Acute mesenteric ischemia: endovascular therapy (original) (raw)
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The role of endovascular therapy in acute mesenteric ischemia
Annals of Gastroenterology
Background Endovascular therapy, including aspiration thrombectomy and local thrombolytic therapy, often associated with angioplasty and stent placement, has been described in the literature. The purpose of this study was to review case series of patients with acute mesenteric ischemia treated with endovascular therapy and evaluate their outcomes. Methods An online review using PubMed was carried out to identify all English articles about this topic in the time interval from 2005 to 2016. The following variables were extracted: number of patients, cause of occlusion, symptoms, arteries involved, number of sessions of treatment, technical success, clinical success, recurrence rate, complications, mortality rate, number of patients who underwent diagnostic laparoscopy or surgical resection of ischemic bowel. Results Eighteen papers met the inclusion criteria and were included. Among the patients with arterial mesenteric ischemia treated with endovascular approach, the technical success rate was high (up to 100%) and data regarding clinical success are encouraging, even though they are few and heterogeneous. Technical success rate and clinical success of patients with acute venous mesenteric ischemia approached with endovascular treatment was 74-100% and 87.5-100% respectively. Conclusions Current advances in endovascular therapies have made these treatments feasible for mesenteric ischemia.
Comparison of open and endovascular treatment of acute mesenteric ischemia
2014
Introduction: Acute mesenteric ischemia (AMI) is a commonly fatal result of inadequate bowel perfusion that requires immediate evaluation by both vascular and general surgeons. Treatment often involves vascular repair as well as bowel resection and the possible need for parenteral nutrition. Little data exist regarding the rates of bowel resection following endovascular vs open repair of AMI. Methods: Using the National Inpatient Sample database, admissions from 2005 through 2009 were identified according to International Classification of Diseases, Ninth Revision codes correlating to both AMI (557.0) and subsequent vascular intervention (39.26, 38.16, 38.06, 39.9, 99.10). Patients with a diagnosis of AMI but no intervention or nonemergent admission status were excluded. Patient level data regarding age, gender, and comorbidities were also examined. Outcome measures included mortality, length of stay, the need for bowel resection (45.6, 45.71-9, 45.8), or infusion of total parenteral nutrition (TPN; 99.10) during the same hospitalization. Statistical analysis was conducted by c 2 tests and Wilcoxon rank-sum comparisons. Results: Of 23,744 patients presenting with AMI, 4665 underwent interventional treatment from 2005 through 2009. Of these patients, 57.1% were female, and the mean age was 70.5 years. A total of 679 patients underwent vascular intervention; 514 (75.7%) underwent open surgery and 165 (24.3%) underwent endovascular treatment overall during the study period. The proportion of patients undergoing endovascular repair increased from 11.9% of patients in 2005 to 30.0% in 2009. Severity of comorbidities, as measured by the Charlson index, did not differ significantly between the treatment groups. Mortality was significantly more commonly associated with open revascularization compared with endovascular intervention (39.3% vs 24.9%; P [ .01). Length of stay was also significantly longer in the patient group undergoing open revascularization (12.9 vs 17.1 days; P [ .006). During the study time period, 14.4% of patients undergoing endovascular procedures required bowel resection compared with 33.4% for open revascularization (P < .001). Endovascular repair was also less commonly associated with requirement for TPN support (13.7% vs 24.4%; P [ .025).
Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery
World Journal of Emergency Surgery
Acute mesenteric ischemia (AMI) is a group of diseases characterized by an interruption of the blood supply to varying portions of the intestine, leading to ischemia and secondary inflammatory changes. If untreated, this process may progress to life-threatening intestinal necrosis. The incidence is low, estimated at 0.09–0.2% of all acute surgical admissions, but increases with age. Although the entity is an uncommon cause of abdominal pain, diligence is required because if untreated, mortality remains in the range of 50%. Early diagnosis and timely surgical intervention are the cornerstones of modern treatment to reduce the high mortality associated with this entity. The advent of endovascular approaches in parallel with modern imaging techniques is evolving and provides new treatment options. Lastly, a focused multidisciplinary approach based on early diagnosis and individualized treatment is essential. Thus, we believe that updated guidelines from World Society of Emergency Surge...
Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery
World journal of emergency surgery : WJES, 2017
Acute mesenteric ischemia (AMI) is typically defined as a group of diseases characterized by an interruption of the blood supply to varying portions of the small intestine, leading to ischemia and secondary inflammatory changes. If untreated, this process will eventuate in life threatening intestinal necrosis. The incidence is low, estimated at 0.09-0.2% of all acute surgical admissions. Therefore, although the entity is an uncommon cause of abdominal pain, diligence is always required because if untreated, mortality has consistently been reported in the range of 50%. Early diagnosis and timely surgical intervention are the cornerstones of modern treatment and are essential to reduce the high mortality associated with this entity. The advent of endovascular approaches in parallel with modern imaging techniques may provide new options. Thus, we believe that a current position paper from World Society of Emergency Surgery (WSES) is warranted, in order to put forth the most recent and ...
Surgical and endovascular treatment for mesenteric ischemia
Annals of Medical Research, 2018
Mesenteric ischemia is a rare, highly fatal, surgical emergency. In addition to open surgical (OS) intervention, endovascular treatment (ET) was also recommended for treatment in last years. Surgical resection becomes inevitable in the cases of intestinal ischemia. We aimed to assess patient-related factors and compare treatment outcomes in mesenteric ischemia treated by OS and ET. Material and Methods: Patients treated for mesenteric vascular occlusion at our hospital between 2013 and 2018 were retrospectively evaluated. Duration of symptoms, time from symptom onset to treatment, treatment used and surgery used, re-laparotomy need, duration of intensive care unit stay, duration of hospital stay, and 30-day and 1-year mortality rates were evaluated. Results: Twenty patients with mesenteric ischemia were evaluated. The OS group had a significantly higher CCI score than the ET group (p<0.05). The most common comorbidities in the OS and ET groups were coronary artery disease and hypertension, respectively. The duration of symptoms and time from symptom onset to treatment were significantly shorter in the OS group than the ET group (p<0.05). The OS group most commonly had SMA emboli while the ET group most common had chronic SMA occlusion (p<0.05). Thirty-day and 1-year mortality rates were significantly greater in the OS group than the ET group (p<0.05). Conclusion: Mesenteric ischemia is a highly morbid and fatal condition. ET significantly reduces morbidity and mortality in the face of signs of intestinal ischemia. On the other hand, OS would be inevitable for patients with signs of diffuse peritoneal irritation or those with suspected intestinal necrosis.
Contemporary management of acute mesenteric ischemia: Factors associated with survival
Journal of Vascular Surgery, 2002
Acute mesenteric ischemia (AMI) is a morbid condition with a difficult diagnosis and a high rate of complications, which is associated with a high mortality rate. For the evaluation of the results of current management and the examination of factors associated with survival, we reviewed our experience. Methods: The clinical data of all the patients who underwent operation for AMI between January 1, 1990, and December 31, 1999, were retrospectively reviewed, clinical outcome was recorded, and factors associated with survival rate were analyzed. Results: Fifty-eight patients (22 men and 36 women; mean age, 67 years; age range, 35 to 96 years) underwent study. The cause of AMI was embolism in 16 patients (28%), thrombosis in 37 patients (64%), and nonocclusive mesenteric ischemia (NMI) in five patients (8.6%). Abdominal pain was the most frequent presenting symptom (95%). Twentyfive patients (43%) had previous symptoms of chronic mesenteric ischemia. All the patients underwent abdominal exploration, preceded with arteriography in 47 (81%) and with endovascular treatment in eight. Open mesenteric revascularization was performed in 43 patients (bypass grafting, n = 22; thromboemboiectomy, n = 19; patch angioplasty, n = 11; endarterectomy, n = 5; reimplantation, n = 2). Thirty-one patients (53%) needed bowel resection at the first operation. Twenty-three patients underwent second-look procedures, 11 patients underwent bowel resections (repeat resection, n = 9), and three patients underwent exploration only. The 30-day mortality rate was 32%. The rate was 31% in patients with embolism, 32% in patients with thrombosis, and 80% in patients with NMI. Multiorgan failure (n = 18 patients) was the most frequent cause of death. The cumulative survival rates at 90 days, at 1 year, and at 3 years were 59%, 43%, and 32%, respectively, which was lower than the rate of a Midwestern white control population (P < .001). Six of the 16 late deaths (38%) occurred because of complications of mesenteric ischemia. Age less than 60 years (P < .003) and bowel resection (P = .03) were associated with improved survival rates. Conclusion: The contemporary management of AMI with revascularization with open surgical techniques, resection of nonviable bowel, and liberal use of second-look procedures results in the early survival of two thirds of the patients with embolism and thrombosis. Older patients, those who did not undergo bowel resection, and those with NMI have the highest mortality rates. The long-term survival rate remains dismal. Timely revascularization in patients who are symptomatic with chronic mesenteric ischemia should be considered to decrease the high mortality rate ofAMI. (J Vasc Surg 2002;35:445-52.) Acute mesenteric ischemia (AMI) is an uncommon condition. It can occur as a result of acute arterial thrombosis, usually as a complication of underlying atherosclerosis, or, less frequently, because ofarteritis, fibromuscular dysplasia, dissection, trauma, or mesenteric aneurysm rupture.k2 In mesentcric embolism, the embolus originates from the left ventricle, from the lef~ atrium, or, less frequently, from the thoracic or upper abdominal aorta, a 6 Nonocclusive mesenteric ischemia (NMI) develops as a result of hypoperfusion caused by a low cardiac output or From the Division of Vascular Surgery a and the Section of Biostatistics, Mayo Clinic. b Competition of interest: nil.
Surgical Management of Acute Mesenteric Ischemia; Review Article
Journal of Pharmaceutical Research International, 2021
Mesenteric ischemia is a condition in which the amount of oxygen available is insufficient to meet the needs of the intestines. The small intestine, colon, or both can be affected by ischemia. The most common cause of occlusive ischemia is an abrupt obstruction of a major artery, which causes a considerable drop in intestinal blood flow. Early diagnosis is one of the most essential components in achieving a favorable outcome. The most prevalent treatment is surgical management. However, there are minimally invasive therapy alternatives that have been shown in observational studies. For arterial thrombosis, endovascular stenting is an option, and anticoagulation is an option for venous thrombosis. Endovascular aspiration, mechanical embolectomy, and local thrombolysis are all possibilities for patients with arterial embolism.
Surgical Management of Acute Mesenteric Ischemia: A Review
2017
Acute mesenteric ischemia (AMI) is an unusual however highly lethal vascular emergency situation, in which intense intestinal ischemia or even infarction may take place if efficient treatment is not supplied immediately. High mortality rates of 30% to 65% have been reported in a number of big scientific series in the past years. The aim of this study was to discuss the surgical management of AMI, also we intended to overview the diagnostic procedures, and mortality and morbidity associated with surgical treatment outcomes. A comprehensive search was conducted through: PubMed/Midline, of the English-language published literature containing human subject, using the terms „„acute‟‟ and „„mesenteric‟‟ or „„mesentery,‟‟ AND “surgical management” or treatment” was performed to identify all articles reporting AMI treated surgical procedures between up to December 2016. Our evaluation of relevant literature found that the conventional management of AMI was open surgical technique, particula...
Acta Cardiologica Sinica, 2017
The current standard care for acute mesenteric ischemia (AMEI) involves urgent revascularization and resection of the necrotic bowel. Since 2012, we have used an AMEI protocol of our own design, which focused on early treatment and allowed interventional cardiologists to become involved when interventional radiologist was not available. A total of 8 patients were treated, and two interventional cardiologists performed all the stenting procedures. The procedure success rate was 100% in patients with non-calcified lesions (6/8). The 30-day survival rate was 100% in patients with angiographic success, and was 0% in patients with failed procedure. In two patients with total occlusion of the superior mesenteric artery, laparotomy was avoided when interventions were successful and completed within six hours of protocol activation. Four surviving patients were discharged after short intensive care unit stays (less than 48 hours); these patients returned to and remained at home throughout t...
Clinical Journal of Gastroenterology, 2011
A 77-year-old man with hypertension, diabetes mellitus, ischemic heart disease and a smoking habit presented at our hospital with sudden abdominal pain. Computed tomography indicated edematous swelling and pneumatosis of the intestinal wall in a localized area of the ascending colon with inflamed adipose tissue. Acute mesenteric ischemia was diagnosed. Abdominal angiography showed stenosis of the mesenteric arteries. Virtual histology-intravascular ultrasound imaging indicated a fibrous change in the superior mesenteric artery with a necrotic core. Endovascular treatment with stent placement after percutaneous transluminal angioplasty was effective. Surgery would usually be considered as the first choice for treating patients with acute mesenteric ischemia; however, when this condition is complicated with metabolic diseases, stenotic changes in the mesenteric arteries that would normally be found in patients with chronic mesenteric ischemia need to be considered to ensure optimal treatment.