The Impact of Revascularisation on Quality of Life in Chronic Mesenteric Ischemia

J T M Blauw, H A M Pastoors, M Brusse-Keizer, R J Beuk, J J Kolkman, R H Geelkerken, For The Dutch Mesenteric Ischemia Study Group, J T M Blauw, H A M Pastoors, M Brusse-Keizer, R J Beuk, J J Kolkman, R H Geelkerken, For The Dutch Mesenteric Ischemia Study Group

Abstract

Background: Chronic mesenteric ischemia (CMI) is characterized by long-standing abdominal symptoms due to insufficient mesenteric circulation. Data on the effect of revascularisation on quality of life (QoL) for CMI are scarce. This study is the first to evaluate the impact of revascularisation on quality of life.

Methods: Seventy-nine patients with CMI or acute-on-chronic mesenteric ischemia (AoCMI) underwent an intervention of one or more mesenteric arteries between January 2010 and July 2012. QoL before and after intervention was measured with the EuroQol-5D. Preintervention questionnaires were of standard care. Postintervention data were obtained by resending a questionnaire to the patients between February and May 2013. To investigate the clinical relevance of our findings, the minimal clinically important difference (MCID) was used. Since there is no established MCID for CMI, we used the literature reference MCID of inflammatory bowel syndrome (IBS) of 0.074.

Results: Fifty-five (69.6%) of 79 patients returned their questionnaire and 23 (29.1%) were completely filled out. There was a significant increase of the median EQ-index score from 0.70 to 0.81 (p=0.02) and a significant reduction of symptoms in the domains usual activities (34.4%) and pain/discomfort (32.3%). There was a significant improvement of 17% in overall current health condition (VAS) (p=0.001). The MCID between baseline and postoperative EQ-5D index score was 0.162, indicating a clinically relevant improvement of quality of life after revascularisation.

Conclusion: Quality of life of CMI patients is improved after mesenteric artery revascularisation.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Copyright © 2019 J. T. M. Blauw et al.

Figures

Figure 1
Figure 1
Flowchart of patient inclusion.

References

    1. Björck M., Koelemay M., Acosta S., et al. Editor’s choice—management of the diseases of mesenteric arteries and veins: clinical practice guidelines of the European society of vascular surgery (ESVS) European Journal of Vascular and Endovascular Surgery. 2017;53(4):460–510. doi: 10.1016/j.ejvs.2017.01.010.
    1. ter Steege R. W. F., Sloterdijk H. S., Geelkerken R. H., Huisman A. B., van der Palen J., Kolkman J. J. Splanchnic artery stenosis and abdominal complaints: clinical history is of limited value in detection of gastrointestinal ischemia. World Journal of Surgery. 2012;36(4):793–799. doi: 10.1007/s00268-012-1485-4.
    1. Hogendoorn W., Hunink M. G. M., Schlösser F. J. V., Moll F. L., Muhs B. E., Sumpio B. E. A comparison of open and endovascular revascularization for chronic mesenteric ischemia in a clinical decision model. Journal of Vascular Surgery. 2014;60(3):715–725. doi: 10.1016/j.jvs.2014.03.009.
    1. Chandra A., Quinones-Baldrich W. J. Chronic mesenteric ischemia: how to select patients for invasive treatment. Seminars in Vascular Surgery. 2010;23(1):21–28. doi: 10.1053/j.semvascsurg.2009.12.003.
    1. Johnston K. W., Lindsay T. F., Walker P. M., Kalman P. G. Mesenteric arterial bypass grafts: early and late results and suggested surgical approach for chronic and acute mesenteric ischemia. Surgery. 1995;118(1):1–7. doi: 10.1016/s0039-6060(05)80002-9.
    1. Blauw J. T. M., Bulut T., Oderich G. S., Geelkerken B. R. H. Mesenteric vascular treatment 2016: from open surgical repair to endovascular revascularization. Best Practice & Research Clinical Gastroenterology. 2017 Feb;31(1):75–84. doi: 10.1016/j.bpg.2017.01.002.
    1. van Petersen A. S., Vriens B. H., Huisman A. B., Kolkman J. J., Geelkerken R. H. Retroperitoneal endoscopic release in the management of celiac artery compression syndrome. Journal of Vascular Surgery. 2009;50(1):140–147. doi: 10.1016/j.jvs.2008.12.077.
    1. Atkins M. D., Kwolek C. J., LaMuraglia G. M., Brewster D. C., Chung T. K., Cambria R. P. Surgical revascularization versus endovascular therapy for chronic mesenteric ischemia: a comparative experience. Journal of Vascular Surgery. 2007;45(6):1162–1171. doi: 10.1016/j.jvs.2007.01.067.
    1. Schermerhorn M. L., Giles K. A., Hamdan A. D., Wyers M. C., Pomposelli F. B. Mesenteric revascularization: management and outcomes in the United States, 1988–2006. Journal of Vascular Surgery. 2009;50(2):341–348. doi: 10.1016/j.jvs.2009.03.004.
    1. Pecoraro F., Rancic Z., Lachat M., et al. Chronic mesenteric ischemia: critical review and guidelines for management. Annals of Vascular Surgery. 2013;27(1):113–122. doi: 10.1016/j.avsg.2012.05.012.
    1. van Petersen A. S., Kolkman J. J., Beuk R. J., Huisman A. B., Doelman C. J. A., Geelkerken R. H. Open or percutaneous revascularization for chronic splanchnic syndrome. Journal of Vascular Surgery. 2010;51(5):1309–1316. doi: 10.1016/j.jvs.2009.12.064.
    1. Bulut T., Oosterhof-Berktas R., Geelkerken R. H., Brusse-Keizer M., Stassen E. J., Kolkman J. J. Long-term results of endovascular treatment of atherosclerotic stenoses or occlusions of the coeliac and superior mesenteric artery in patients with mesenteric ischaemia. European Journal of Vascular and Endovascular Surgery. 2017;53(4):583–590. doi: 10.1016/j.ejvs.2016.12.036.
    1. Blauw J. T. M., Meerwaldt R., Brusse-Keizer M., Kolkman J. J., Gerrits D., Geelkerken R. H. Retrograde open mesenteric stenting for acute mesenteric ischemia. Journal of Vascular Surgery. 2014;60(3):726–734. doi: 10.1016/j.jvs.2014.04.001.
    1. Banz V. M., Paul K., de Moya M., Zimmermann H., Candinas D., Exadaktylos A. K. Ignoring non-specific abdominal pain in emergency department patients may be related to decreased quality of life. A follow up of an underestimated problem. Swiss Medical Weekly. 2011;141 doi: 10.4414/smw.2011.13167.w13167
    1. Bovenschen H. J., Laheij R. J. F., Tan A. C. I. T. L., Witteman E. M., Rossum L. G. M., Jansen J. B. M. J. Health-related quality of life of patients with gastrointestinal symptoms. Alimentary Pharmacology and Therapeutics. 2004;20(3):311–319. doi: 10.1111/j.1365-2036.2004.02076.x.
    1. Detmar S. B., Muller M. J., Schornagel J. H., Wever L. D. V., Aaronson N. K. Health-related quality-of-life assessments and patient-physician communication: a randomized controlled trial. JAMA. 2002;288(23):3027–3034. doi: 10.1001/jama.288.23.3027.
    1. Kolkman J. J., Mensink P. B. F., Petersen A. S. v., Huisman A. B., Geelkerken R. H. Clinical approach to chronic gastrointestinal ischaemia: from “intestinal angina” to the spectrum of chronic splanchnic disease. Scandinavian Journal of Gastroenterology. 2004;39(241):9–16. doi: 10.1080/00855920410010933.
    1. Rabin R., Charro F. d. EQ-SD: a measure of health status from the EuroQol group. Annals of Medicine. 2001;33(5):337–343. doi: 10.3109/07853890109002087.
    1. Jaeschke R., Singer J., Guyatt G. H. Measurement of health status: ascertaining the minimal clinically important difference. Controlled Clinical Trials. 1989;10(4):407–415. doi: 10.1016/0197-2456(89)90005-6.
    1. Gerlinger C., Schumacher U., Faustmann T., Colligs A., Schmitz H., Seitz C. Defining a minimal clinically important difference for endometriosis-associated pelvic pain measured on a visual analog scale: analyses of two placebo-controlled, randomized trials. Health and Quality of Life Outcomes. 2010;8(1):p. 138. doi: 10.1186/1477-7525-8-138.
    1. Walters S. J., Brazier J. E. Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D. Quality of Life Research. 2005;14(6):1523–1532. doi: 10.1007/s11136-004-7713-0.
    1. Rutherford R. B., Baker J. D., Ernst C., et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. Journal of Vascular Surgery. 1997;26(3):517–538. doi: 10.1016/s0741-5214(97)70045-4.
    1. Diehm N., Baumgartner I., Jaff M., et al. A call for uniform reporting standards in studies assessing endovascular treatment for chronic ischaemia of lower limb arteries. European Heart Journal. 2007;28(7):798–805. doi: 10.1093/eurheartj/ehl545.
    1. Skelly C. L., Stiles-Shields C., Mak G. Z., et al. The impact of psychiatric comorbidities on patient-reported surgical outcomes in adults treated for the median arcuate ligament syndrome. Journal of Vascular Surgery. 2018;68(5):1414–1421. doi: 10.1016/j.jvs.2017.12.078.
    1. Wagenhäuser M. U., Meyer-Janiszewski Y. K., Dueppers P., et al. Chronic mesenteric ischemia: patient outcomes using open surgical revascularization. Digestive Surgery. 2017;34(4):340–349. doi: 10.1159/000464413.
    1. Gralnek I. M., Hays R. D., Kilbourne A., Naliboff B., Mayer E. A. The impact of irritable bowel syndrome on health-related quality of life. Gastroenterology. 2000;119(3):654–660. doi: 10.1053/gast.2000.16484.
    1. Hou X., Chen S., Zhang Y., et al. Quality of life in patients with irritable bowel syndrome (IBS), assessed using the IBS-quality of life (IBS-QOL) measure after 4 and 8 weeks of treatment with mebeverine hydrochloride or pinaverium bromide: results of an international prospective observational cohort study in Poland, Egypt, Mexico and China. Clinical Drug Investigation. 2014;34(11):783–793. doi: 10.1007/s40261-014-0233-y.
    1. Cremonini F., Nicandro J. P., Atkinson V., Shringarpure R., Chuang E., Lembo A. Randomised clinical trial: alosetron improves quality of life and reduces restriction of daily activities in women with severe diarrhoea-predominant IBS. Alimentary Pharmacology & Therapeutics. 2012;36(5):437–448. doi: 10.1111/j.1365-2036.2012.05208.x.
    1. Wang Y. T., Lim H. Y., Tai D., et al. The impact of irritable bowel syndrome on health-related quality of life: a Singapore perspective. BMC Gastroenterol. 2012;12(1):p. 104. doi: 10.1186/1471-230x-12-104.
    1. Gibson P. R., Vaizey C., Black C. M., et al. Relationship between disease severity and quality of life and assessment of health care utilization and cost for ulcerative colitis in Australia: a cross-sectional, observational study. Journal of Crohn’s and Colitis. 2014;8(7):598–606. doi: 10.1016/j.crohns.2013.11.017.
    1. Stark R. G., Reitmeir P., Leidl R., König H.-H. Validity, reliability, and responsiveness of the EQ-5D in inflammatory bowel disease in Germany. Inflammatory Bowel Diseases. 2010;16(1):42–51. doi: 10.1002/ibd.20989.
    1. Probert C. S. J., Dignass A. U., Lindgren S., Oudkerk Pool M., Marteau P. Combined oral and rectal mesalazine for the treatment of mild-to-moderately active ulcerative colitis: rapid symptom resolution and improvements in quality of life. Journal of Crohn’s and Colitis. 2014;8(3):200–207. doi: 10.1016/j.crohns.2013.08.007.
    1. de Buck van Overstraeten A., Wolthuis A. M., Vermeire S., et al. Long-term functional outcome after ileal pouch anal anastomosis in 191 patients with ulcerative colitis. Journal of Crohn’s and Colitis. 2014;8(10):1261–1266. doi: 10.1016/j.crohns.2014.03.001.
    1. Malik B. A., Gibbons K., Spady D., Lees G., Otley A., Huynh H. Q. Health-related quality of life in pediatric ulcerative colitis patients on conventional medical treatment compared to those after restorative proctocolectomy. International Journal of Colorectal Disease. 2013;28(3):325–333. doi: 10.1007/s00384-012-1561-0.
    1. Luo N., Johnson J. A., Coons S. J. Using instrument-defined health state transitions to estimate minimally important differences for four preference-based health-related quality of life instruments. Medical Care. 2010;48(4):365–371. doi: 10.1097/mlr.0b013e3181c162a2.

Source: PubMed

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