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Asymptomatic Radiologically Diagnosed Severe Mesenteric Artery Disease rarely progresses to Symptomatic Mesenteric Ischemia and may not Vascular Surgery Intervention
Keerthi B. Harish, Ethan Chervonski, Rae Rokosh, MD, Karan Garg, MD, Todd L. Berland, MD, Mikel Sadek, MD, Katherine A. Teter, MD, Caron B. Rockman, MD, Glenn R. Jacobowitz, MD, Thomas S. Maldonado, MD.
NYU Grossman School of Medicine, New York, NY, USA.

OBJECTIVES: The objective of this study was to compare features of patients with asymptomatic mesenteric artery occlusive disease (MAOD) to those with symptomatic chronic mesenteric ischemia (CMI).
METHODS: This single-institution retrospective analysis included patients diagnosed with >70% stenosis of the celiac or superior mesenteric arteries (SMA) in an institutional radiology database. Patients were grouped into asymptomatic MAOD (Group A) and symptomatic CMI (Group B) cohorts per clinical presentation at index study. Axial imaging, demographic, and clinical data were collected using the EMR.
RESULTS: 79 patients were identified, with 43 in Group A and 36 in Group B. Group A was followed for mean 32.730.2 months; 60.5% (n=26) were referred to and followed by a vascular surgeon for 21.527.8 months. No patients in Group A developed symptoms of CMI or acute mesenteric ischemia (AMI) during the follow-up period. In contrast, all patients in Group B were evaluated by a vascular surgeon and treated for chronic mesenteric anemia within 6 months of diagnosis. Group A was less likely to have a history of smoking (69.4% vs. 44.2%, p=0.02) and more likely to be anticoagulated (0.0% vs. 23.3%, p<0.01). Group A trended towards a lower prevalence of coronary artery disease (48.6% vs 27.9%, p=0.06). Mortality was not different between the two groups. On imaging, patients in Group A were less likely to have calcific lesions (88.9% vs. 65.1%, p=0.01), lesser severity of SMA stenoses (p<0.01), and less severely diseased mesenteric arteries (p=0.01). They were also more likely to have at least one diseased hypogastric artery (55.6% vs 10.0%, p<0.01). Table 1 summarizes imaging characteristics. On multivariate analysis, anticoagulation (p<0.01) and bilateral hypogastric patency (p<0.01) were associated with lower odds of symptomatic mesenteric stenosis.
CONCLUSIONS: Symptomatic patients were more likely to have concomitant hypogastric disease and less likely to be on anticoagulation than asymptomatic patients. These findings may suggest the importance of collateralization via pelvic circulation. However, the rate of progression from MAOD to CMI or AMI appears low, and it appears appropriate to treat asymptomatic MAOD diagnosed radiologically with aggressive medical management and atherosclerotic risk factor modification alone.
Table 1: Summary of Imaging Characteristics

MAOD, N = 431CMI, N = 361p-value2
Aortic Calcification65.1% (28)88.9% (32)0.014
Celiac Artery Status0.8
<50% Stenosis21.4% (9)22.2% (8)
50% to 70% Stenosis9.5% (4)11.1% (4)
>70% Stenosis57.1% (24)47.2% (17)
Occluded or Atretic11.9% (5)19.4% (7)
Superior Mesenteric Artery Status<0.001
<50% Stenosis39.5% (17)0.0% (0)
50% to 70% Stenosis9.3% (4)11.1% (4)
>70% Stenosis37.2% (16)75.0% (27)
Occluded or Atretic14.0% (6)13.9% (5)
Inferior Mesenteric Artery Status0.12
<50% Stenosis81.4% (35)61.1% (22)
50% to 70% Stenosis0.0% (0)5.6% (2)
>70% Stenosis9.3% (4)11.1% (4)
Occluded or Atretic9.3% (4)22.2% (8)
Number of Mesenteric Arteries with >70% Stenosis or Occlusive Disease0.010
167.4% (29)33.3% (12)
220.9% (9)44.4% (16)
311.6% (5)22.2% (8)
Internal Iliac Artery Status<0.001
Bilateral Patency90.0% (36)44.4% (16)
Unilateral >70% Stenosis or Occlusive Disease2.5% (1)22.2% (8)
Bilateral >70% Stenosis or Occlusive Disease7.5% (3)33.3% (12)
1% (n)
2Pearson's Chi-squared test; Fisher''s exact test

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