The role of endovascular therapy in acute mesenteric ischemia (original) (raw)
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Acute mesenteric ischemia: endovascular therapy
Abdominal Imaging, 2007
Acute mesenteric ischemia (AMI) is an abdominal emergency with a high mortality. Prompt revascularization can prevent intestinal infarction and reduce mortality. We report three cases of acute occlusive mesenteric ischemia without signs of intestinal necrosis, which were successfully managed with endovascular interventions. Mechanical thrombus fragmentation was performed and underlying chronic stenoses were treated with stent implantation. All the patients had pain relief immediately after the procedure, and none of them required surgery for bowel resection. The patients remained symptom free during a follow-up of 12-16 months. We suggest that endovascular treatment is a feasible option in patients with AMI and can prevent intestinal infarction.
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).
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...
Endovascular Therapy as a Primary Revascularization Modality in Acute Mesenteric Ischemia
Cardiovascular and interventional radiology, 2015
To evaluate endovascular therapy (EVT) as the primary revascularization method for acute mesenteric ischemia (AMI). A retrospective review was performed on all consecutive patients treated for AMI during a 5-year period (January 2009 to December 2013). EVT was attempted in all patients referred for emergent revascularization. Surgical revascularization was performed selectively after failure of EVT. Patient characteristics, clinical presentation, and outcomes were studied. Failures and complications of EVT were recorded. Fifty patients, aged 79 ± 9 years (mean ± SD), out of 66 consecutive patients with AMI secondary to embolic or thrombotic obstruction of the superior mesenteric artery were referred for revascularization. The etiology of AMI was embolism in 18 (36 %) and thrombosis in 32 (64 %) patients. EVT was technically successful in 44 (88 %) patients. Mortality after successful or failed EVT was 32 %. The rates of emergency laparotomy, bowel resection, and EVT-related complica...
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.
Endovascular Management for Symptomatic Chronic Mesenteric Ischemia: A Single-Center Experience
Vascular and endovascular surgery, 2017
Chronic mesenteric ischemia (CMI) is an uncommon condition encountered by clinicians. Presentation may vary from asymptomatic to classical intestinal ischemia, although a clear pathophysiology has yet to be elucidated. Here, we have presented our institution's experience in the management of symptomatic CMI. From February 2007 to February 2016, a retrospective study was performed of all consecutive patients with symptomatic CMI managed by endovascular treatment (ET). We reviewed these patients' demographics, comorbidities, clinical presentations, and treatment modalities. Perioperative and midterm outcomes included technical success, clinical symptom relief, complications, symptomatic recurrence, mortality, restenosis, and reintervention. Thirty-five mesenteric arteries (74.3% stenotic/25.7% occluded) identified in 32 patients (12 females, 20 males) were treated with endovascular procedures. There were no 30-day deaths; the perioperative complication rate was 12.5%. Overall,...
Endovascular Therapy for Chronic Mesenteric Ischemia
World Journal of Surgery, 2007
Purpose The purpose of this article is to report on the effectiveness and durability of endovascular therapy for obstructive disease of the superior mesenteric artery and celiac trunk. Patients and methods Our retrospective study population included nine patients (five women, four men; mean age 64 years, range 34-83 years) with 15 lesions. The indication for endovascular therapy was chronic mesenteric ischemia. The technical and clinical success rates and the incidence of complications were determined. Follow-up parameters included maintained patency and sustained clinical benefit. Results Ten vessels were treated. The primary technical and clinical success rates were both 100% with no perioperative mortality. Major complications occurred in two patients (pseudoaneurysms). During a mean follow-up of 31 ± 18 months (range 3-60 months), thrombosis occurred in two patients at 1 and 3 months after the procedures, respectively. Thrombosis was successfully treated by catheter-directed intraarterial thrombolysis followed by percutaneous transluminal angioplasty (PTA) (n = 1) or
Endovascular treatment of mesenteric ischemia
Catheterization and Cardiovascular Interventions, 2011
Objectives: Our goal was to describe a single-center's experience in managing acute and chronic mesenteric ischemia with endovascular therapies. Background: Open surgical revascularization has been considered the historical gold standard treatment for mesenteric ischemia though it poses considerable morbidity and mortality risk. An aging population with increased comorbidities makes endovascular treatment a more attractive treatment option. Methods: Consecutive subjects receiving percutaneous mesenteric interventions for acute and chronic mesenteric ischemia from 2004 to 2010 were identified retrospectively. Information on comorbidities, symptoms, screening tests, procedural outcomes, and follow up was obtained. Results: Thirty-one patients received percutaneous mesenteric interventions during this period. The mean age of the population was 65.0 years with roughly equal proportions of males (48.4%) and females (51.6%). Traditional cardiovascular risk factors were highly prevalent (hypertension 45.2%, diabetes 25.8%, dyslipidemia 38.7%, nicotine use 45.2%). Procedural success was 93.5%; no periprocedural complications were reported. During a mean follow up of 13 months, 16.1% required repeat revascularization and 22.6% died. Endovascular treatment of acute mesenteric ischemia was successful (n 5 8) and no patient required open surgical revascularization acutely or during follow-up. Conclusions: Endovascular treatment of mesenteric ischemia is a safe and effective therapy with acceptable long-term results. Our experience with acute mesenteric ischemia suggests that percutaneous treatment may be an effective alternative to surgical revascularization in appropriately selected patients. V
Endovascular Treatment of Chronic Mesenteric Ischemia: Report of Five Cases
CardioVascular and Interventional Radiology, 1998
Purpose: To evaluate the midterm results of percutaneous transluminal angioplasty (PTA) and stent placement in stenotic and occluded mesenteric arteries in five consecutive patients with chronic mesenteric ischemia. Methods: Five patients with 70%-100% obliterations of all mesenteric vessels resulting in chronic mesenteric ischemia (n ϭ 4) and as a prophylactic measure prior to abdominal aortic aneurysm repair (n ϭ 1) underwent PTA of celiac and/or superior mesenteric artery (SMA) stenoses (n ϭ 2), primary stenting of ostial celiac occlusions (n ϭ 2), and secondary stenting of a SMA occlusion (n ϭ 1; recoil after initial PTA). All patients underwent duplex ultrasonography (US) (n ϭ 3) and/or angiography (n ϭ 5) during a median follow-up of 21 months (range 8-42 months). Results: Clinical success was obtained in all five patients. Asymptomatic significant late restenoses (n ϭ 3) were successfully treated with repeat PTA (n ϭ 2) and stenting of an SMA occlusion (n ϭ 1; celiac stent restenosis). Recurrent pain in one patient was interpreted as secondary to postsurgical abdominal adhesions. Two puncture-site complications occurred requiring local surgical treatment. Conclusions: Endovascular techniques may be attempted prior to surgery in cases of stenotic or short occlusive lesions in patients with chronic mesenteric ischemia. Surgery may still be preferred in patients with long occlusions and a low operative risk.