Table 5: Chronic Mesenteric Artery Disease Elements and Definitions

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1 History Risk Factors Atherosclerosis Known atherosclerosis in any vascular territory Patient Assessment - Symptoms Indicate if any of the symptoms listed below are present Symptoms suggestive of mesenteric ischemia Post-prandial abdominal pain Fear of eating Weight loss Malnutrition Malabsorption/steatorrhea Abdominal fullness, bloating, discomfort following eating that ultimately results in fear of food. Weight loss, anorexia, failure to thrive. All associated with presence of atherosclerosis in other vascular beds, or the presence of cardiac dysrhythmia (i.e. atrial fibrillation) or severe left ventricular dysfunction Pain, bloating, early satiety following ingestion of food and/or liquids Avoidance of eating due to predictable abdominal pain, often resulting in more frequent eating of small amounts of food Specify the amount of weight loss in pounds or kilograms Due to inadequate caloric intake to meet metabolic demands, as well as dehydration, the patient manifests malnutrition. Diarrhea Oily stool Floating stool Physical Examination Complete Abdominal Examination Body Habitus Aortic diameter Abdominal Bruit Rectal Exam Digital rectal exam Stool testing for occult blood Laboratory Testing Amylase, Lipase Indicate the patient s body habitus. Choose one of the following: Thin rmal Obese Estimate of abdominal aortic diameter by palpation in inches or centimeters Indicate the absence or presence of abdominal bruit. Choose one of the following: Absent Present Examination of the lower rectum to check for abnormalities in the rectum and stool (Hemoccult). Occult blood present or absent Indicate the following: Date of test Value Unit of measurement rmal range

2 Stool fat content Microscopic indicate the number of stainable lipid globules per high-powered microscope field Gravimetric indicate the collection period (number of days), reference range and test result in grams of lipid per 24 hours Titrimetric Fecal occult blood Occult blood present or absent Non-invasive Diagnostic Procedures Mesenteric artery duplex ultrasound Indicate the date of the procedure Operator name Last name, First Middle Peak systolic velocity measurements Aorta Ratio of mesenteric artery to aorta Record ratio for celiac, superior mesenteric, and inferior peak systolic velocities mesenteric arteries Location of stenosis Indicate the location of stenosis. Choose all that apply: Category of stenosis Specify for celiac, superior mesenteric, and inferior mesenteric arteries. Choose one of the following: 0-69% 70-99% Occlusion Computed Tomographic Angiography Artery imaged Location of stenosis Artery stenosis Indicate the artery imaged. Choose all that apply: Indicate the location of the stenosis formula; 100 x (1 minimum lumen diameter)/maximum diameter of reference segment Aneurysm Dilation of a mesenteric artery to a diameter 1.5 times its nondilated diameter

3 Small and large bowel Indicate if there is thickening of the small or large bowel wall. Choose one of the following: Free air in the abdomen Mesenteric venous thrombosis Pneumatosis coli Magnetic Resonance Angiography Artery imaged Location of stenosis Artery stenosis Indicate the presence of free air in the abdomen. Choose one of the following: Patent venous opacification of the superior mesenteric vein and portal vein Indicate the presence of pneumatosis coli Indicate the artery imaged. Choose all that apply: Indicate the location of the stenosis. formula; 100 x (1 minimum lumen diameter)/maximum diameter of reference segment Aorta Small and large bowel Free air in the abdomen Mesenteric venous thrombosis Pneumatosis coli Diagnostic Procedure Invasive Catheter-based angiography Identify atherosclerosis, stenosis, occlusion, and/or aneurysm of the abdominal aorta Indicate if there is thickening of the small or large bowel wall. Choose one of the following: Indicate the presence of free air in the abdomen. Choose one of the following: Patent venous opacification of the superior mesenteric vein and portal vein Indicate the presence of pneumatosis coli

4 Artery imaged Indicate the artery imaged. Choose all that apply: Artery stenosis formula; 100 x (1 minimum lumen diameter)/maximum diameter of reference segment Aorta Diffuse vasospasm Mesenteric venous thrombosis Identify atherosclerosis, stenosis, occlusion, and/or aneurysm of the abdominal aorta Indicate presence or absence of vasospasm consistent with non occlusive mesenteric ischemia Indicate whether the superior mesenteric vein and portal vein are patent or occluded by thrombus Invasive Therapeutic Procedures Catheter based Mesenteric Artery AngioplastyStenting Angioplasty/stenting Balloon length Nominal balloon diameter Stent type Stent brand name Stent model Stent manufacturer Stent length Stent diameter Choose one: Balloon angioplasty alone Stent Indicate the length of the balloon used in mm Indicate the diameter of the balloon at initial inflation and final inflation in mm Indicate the type of stent used. Choose all that apply: Balloon expandable Self-expanding Drug eluting stent Covered stent Identify the brand name of the stent used Indentify the model number of the stent used Identify the manufacturer of the stent used Indicate the length of the stent used in mm Indicate the diameter of the stent used in mm

5 Target mesenteric artery Indicate whether the target vessel for the procedure is celiac, superior mesenteric, and/or inferior mesenteric artery Current procedure part of clinical trial Indicate whether the procedure is part of a clinical trial. Choose one: If yes, indicate the trial type: - IDE - Post-market approval - Other (specify) Anesthesia Indicate if the patient received general anesthesia, conscious sedation, local anesthesia or no anesthesia during the current procedure Procedure indications and anatomic variables Clinical indication Symptoms of mesenteric ischemia Weight loss Malnutrition Other Re-stenosis in target vessel after prior renal stent Note if the indication for the current procedure is restenosis in the target mesenteric artery which was previously treated with an angioplasty and/or stent. Contrast volume Fluoroscopy Time Procedure arterial access site Indicate the volume of iodinated contrast injected during the procedure in milliliters (ml). Indicate total fluoroscopy time recorded during the procedure visit to the nearest 0.1-minute. The time recorded should include the total time for the procedure. Indicate the primary arterial access site utilized to perform the carotid artery stenting (CAS) procedure. Note location: Femoral Brachial Radial Axillary Arterial access closure method List methods and devices in chronological order of closure. Indicate the method used to achieve hemostasis. - Device - Nondevice (such as manual compression) Lesions Target lesion location Indicate location of target lesion

6 Visible thrombus present Indicate if the target lesion contains thrombus as assessed by baseline angiography and implied by presence of filling defect. Calcification - Indicate if calcification is present. If calcification is present, specify location. Choose one of the following: ne Mild Moderate Severe Lesion length Minimal luminal diameter (MLD) Indicate the length of the target lesion in millimeters (mm) as assessed by baseline angiography. Indicate the target lesion s minimum luminal diameter in millimeters (mm) as assessed by baseline angiography. Diameter of distal mesenteric artery Pre-procedure % stenosis of mesenteric artery Indicate the diameter of the non-tapering distal segment of mesenteric artery measurement at the intended landing zone of the distal edge of the stent formula; 100 x (1 minimum lumen diameter)/maximum diameter of reference segment Lesion treatment incomplete or aborted Embolic protection attempted Indicate if the lesion treatment was incomplete or aborted. Choose one of the following: - If yes, note reasons: Failure to gain vascular access. Failure to engage ostium with guide catheter Unable to cross with guide wire. Unable to deploy stent. Failure to confirm significant stenosis. Unable to cross balloon. Cardiac ischemia Unable to deploy device Hypotension Hypertension Unable to deliver stent Other Indicate if the operator attempted to use an embolic protection device (EPD). Choose one of the following: - If yes, indicate if pre-dilatation prior to balloon or stent was performed or not. - If yes, list EPD in chronological order. Note if successfully deployed.

7 Stent mal-position Indicate if the stent was deployed in a location or position other than for which it was intended. Final minimal luminal diameter (MLD) Final % stenosis of mesenteric artery Indicate the final residual lumen diameter in millimeters (mm) formula; 100 x (1 minimum lumen diameter)/maximum diameter of reference segment How many stents used (per artery)? One More than one Invasive Therapeutic Procedure Surgical Revascularization Aortomesenteric bypass graft surgery Proximal anastomosis Indicate location of proximal anastomosis location with graft (i.e. supraceliac aorta, iliac artery) Distal anastomosis Indicate location of distal anastomosis location with graft (i.e. midceliac artery, mid-superior mesenteric artery) Conduit Indicate type of graft material used for bypass (i.e. synthetic, autologous Mesenteric Endarterectomy Outcomes of Endovascular/Open Surgery Procedures Time Points Complications of endovascular procedure Indicate the period at which outcome measures are assessed. Choose all that apply: Peri-procedure (24 hour) Procedure related (30-days) 3 months 6 months 1 year Indicate postoperative clinical events or conditions associated with the endovascular procedure. Choose all that apply: Pseudoaneurysm AV fistula Hematoma Dissection Vessel thrombosis Vessel perforation Atheromatous embolization Contrast nephropathy Contrast hypersensitivity Requirement of intervention to prevent permanent impairment/damage

8 Complications of Open surgery Indicate the complications of open surgery. Choose all that apply: Minor complication Major complication; i.e. life-threatening Death Hospitalization including prolonged hospitalization Hemodynamic Infection Coagulopathy Thrombosis Systemic Graft Clinical outcomes Time points Patient assessment Indicate the period at which outcome measures are assessed. Choose all that apply: 1 month 3 months 6 months 1 year Assess recurrent signs and symptoms of mesenteric disease: Appetite Caloric intake Nutritional status Presence or absence of post-prandial abdominal pain Food avoidance/tolerance Weight loss/gain Adverse events Recurrent bowel ischemia/infarction Repeat revascularization Bowel resection Myocardial infraction Stroke Other adverse event Death