental — accuracy not yet measuredIn that study, atherosclerotic CA and/or SMA stenosis accounted for 7.3 per 100 000 inhabitants and MALS for 1.3 per 100 000 inhabitants.
“Atherosclerotic CA and or SMA stenosis accounted for 7.3 (95% CI 4.6 e 11.3) per 100 000 inhabitants and MALS for 1.3 (95% CI 0.5 e 3.6) per 100 000 inhabitants.”
Chronic single vessel atherosclerotic occlusion can cause symptoms, especially if the SMA is involved and the collateral network is insufficient.
“Chronic single vessel atherosclerotic occlusion, however, can cause symptoms, especially if the SMA is involved and in the absence of a sufficient collateral network. 10”
In 358 patients, a definitive diagnosis of CMI was found in 16% with a single vessel stenosis, 81% with stenosis of more than one vessel, and 25% with CA compression.
“In the 358 patients included in that study, a definitive diagnosis of CMI wasfoundin12/75patients (16%) witha single vessel stenosis, in 93/115patients(81%)withstenosis ofmorethanonevessel, and in 20/81 patients (25%) with CA compression.”
A study in a Dutch referral centre estimated an annual CMI incidence of 9.2 per 100 000 inhabitants.
“A study in a Dutch referral centre estimated an annual CMI incidence of 9.2 (95% confidence interval [CI] 6.2 e 13.7) per 100 000 inhabitants. 10”
Revascularisation has a higher clinical success rate in patients with multivessel disease (95.4%) compared with those with single vessel disease (69%).
“Revascularisation has a higher clinical success rate in patients with multivessel disease (95.4%) compared with those with single vessel disease (69%).”
A prospective, single centre Dutch study demonstrated a higher probability of the diagnosis of CMI in patients with multivessel disease.
“Similarly, a prospective, single centre Dutch study demonstrated a higher probability of the diagnosis of CMI in patients with multivessel disease.”
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Metadata
- Authors
- Terlouw, L. G., Verbeten, M., van Noord, D., Brusse-Keizer, M., Beumer, R. R., Geelkerken, R. H., Bruno, M. J., Kolkman, J. J., & Dutch Mesenteric Ischemia Study Group
- Affiliations
- Erasmus MC (NL)
- Medisch Spectrum Twente (NL)
- Sint Franciscus Gasthuis (NL)
- University Medical Center Groningen (NL)
- Corresponding author
- Terlouw, Luke G.
- ORCID
- Venue
- Clinical and Translational Gastroenterology
- Published
- 2020-08
- Volume
- 11
- Issue
- 8
- Pages
- e00200
- ISSN
- 2155-384X (ISSN-L)
- PMC
- PMC7431271
- OpenAlex
- W3047537707
- Cited by
- 39
- References
- 25
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 5 · 2023: 10 · 2022: 6 · 2021: 4 · 2020: 1
- FWCI
- 4.80
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Clinical and Translational Gastroenterology (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, cc-by-nc-nd)
- University of Twente Research Information (publishedVersion, cc-by-nc-nd)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by-nc-nd)
- University of Twente Research Information (submittedVersion, cc-by-nc-nd)
- Funders
- Universiteit Leiden
- Universiteit Maastricht
- Maastricht Universitair Medisch Centrum
- St. Antonius Ziekenhuis
- Leids Universitair Medisch Centrum
- Universitair Medisch Centrum Groningen
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Surgery › Vascular anomalies and interventions
- Health Sciences › Medicine › Nephrology › Renal and Vascular Pathologies
- Keywords
- chronic mesenteric ischemia, incidence, mesenteric artery stenosis, atherosclerosis, superior mesenteric artery stenosis, celiac artery compression, median arcuate ligament syndrome, sex differences, age, multivessel coronary artery disease
- MeSH terms
- Median Arcuate Ligament Syndrome, Adult, Age Factors, Aged, Chronic Disease, Constriction, Pathologic, Female, Humans, Male, Middle Aged, Netherlands, Prospective Studies, Risk Factors, Severity of Illness Index, Sex Factors, Incidence, Mesenteric Artery, Superior, Atherosclerosis, Secondary Care Centers, Mesenteric Ischemia
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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