Mesenteric Ischemia After Cardiac Surgery in Dialysis Patients: An Overlooked Risk Factor
Keywords:mesenteric ischemia, dialysis, cardiac surgery, superior mesenteric artery, vascular calcification
Background: No study has examined the association of the calcification of abdominal artery orifices with nonocclusive mesenteric ischemia (NOMI) in dialysis patients undergoing cardiac surgery. Thus, this study aimed to determine whether calcification of abdominal blood vessel orifices in hemodialysis patients may be a risk factor for NOMI and examine the long-term survival of dialysis patients after undergoing cardiac surgery.
Methods: From April 2014 to September 2020, 100 dialysis patients underwent cardiac surgery at our hospital. The calcification of the celiac artery (CA) and superior mesenteric artery (SMA) was evaluated by computed tomography, and the degree of orifice stenosis was graded as follows: patent, 0; partial occlusion, 1; and complete occlusion, 2.
Results: Eight patients experienced NOMI, and all of them died. SMA calcification scores were not significantly different between the NOMI and non-NOMI groups (1.38±0.52 vs. 1.13±0.69; P = 0.247). However, the average CA orifice calcification score was significantly greater in the NOMI group than in the non-NOMI group (1.63±0.52 vs. 1.15±0.65; P = 0.039), and the SMA+CA orifice calcification scores were significantly different between the groups (3.00±0.76 vs. [non-NOMI] 2.25±1.18; P = 0.028). In all patients, the 30-day and in-hospital mortality rates were 13% and 18%, respectively. All patients were completely followed up with a mean follow-up period of 604±585 days. Kaplan–Meier survival curves showed that patients with SMA and CA calcification tended to have a shorter overall survival than patients without calcification; however, no significant difference was noted.
Conclusions: The calcification of CA and/or SMA orifices was associated with postoperative NOMI and poor long-term survival among dialysis patients undergoing cardiac surgery.
Acosta S, Ogren M, Sternby NH, Bergqvist D, Björck M. 2006. Fatal nonocclusive mesenteric ischaemia: Population-based incidence and risk factors. J Intern Med. 259:305-13.
Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R. 1990. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 15:827-32.
Chertow GM, Raggi P, Chasan-Taber S, Bommer J, Holzer H, Burke SK. 2004. Determinants of progressive vascular calcification in haemodialysis patients. Nephrol Dial Transplant. 19:1489-96.
Davies MR, Hruska KA. 2001. Pathophysiological mechanisms of vascular calcification in end-stage renal disease. Kidney Int. 60:472-9.
Groesdonk HV, Klingele M, Schlempp S, et al. 2013. Risk factors for nonocclusive mesenteric ischemia after elective cardiac surgery. J Thorac Cardiovasc Surg. 145:1603-10.
Guillaume A, Pili-Floury S, Chocron S, et al. 2017. Acute mesenteric ischemia among postcardiac surgery patients presenting with multiple organ failure. Shock. 47:296-302.
Juif A, Calame P, Winiszewski H, et al. 2021. Atherosclerosis is associated with poorer outcome in non-occlusive mesenteric ischemia. Eur J Radiol. 134:109453.
Klotz S, Vestring T, Rötker J, Schmidt C, Scheld HH, Schmid C. 2001. Diagnosis and treatment of nonocclusive mesenteric ischemia after open heart surgery. Ann Thorac Surg. 72:1583-6.
Mazzei MA, Volterrani L. 2015. Nonocclusive mesenteric ischaemia: think about it. Radiol Med. 120:85-95.
Okuno S, Ishimura E, Kitatani K, et al. 2007. Presence of abdominal aortic calcification is significantly associated with all-cause and cardiovascular mortality in maintenance hemodialysis patients. Am J Kidney Dis. 49:417-25.
Pérez-García C, de Miguel Campos E, Fernández Gonzalo A, et al. 2018. Non-occlusive mesenteric ischaemia: CT findings, clinical outcomes and assessment of the diameter of the superior mesenteric artery. Br J Radiol. 91:20170492.
Quiroga B, Verde E, Abad S, et al. 2013. Detection of patients at high risk for non-occlusive mesenteric ischemia in hemodialysis. J Surg Res. 180:51-5.
Sakamoto T, Fujiogi M, Matsui H, Fushimi K, Yasunaga H. 2020. Clinical features and outcomes of nonocclusive mesenteric ischemia after cardiac surgery: A retrospective cohort study. Heart Vessels 35:630-6.
Sato H, Nakamura M, Uzuka T, Kondo M. 2018. Detection of patients at high risk for nonocclusive mesenteric ischemia after cardiovascular surgery. J Cardiothorac Surg. 13:115.
Taniwaki H, Ishimura E, Tabata T, et al. 2005. Aortic calcification in haemodialysis patients with diabetes mellitus. Nephrol Dial Transplant. 20:2472-8.
Terlouw LG, van Noord D, van Walsum T, Bruno MJ, Moelker A. 2021. Mesenteric artery calcium scoring: A potential screening method for chronic mesenteric ischemia. Eur Radiol. 31:4212-20.
Terlouw LG, van Noord D, van Walsum T, van Dijk LGD, Moelker A, Bruno MJ. 2021. Early risk stratification of patients with suspected chronic mesenteric ischaemia using a symptom and mesenteric artery calcium score based score chart. United European Gastroenterol. J 9:626-34.