Interdisciplinary approach in emergency revascularization and treatment for acute mesenteric ischemia

Abstract

Background Mesenteric ischemia is associated with poor outcome and high overall mortality. The aim was to analyze an interdisciplinary treatment approach of vascular and visceral specialists focusing on the in-hospital outcome and follow-up in patients with acute and acute-on-chronic mesenteric ischemia. Methods From 2010 until 2017, 26 consecutive patients with acute or acute on chronic mesenteric ischemia were treated by an interdisciplinary team. Data were prospectively collected and retrospectively evaluated. Throughout the initial examination, the extent of bowel resection was determined by the visceral surgeon and the appropriate mode of revascularization by the vascular surgeon. The routine follow-up included clinical examination and ultrasound- or CT-imaging for patency assessment and overall survival as primary endpoint of the study. Results Out of 26 patients, 18 (69.2%) were rendered for open repair. Ten patients (38.5%) received reconstruction of the superior mesenteric artery with an iliac-mesenteric bypass. Seven patients (26.9%) underwent thrombembolectomy of the mesenteric artery. One patient received an infra-diaphragmatic aorto-celiac-mesenteric bypass. Out of the 8 patients, who were not suitable for open revascularization, 2 patients (7.7%) were treated endovascularly and 6 (23.1%) underwent explorative laparotomy. The in-hospital mortality was 23% (n = 6). The mean survival of the revascularized group (n = 20) was 51.8 months (95% CI 39.1–64.5) compared to 15.7 months in the non-revascularized group (n = 6) (95% CI − 4.8–36.1; p = 0.08). The median follow-up was 64.6 months. Primary patency in the 16 patients after open and 2 after interventional revascularization was 100% and 89.9% in the follow-up. Conclusion The interdisciplinary treatment of mesenteric ischemia improves survival if carried out in time. Hereby open revascularization measures are advantageous as they allow bowel assessment, resection, and revascularization in a one-stop fashion especially in advanced cases.

Antibiotic use in acute mesenteric ischemia: a review of the evidence and call to action

“…Examining some of the recent literature that is summarized in Table 1 , two additional trends seem evident. In recent years, there have been multiple trials that document the proliferation of intestinal stroke centers, seemingly mirroring clinical care pathways that already exist for neurological stroke or myocardial [ 41 – 44 ]. These studies endorse this development and believe intestinal stroke centers can improve AMI outcomes.…”

“… Risk factors of geriatrics index of comorbidity and MDCT findings for predicting mortality in patients with acute mesenteric ischemia due to superior mesenteric artery thromboembolism [ 57 ] 2020 2013–2018 Retrospective Single Institution 33 Not mentioned. None Interdisciplinary approach in emergency revascularization and treatment for acute mesenteric ischemia [ 44 ] 2021 2010–2017 Prospective Single Institution 26 Not mentioned. None The implementation of a pathway and care bundle for the management of acute occlusive arterial mesenteric ischemia reduced mortality [ 42 ] 2021 2014–2020 Retrospective Single Institution 145 All patients treated after implementation of clinical pathway received broad-spectrum antibiotics.…”

Factors that may affect the outcome of acute occlusive mesenteric ischemia. A single-center study

“…Acute occlusive mesenteric ischemia (AOMI) consists of the EAMI, TAMI and VAMI. The incidence rate of complications ranges from 13.33–61.5% [ 5 – 10 ]. The complications include short bowel syndrome (SBS), electrolyte imbalance, intestinal obstruction, intestinal hemorrhage, renal or cardiac dysfunction, intestinal fistula and wound infection.…”

Successfully superior mesenteric artery stenting in operated type A aortic dissection complicated with delayed mesenteric malperfusion

“… 4 The interdisciplinary treatment of mesenteric ischemia improves survival if carried out in time. 5 Earlier detection and prompt restoration of mesenteric blood flow are the only pathways that will significantly improve the outcome to reduce the overall mortality associated with AAD and mesenteric malperfusion syndrome. 6 …”