Mesenteric ischemia guidelines for diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The guidelines for diagnosing mesenteric ischemia state that in persons who have a history of cardiovascular disease, the development of acute abdominal pain with pain out of proportion to physical examination, should lead to a suspected diagnosis of mesenteric ischemia. Patients should also be suspected as to having mesenteric ischemia if they develop acute abdominal pain after an arterial intervention with catheters that traverse the aorta, or after a myocardial infarction. Duplex ultrasonography is not an appropriate diagnostic tool for suspected intestinal ischemia.

Guidelines for Diagnosis

Management of Patients With Peripheral Artery Disease (Compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations) : A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[1]

Acute Intestinal Ischemia (DO NOT EDIT)[2]

Class I
"1. Patients with acute abdominal pain out of proportion to physical findings and who have a history of cardiovascular disease should be suspected of having acute intestinal ischemia. (Level of Evidence: B)"
"2. Patients who develop acute abdominal pain after arterial interventions in which catheters traverse the visceral aorta or any proximal arteries or who have arrhythmias (such as atrial fibrillation) or recent MI should be suspected of having acute intestinal ischemia. (Level of Evidence: C)"
Class III
"1. In contrast to chronic intestinal ischemia, duplex sonography of the abdomen is not an appropriate diagnostic tool for suspected acute intestinal ischemia. (Level of Evidence: C)"

Acute Nonocclusive Intestinal Ischemia (DO NOT EDIT)[2]

Class I
"1. Arteriography is indicated in patients suspected of having nonocclusive intestinal ischemia whose condition does not improve rapidly with treatment of their underlying disease. (Level of Evidence: B) "

Chronic Intestinal Ischemia (DO NOT EDIT)[2]

Class I
"1. Chronic intestinal ischemia should be suspected in patients with abdominal pain and weight loss without other explanation, especially those with cardiovascular disease. (Level of Evidence: B) "
"2. Duplex ultrasound, CTA, and gadolinium-enhanced MRA are useful initial tests for supporting the clinical diagnosis of chronic intestinal ischemia. (Level of Evidence: B)"
"3. Diagnostic angiography, including lateral aortography, should be obtained in patients suspected of having chronic intestinal ischemia for whom noninvasive imaging is unavailable or indeterminate. (Level of Evidence: B) "

References

  1. Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss L; et al. (2013). "Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.". J Am Coll Cardiol. 61 (14): 1555–70. PMC 4492473Freely accessible. PMID 23473760. doi:10.1016/j.jacc.2013.01.004. 
  2. 2.0 2.1 2.2 Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM, White CJ, White J, White RA, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B (2006). "ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation". Circulation. 113 (11): e463–654. PMID 16549646. doi:10.1161/CIRCULATIONAHA.106.174526. Retrieved 2012-10-09. 



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