ACR Appropriateness Criteria® Radiologic Management of Mesenteric Ischemia: 2022 Update

Lam, Augustine; Kim, Yoon-Jin; Fidelman, Nicholas; Higgins, Mikhail C.S.S.; Cash, Brooks D.; Charalel, Resmi A.; Guimarães, Marcelo; Kwan, Sharon W.; Patel, Parag J.; Plett, Sara; Scali, Salvatore T.; Stadtlander, Kevin S.; Stoner, Michael C.; Tong, Ricky T.; Kapoor, Baljendra

doi:10.1016/j.jacr.2022.09.006

Cited by 10 publications

(3 citation statements)

References 48 publications

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“…According to the recently published update of the ACR criteria of the radiologic management of mesenteric ischemia, in our case is considered appropriate an endovascular approach. The ACR criteria also suggest that a transcatheter thrombolysis may be considered if aspiration embolectomy fails ( 8 ).…”

Section: Discussionmentioning

confidence: 99%

Case report: ultrasound assisted catheter directed thrombolysis of an embolic partial occlusion of the superior mesenteric artery

Bongiovanni

Amabile

et al. 2023

Front. Radiol.

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Acute mesenteric ischemia (AMI) is a severe medical condition defined by insufficient vascular supply to the small bowel through mesenteric vessels, resulting in necrosis and eventual gangrene of bowel walls. We present the case of a 64-year-old man with recrudescence of prolonged epigastric pain at rest of few hours duration, cold sweating and episodes of vomiting. A computed tomography scan of his abdomen revealed multiple filling defects in the mid-distal part of the superior mesenteric artery (SMA) and the proximal part of jejunal branches, associated with small intestine walls thickening, suggesting SMA thromboembolism and initial intestinal ischemia. Considering the absence of signs of peritonitis at the abdominal examination and the presence of multiple arterial emboli was decided to perform an endovascular treatment with ultrasound assisted catheter-directed thrombolysis with EkoSonic Endovascular System—EKOS, which resulted in complete dissolution of the multiple emboli and improved blood flow into the intestine wall. The day after the procedure the patient's pain improved significantly and 5 days after he was discharged home asymptomatic on warfarin anticoagulation. After 1 year of follow-up the patient is fine with no further episodes of mesenteric ischemia or other embolisms.

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Section: Discussionmentioning

confidence: 99%

Case report: ultrasound assisted catheter directed thrombolysis of an embolic partial occlusion of the superior mesenteric artery

Bongiovanni

Amabile

et al. 2023

Front. Radiol.

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“…Nesse exame, pode-se identificar espessamento da parede do intestino, dilatação do intestino, pneumatose intestinal, gás venoso portal, oclusão da vasculatura mesentérica, espessamento da parede do intestino com sinal de impressão digital, indicando edema ou hemorragia da submucosa; podendo mostrar também a causa subjacente da isquemia (TONG et al, 2022) Dessa forma, conforme Freitas et al, (2018), o tratamento para o abdome agudo isquêmico depende do local e da gravidade da isquemia, assim como da fisiopatologia e da evolução no decorrer do tempo. Logo, a avaliação completa e a intervenção apropriada imediata são de extrema importância para aliviar os sintomas e melhorar o desfecho clínico, podendo ter caráter clínico ou cirúrgico.…”

Section: Discussionunclassified

Abdome Agudo Isquêmico: Um Relato De Caso Sobre Os Achados Mais Comuns Em Um Exame De Imagem

Dias¹,

Mota²,

Santana³

et al. 2023

REASE

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O abdome agudo pode ser definido como a apresentação de sintomas típicos como dor e geralmente sensibilidade abdominal e quase sempre de evolução rápida e com gravidade, tendo características e sinais clínicos variantes. Diante disso, deve ser tomado condutas diagnósticas e terapêuticas urgentes a fim de minimizar outros riscos ao paciente. O presente relato de caso, mostra uma paciente com queixa de dor abdominal em hipocôndrio direito com sinais e sintomas clínicos sugestivos para abdome agudo isquêmico segundo exames de imagem.

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“…The diagnostic tool of choice is biphasic computed tomography angiography (CTA) with arterial and portal venous phase [ 5 ]. Treatment regimen depend on many different factors including for example etiology, disease stage and rate of comorbidities; main goal is to restore blood supply to the bowel, to prevent infections and to resect nonviable portions of the bowel [ 2 , 6 ]. Besides fluid resuscitation, anticoagulation and administration of antibiotics, there are either surgical or endovascular treatment options [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Treatment of acute mesenteric ischemia between 2010 and 2020 – a German nation-wide study

Bette,

Habeeballah,

Luitjens

et al. 2023

BMC Gastroenterol

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Background Aim of this study was to analyze long-term trends of hospitalizations, treatment regimen and in-hospital mortality of in-patients with acute mesenteric ischemia (AMI) over the past decade and effects of the SARS-CoV2-pandemic. Methods We analyzed fully anonymized data from the German Federal Statistical Office of patients with AMI between 2010 and 2020. Besides descriptive analyses of age, gender, in-hospital mortality, comorbidity burden and treatment regimen, multivariable logistic regression analyses were performed to identify independent variables associated with in-hospital mortality and different treatment. Results A total of 278,121 hospitalizations (120,667 male [43.4%], mean age 72.1 years) with AMI were included in this study. The total number of hospitalizations increased from 2010 (n = 24,172) to 2019 (n = 26,684) (relative increase 10.4%). In-hospital mortality decreased over the past decade from 36.6% to 2010 to 31.1% in 2019 (rel. decrease 15.2%). Independent risk factors for in-hospital mortality were older age (OR = 1.03 per year), higher comorbidity burden (OR = 1.06 per point in van Walraven score [vWs]), male gender (OR = 1.07), AMI as a secondary diagnosis (OR = 1.44), and the need for surgical (visceral surgery: OR = 1.38, vascular surgery: OR = 3.33) and endovascular treatment (OR = 1.21). We report a decline in hospitalizations during the first wave of infection in spring 2020 (rel. decrease 9.7%). Conclusion In-hospital mortality rate has declined over the past decade, but remains high at above 30%. Older age, increased comorbidity and male gender are independent factors for in-hospital mortality. Hospitalizations requiring vascular surgery are associated with high in-hospital mortality, followed by visceral surgery and endovascular approaches. The first wave of the SARS-CoV2-pandemic in spring 2020 implied a decrease in hospital admissions.

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ACR Appropriateness Criteria® Radiologic Management of Mesenteric Ischemia: 2022 Update

Cited by 10 publications

References 48 publications

Case report: ultrasound assisted catheter directed thrombolysis of an embolic partial occlusion of the superior mesenteric artery

Case report: ultrasound assisted catheter directed thrombolysis of an embolic partial occlusion of the superior mesenteric artery

Abdome Agudo Isquêmico: Um Relato De Caso Sobre Os Achados Mais Comuns Em Um Exame De Imagem

Treatment of acute mesenteric ischemia between 2010 and 2020 – a German nation-wide study

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