Local thrombolytic therapy in acute mesenteric ischemia (original) (raw)
Related papers
Acute Mesenteric Ischemi a (AMI): A surgical perspective
SPG BioMed
Acute mesenteric ischemia (AMI) is a rare surgical emergency as it involves perfusion and need frequent surgical interventions. It is a life threatening emergency with a poor prognosis. It is classified according to the etiological basis thromboembolism, non-obstructive and venous origin. AMI has various risk factors ranging from cardiac arrhythmias to the intraabdominal hypertension. Apart from the signs and symptoms, the multi-detector computer tomography remains a diagnostic tool with accuracy. In the management of AMI patients' initial resuscitation, hydration and analgesia play important role, however the operative /interventional management is either endovascular thrombectomy with or without stenting when there is no bowel involvement or peritonitis. The laparotomy with open vascular thrombectomy with vascular graft, it is indicated when bowel involvement and peritonitis patients. Often the whole bowel is gangrenous and no further treatment is needed because of certain mortality. The 2 nd step is to know the extent of bowel involvement meticulously and resection of bowel with necrosis or gangrene with anastomosis, further relook laparotomies and resection of the bowel may be need. Initially abdomen will be closed with Bagota bag or VAC (Vacuum Assisted Closed) dressing and final staged abdominal closer, once pathology resolves completely. As far as prevention of all types
Polish Journal of Surgery, 2020
Background: Acute mesenteric ischemia (AMI) is a catastrophic abdominal emergency characterized by sudden critical interruption to the intestinal blood flow which commonly leads to bowel infarction and death. AMI still has a poor prognosis with an in-hospital mortality rate of 50-69%. This high mortality rate is related to the delay in diagnosis which is often difficult and overlooked. Early intervention is crucial and gives a chance for intestinal viability. Methods: The charts of 140 patients who were hospitalized with AMI between May 1997 and August 2013 in Ege University Faculty of Medicine, Department of General Surgery were retrospectively reviewed. Demographical and clinical features of patients constituting the best predictors of morbidity and mortality were evaluated with Multiple Logistic Regression analysis by Enter method after adjustment for all possible confounding factors. Results: Out of 140 patients, 77 were men (55%) and 63 were women (45%). The mean age was 66.6 ± 14.5 (16-94) years. Demographical findings, comorbidities, ASA scores, drugs used for mesenteric ischemia and diagnostic imaging materials were summarized. The most common comorbidities were cardiac problems (42.9%). Twenty-seven (19.3%) patients had diabetes mellitus. The median ASA score was 3. Abdominal computed tomography (CT) was the most commonly used imaging modality and it was performed in 119 (85%) patients. Twenty-five (17.9%) patients were in shock and 48 (34.3%) had acidosis. The time of delay between the onset of acute abdominal pain to surgery was <12 hours in 14 patients (10.0%), 12 to 24 hours in 46 patients (32.9%), and >24 hours in 80 patients (57.1%). The most common etiology in AMI was thrombus, in 69 patients (49.3%). The most affected or involved organ was both small and large bowel-in 80 patients (57.1%) in total. The most commonly performed surgery was small bowel resection-in 42 patients (30%). As many as 127 (90.7%) of all patients underwent surgery and 18 (12.9%) patients underwent a second-look laparotomy. Small bowel length of less than 100 cm was recorded in 46 patients (32.9%). The length of hospital stay was 7 days (1-90 days). Morbidities were found in 51 patients (36.4%) and death in 74 patients (52.9%). Conclusion: The purpose of this study was to evaluate the prognostic factors of AMI to better understand it and optimize both medical and surgical management with improvement of treatment results. We suggested that the diagnosis of AMI should be based on suspicion of a clinician only and that laparotomy should be performed as soon as possible, before the onset of the clinical signs of peritonitis. Age and time of delay between the onset of acute abdominal pain and surgery longer than 24 hours are the most important prognostic factors for mortality in patients presenting with shock and acidosis.
Identification of Risk Factors for Perioperative Mortality in Acute Mesenteric Ischemia
World Journal of Surgery, 2006
Introduction Acute intestinal ischemia is in most cases a lethal condition with a low survival rate. Risk factors of perioperative mortality are poorly defined. The aim of this study was to define risk factors that predict an adverse outcome of acute mesenteric ischemia (AMI). Methods A total of 132 consecutive patients (73 men, 59 women), mean ± SD age 71.96 ± 13.64 years, who underwent surgery because of AMI in a university tertiary care center were evaluated over a period of 10 years. Clinical features, laboratory findings, etiologic factors, and surgical procedures were recorded and assessed as possible risk factors for perioperative mortality. Results Of 132 patients, 86 (65.2%) died during the perioperative period as a direct result of AMI. Significant univariate predictors of perioperative mortality were age (P = 0.01), cardiopathy (P = 0.002), digoxin intake (P = 0.015), shock (P = 0.01), urea plasma level (P P P = 0.042), low pH (P = 0.015) and bicarbonate (P = 0.035); hemoglobin ≥ 2.48 mmol/L (P = 0.035); time delay to surgery (P = 0.023); colonic involvement (P P P = 0.007); and intestinal resection (P P = 0.045), urea plasma levels (P P Conclusions Age, time delay to surgery, shock, and acidosis significantly increase the risk of mortality due to AMI, whereas intestinal resection has a protective effect. However, only previous cardiac illness, acute renal failure, and large bowel ischemia have a negative effect as independent risk factors of mortality of AMI.
Annals of Gastroenterology, 2019
Background Abdominal exploration followed by vascular bypass has been the standard of care for acute mesenteric ischemia (AMI), but there is increasing use of endovascular treatment with selective exploratory laparotomy. Methods We performed a retrospective review of patients diagnosed with AMI who underwent mesenteric artery angioplasty or stenting at a single institution from 2010-2017. Patients were divided into 3 groups: those who did not undergo exploratory laparotomy; those who received endovascular treatment before laparotomy (post-reperfusion laparotomy group); and those who had endovascular treatment after laparotomy (pre-reperfusion laparotomy group). Results Patients who did not undergo exploratory laparotomy showed 85.7% (12/14) survival, compared with 63.6% (7/11) in the post-reperfusion group and 25.0% (2/8) in the pre-reperfusion group, P=0.077). Time to reperfusion was significant (P=0.009) in predicting survival for patients who underwent exploratory laparotomy. Conclusion Emergent endovascular treatment prior to laparotomy seems to be associated with a higher survival.
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 ...
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...
American Journal of Surgery, 1995
BACKGROUND: The factors associated with outcome of patients with nonocclusive mesenteric ischemia are poorly defined. wETHoDs: Over a 7-year period, 34 consecutive patients with nonocclusive mesenteric ischemia were identified. RESULTS: The mean age of the study patients was 63 years (range 31 to 94); 21 of 34 (62%) were men. The mean delay in diagnosis was 31 hours (range 7 hours to 6 days). Seven of 34 (21%) underwent preoperative visceral arteriography. Two of these 7 required surgery, and both dii as a result of intestinal infarction. The remalning 27 had the diagnosis made at celiotomy. Among the 29 who were explored, 16 of 29 (55%) had intestinal infarction. Twentyone of 29 (72%) had segmentel bowel injury whereas 8 of 29 (28%) had massive injury. Among those with segmental infarMon, primary anastomosis was performed in 12 of 21 patients (57%); 5 of the 12 (42%) died. Nine of 21 patients (43%) underwent delayed anastomosis; 2 of the 9 (22%) died. No patlent with massive injury underwent primary anastomosis. Second&ok laoarotomy ws performed on 22 of 29 (76%). Eleven of those 22 (59%) had a further bowl resection. Overall, 16 of 29 (55%) who UnderweM surgery for nonocclusive mesenWic ischemia are alive.