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Nonatherosclerotic Abdominal Vasculopathies.

Abstract

BACKGROUND

Nonatherosclerotic abdominal arterial vasculopathies (NAVs), including mesenteric or renal artery dissection, aneurysm, stenosis, and vasculitis, are rare but have great clinical significance. Patients may present emergently with life-threatening complications such as arterial rupture and hemorrhagic shock. Herein, we present our center's experience with NAVs and provide extensive literature review to close the gap in the scarce, related literature.

METHODS

From a single-center retrospective data analysis, we identified and characterized subjects (aged 18-60 years) who presented with NAV between January 2000 and December 2015. Of the 1416 charts reviewed, 118 met inclusion criteria.

RESULTS

The average age of patients with NAV was 47.0 ± 9.9 years, mostly affecting women (64%). Primary diagnoses included fibromuscular dysplasia (FMD) (25.4%), isolated aneurysms (24.6%), and median arcuate ligament syndrome (MALS) (15.3%). Less common diagnoses were localized vasculitis of the gastrointestinal tract (LVGT) (7.6%), isolated dissection (5.1%), microscopic polyangiitis and granulomatosis with polyangiitis (5.1%), trauma (4.2%), segmental arterial mediolysis (4.2%), Ehlers-Danlos syndrome (2.5%), Takayasu's arteritis (2.5%), polyarteritis nodosa (1.7%), idiopathic abdominal aortitis (0.8%), and Loeys-Dietz syndrome (0.8%). Females constituted 90% of patients with FMD, 77.8% with MALS, 77.8% with isolated aneurysms, 66.7% with Takayasu arteritis, and 55.6% with LVGT. Prevalent comorbidities included tobacco use (43.6%) and hypertension (52.1%). Coil embolization was used in 14.4%, anticoagulation in 11.9%, angioplasty/stenting in 11.9%, open resection/surgical revascularization in 10.2%, and prednisone in 10.2% of the cases. Conservative management was pursued in 33.1% of the patients. A high degree of symptom relief was shown in 91.7%.

CONCLUSIONS

NAV are rare and can be caused by different etiologies that primarily affect females. Hypertension and tobacco use were prevalent. Various imaging strategies revealed aneurysms, stenosis, dissection, and/or thrombosis affecting renal and celiac arteries. Most patients improved with conservative, medical, endovascular, or surgical approach. More research is needed to standardize management approach to patients with NAV.

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  • Authors+Show Affiliations

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    Minneapolis Heart Institute, Minneapolis, MN, USA. Electronic address: nedaa.skeik@allina.com.

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    Minneapolis Heart Institute, Minneapolis, MN, USA.

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    Minneapolis Heart Institute, Minneapolis, MN, USA.

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    Minneapolis Heart Institute, Minneapolis, MN, USA.

    ,

    Minneapolis Heart Institute, Minneapolis, MN, USA.

    ,

    Minneapolis Heart Institute, Minneapolis, MN, USA.

    ,

    Minneapolis Heart Institute, Minneapolis, MN, USA.

    ,

    Minneapolis Heart Institute, Minneapolis, MN, USA.

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    Minneapolis Heart Institute, Minneapolis, MN, USA.

    Minneapolis Heart Institute, Minneapolis, MN, USA.

    Source

    Annals of vascular surgery : 2019 Jun 12 pg

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    31200053

    Citation

    Skeik, Nedaa, et al. "Nonatherosclerotic Abdominal Vasculopathies." Annals of Vascular Surgery, 2019.
    Skeik N, Hyde JR, Olson SL, et al. Nonatherosclerotic Abdominal Vasculopathies. Ann Vasc Surg. 2019.
    Skeik, N., Hyde, J. R., Olson, S. L., Thaler, C. M., Abuatiyeh, W., Ahmed, A. K., ... Sullivan, T. (2019). Nonatherosclerotic Abdominal Vasculopathies. Annals of Vascular Surgery, doi:10.1016/j.avsg.2019.04.004.
    Skeik N, et al. Nonatherosclerotic Abdominal Vasculopathies. Ann Vasc Surg. 2019 Jun 12; PubMed PMID: 31200053.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Nonatherosclerotic Abdominal Vasculopathies. AU - Skeik,Nedaa, AU - Hyde,Jonathan R, AU - Olson,Sydney L, AU - Thaler,Christina M, AU - Abuatiyeh,Wala, AU - Ahmed,Aisha K, AU - Lyon,Danielle R, AU - Witt,Dawn R, AU - Garberich,Ross, AU - Sullivan,Timothy, Y1 - 2019/06/12/ PY - 2018/12/17/received PY - 2019/03/11/revised PY - 2019/04/04/accepted PY - 2019/6/15/pubmed PY - 2019/6/15/medline PY - 2019/6/15/entrez JF - Annals of vascular surgery JO - Ann Vasc Surg N2 - BACKGROUND: Nonatherosclerotic abdominal arterial vasculopathies (NAVs), including mesenteric or renal artery dissection, aneurysm, stenosis, and vasculitis, are rare but have great clinical significance. Patients may present emergently with life-threatening complications such as arterial rupture and hemorrhagic shock. Herein, we present our center's experience with NAVs and provide extensive literature review to close the gap in the scarce, related literature. METHODS: From a single-center retrospective data analysis, we identified and characterized subjects (aged 18-60 years) who presented with NAV between January 2000 and December 2015. Of the 1416 charts reviewed, 118 met inclusion criteria. RESULTS: The average age of patients with NAV was 47.0 ± 9.9 years, mostly affecting women (64%). Primary diagnoses included fibromuscular dysplasia (FMD) (25.4%), isolated aneurysms (24.6%), and median arcuate ligament syndrome (MALS) (15.3%). Less common diagnoses were localized vasculitis of the gastrointestinal tract (LVGT) (7.6%), isolated dissection (5.1%), microscopic polyangiitis and granulomatosis with polyangiitis (5.1%), trauma (4.2%), segmental arterial mediolysis (4.2%), Ehlers-Danlos syndrome (2.5%), Takayasu's arteritis (2.5%), polyarteritis nodosa (1.7%), idiopathic abdominal aortitis (0.8%), and Loeys-Dietz syndrome (0.8%). Females constituted 90% of patients with FMD, 77.8% with MALS, 77.8% with isolated aneurysms, 66.7% with Takayasu arteritis, and 55.6% with LVGT. Prevalent comorbidities included tobacco use (43.6%) and hypertension (52.1%). Coil embolization was used in 14.4%, anticoagulation in 11.9%, angioplasty/stenting in 11.9%, open resection/surgical revascularization in 10.2%, and prednisone in 10.2% of the cases. Conservative management was pursued in 33.1% of the patients. A high degree of symptom relief was shown in 91.7%. CONCLUSIONS: NAV are rare and can be caused by different etiologies that primarily affect females. Hypertension and tobacco use were prevalent. Various imaging strategies revealed aneurysms, stenosis, dissection, and/or thrombosis affecting renal and celiac arteries. Most patients improved with conservative, medical, endovascular, or surgical approach. More research is needed to standardize management approach to patients with NAV. SN - 1615-5947 UR - https://www.unboundmedicine.com/medline/citation/31200053/Non-atherosclerotic_Abdominal_Vasculopathies L2 - https://linkinghub.elsevier.com/retrieve/pii/S0890-5096(19)30382-6 DB - PRIME DP - Unbound Medicine ER -