Mesenteric ischemia risk factors

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Feham Tariq, MD [2]

Overview

Risk factors causing mesenteric ischemia can be divided based on the underlying etiology. Conditions that pose a significant risk to the development of mesenteric ischemia include the interruption of blood flow through the artery or vein supplying the small intestine (e.g thromboembolism) or reduction of blood supply (e.g. vasoconstriction). Also, there are certain life-style related risk factors which predominantly cause mesenteric ischemia in the older age group.

Risk Factors

The following conditions pose a significant risk towards the development of mesenteric ischemia either by interrupting the blood flow through the artery or vein supplying the small intestine (e.g.thromboemboli) or by reducing the blood supply (e.g. vasoconstriction). Also, there are certain life-style related risk factors which predominantly cause mesenteric ischemia in the older age group.^[1]^[2]^[3]

Venous thrombosis is more frequently seen in women and arterial thrombosis is more commonly seen in men.^[4]^[5]

Mesenteric ischemia is more prevalent in women as compared to males.^[6]

Risk factors
Occlusive	Embolic	Atrial fibrillation
		Cardiac arrhythmia
		Valvular heart disease
		Infective endocarditis
		Recent myocardial infarction
		Ventricular aneurysm
		Aortic atherosclerosis
	Thrombotic	Advanced age
		Low cardiac output states
		Peripheral arterial disease
		Traumatic injury
		Inherited thrombophilia– Factor V Leidin mutation Prothrombin G20210A mutation Protein S deficiency Antithrombin III deficiency Activated protein C resistance Antiphospholipid syndrome Myeloproliferative disorders(JAK2 V617F) mutation.
		Acquired thrombophilia– malignancy, oral contraceptives intake.
Non-occlusive		Heart failure
		Aortic insufficiency
		Septic shock
		Vasoconstrictive drugs: Digoxin Alpha-adrenergic agonists
		Cocaine abuse or ergot poisoning
		Hemodialysis
Other factors		Lifestyle related risk factors:^[7] High cholesterol levels History of smoking Immobility Hypertension Hyperlipidemia Diabetes Less common risk factors: Fibromuscular dysplasia Beta receptor blocking agents Hepatitis

Common risk factors in the development of mesenteric ischemia include:

Occlusive causes:

(a) Embolic causes:^[1]

(b) Thrombotic causes:^[2]

Advanced age
Low cardiac output states
Traumatic injury
Peripheral artery disease

Non-occlusive causes:^[3]

Heart failure
Aortic insufficiency
Septic shock
Vasoconstrictive drugs (e.g. Digoxin, alpha-adrenergic agonists)
Cocaine abuse or ergot poisoning
Hemodialysis

References

↑ ^1.0 ^1.1 Fitzgerald T, Kim D, Karakozis S, Alam H, Provido H, Kirkpatrick J (2000). “Visceral ischemia after cardiopulmonary bypass”. Am Surg. 66 (7): 623–6. PMID 10917470.
↑ ^2.0 ^2.1 Martinelli I, Mannucci PM, De Stefano V, Taioli E, Rossi V, Crosti F; et al. (1998). “Different risks of thrombosis in four coagulation defects associated with inherited thrombophilia: a study of 150 families”. Blood. 92 (7): 2353–8. PMID 9746774.
↑ ^3.0 ^3.1 Acosta S, Ogren M, Sternby NH, Bergqvist D, Björck M (2006). “Fatal nonocclusive mesenteric ischaemia: population-based incidence and risk factors”. J Intern Med. 259 (3): 305–13. doi:10.1111/j.1365-2796.2006.01613.x. PMID 16476108.
↑ Endean ED, Barnes SL, Kwolek CJ, Minion DJ, Schwarcz TH, Mentzer RM (2001). “Surgical management of thrombotic acute intestinal ischemia”. Ann Surg. 233 (6): 801–8. PMC 1421323. PMID 11407335.
↑ Corcos, Olivier; Nuzzo, Alexandre (2013). “Gastro-Intestinal Vascular Emergencies”. Best Practice & Research Clinical Gastroenterology. 27 (5): 709–725. doi:10.1016/j.bpg.2013.08.006. ISSN 1521-6918.
↑ Veenstra RP, ter Steege RW, Geelkerken RH, Huisman AB, Kolkman JJ (2012). “The cardiovascular risk profile of atherosclerotic gastrointestinal ischemia is different from other vascular beds”. Am J Med. 125 (4): 394–8. doi:10.1016/j.amjmed.2011.09.013. PMID 22305578.
↑ Dahlke, M.H.; Asshoff, L.; Popp, F.C.; Feuerbach, S.; Lang, S.A.; Renner, P.; Slowik, P.; Stoeltzing, O.; Schlitt, H.J.; Piso, P. (2008). “Mesenteric Ischemia – Outcome after Surgical Therapy in 83 Patients”. Digestive Surgery. 25 (3): 213–219. doi:10.1159/000140692. ISSN 1421-9883.

[pmid10917470-1] 1.0 ^1.1 Fitzgerald T, Kim D, Karakozis S, Alam H, Provido H, Kirkpatrick J (2000). “Visceral ischemia after cardiopulmonary bypass”. Am Surg. 66 (7): 623–6. PMID 10917470.

[pmid9746774-2] 2.0 ^2.1 Martinelli I, Mannucci PM, De Stefano V, Taioli E, Rossi V, Crosti F; et al. (1998). “Different risks of thrombosis in four coagulation defects associated with inherited thrombophilia: a study of 150 families”. Blood. 92 (7): 2353–8. PMID 9746774.

[pmid16476108-3] 3.0 ^3.1 Acosta S, Ogren M, Sternby NH, Bergqvist D, Björck M (2006). “Fatal nonocclusive mesenteric ischaemia: population-based incidence and risk factors”. J Intern Med. 259 (3): 305–13. doi:10.1111/j.1365-2796.2006.01613.x. PMID 16476108.

[pmid11407335-4] Endean ED, Barnes SL, Kwolek CJ, Minion DJ, Schwarcz TH, Mentzer RM (2001). “Surgical management of thrombotic acute intestinal ischemia”. Ann Surg. 233 (6): 801–8. PMC 1421323. PMID 11407335.

[CorcosNuzzo2013-5] Corcos, Olivier; Nuzzo, Alexandre (2013). “Gastro-Intestinal Vascular Emergencies”. Best Practice & Research Clinical Gastroenterology. 27 (5): 709–725. doi:10.1016/j.bpg.2013.08.006. ISSN 1521-6918.

[pmid22305578-6] Veenstra RP, ter Steege RW, Geelkerken RH, Huisman AB, Kolkman JJ (2012). “The cardiovascular risk profile of atherosclerotic gastrointestinal ischemia is different from other vascular beds”. Am J Med. 125 (4): 394–8. doi:10.1016/j.amjmed.2011.09.013. PMID 22305578.

[DahlkeAsshoff2008-7] Dahlke, M.H.; Asshoff, L.; Popp, F.C.; Feuerbach, S.; Lang, S.A.; Renner, P.; Slowik, P.; Stoeltzing, O.; Schlitt, H.J.; Piso, P. (2008). “Mesenteric Ischemia – Outcome after Surgical Therapy in 83 Patients”. Digestive Surgery. 25 (3): 213–219. doi:10.1159/000140692. ISSN 1421-9883.

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