Optimizing outcome and quality of life for mesenteric ischemia patients by improving diagnostic and treatment strategies

Juliëtte Blauw

Research output: ThesisPhD Thesis - Research external, graduation UT

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Abstract

With this thesis we have shown that outcome for mesenteric ischemia patients has improved over time. The main reasons for this are the introduction of minimally invasive treatment options and increased awareness of the disease. Both have let to more organ-sparing strategies and enhancement of quality of life.
Timely diagnosis is still very difficult. Although many researchers have tried to find a biomarker or combination of biomarkers to aid in the diagnostic process of AMI patients, we have shown that the use of biomarkers in the diagnostic process of AMI is insufficiently substantiated. The actual diagnosis of AMI can currently only be made on the basis of a high index of suspicion followed by a multislice CTA.
To save bowel and reduce morbidity and mortality, prompt revascularization is essential before assessment of bowel with possible resection should be performed. We have shown that endovascular treatment (EVT) has replaced open surgical revascularization as primary treatment strategy with antegrade (PMAS) as the first and retrograde (ROMS) as the second option. Although EVT has a lower primary patency, the less invasive character and concomitant lower morbidity and mortality is favourable for these cachectic and severely ill patients.
While great progress has been made in treatment options in the field of atherosclerotic mesenteric ischemia for years, the raison d'être of the median arcuate ligament syndrome (MALS) is still a huge point of discussion. With our comprehensive systematic review, we have shown that (endoscopic) coeliac artery release (e)CAR gives a sustainable symptom relief of 68% in adults and 82% in paediatric patients. These results were the basis for our application to the Dutch National Health Institute, who have appointed us €1,3M for our blinded, randomised controlled trial comparing (e)CAR with a sham operation in patients suspected of MALS. It is estimated that the CARoSO trial will end the debate, whether MALS really does exist and if (e)CAR is a cost-effective treatment for these patients.
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
  • University of Twente
Supervisors/Advisors
  • Geelkerken, Bob, Supervisor
  • Brusse-Keizer, Marjolein G.J., Co-Supervisor
Award date25 Mar 2022
Place of PublicationEnschede
Publisher
Print ISBNs978-90-365-5327-8
DOIs
Publication statusPublished - 25 Mar 2022

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