Acute mesenteric ischemia of arterial origin: Importance of early revascularization

Plumereau, F.; Mucci, S.; Naoures, P. Le; Finel, J.B.; Hamy, A.

doi:10.1016/j.jviscsurg.2014.11.001

Cited by 15 publications

(10 citation statements)

References 12 publications

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“…The goals of open surgical therapy for acute mesenteric ischemia are to revascularize the occluded vessel, assess the viability of the bowel, and resect the necrotic bowel. 45 Emboli that cause acute occlusion typically lodge within the proximal superior mesenteric artery and have a good response to surgical embolectomy. If embolectomy is unsuccessful, arterial bypass may be performed.…”

Section: Endovascular Repairmentioning

confidence: 99%

Mesenteric Ischemia

2016

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esenteric ischemia is caused by blood flow that is insufficient to meet the metabolic demands of the visceral organs. The severity of ischemia and the type of organ involved depend on the affected vessel and the extent of collateral-vessel blood flow. Despite advances in the techniques used to treat problems in the mesenteric circulation, the most critical factor influencing outcomes in patients with this condition continues to be the speed of diagnosis and intervention. Although mesenteric ischemia is an uncommon cause of abdominal pain, accounting for less than 1 of every 1000 hospital admissions, an inaccurate or delayed diagnosis can result in catastrophic complications; mortality among patients in whom this condition is acute is 60 to 80%. 1-3 This article highlights the pathophysiological features, diagnosis, and treatment of ischemic syndromes in the foregut and intestines. The goal of this review is to improve the understanding and management of this life-threatening disorder. T y pes of Mesenter ic Ischemi a Arterial obstruction, the most common cause of mesenteric ischemia, has both acute and chronic forms. Acute mesenteric ischemia constitutes a surgical emergency. It is associated with embolic occlusion in 40 to 50% of cases (Fig. 1), with thrombotic occlusion of a previously stenotic mesenteric vessel in 20 to 35% of cases, 4 and with dissection or inflammation of the artery in less than 5% of cases. More than 90% of cases of chronic mesenteric ischemia are related to progressive atherosclerotic disease that affects the origins of the visceral vessels; treatment in such cases is focused on elective revascularization to avert the risk of complications and death associated with the development of acute ischemia (Fig. 2). Mesenteric venous thrombosis, which accounts for 5 to 15% of cases of mesenteric ischemia, results in impaired venous outflow, visceral edema, and abdominal pain. Its causes include primary or idiopathic thrombosis; however, 90% of cases are related to thrombophilia, trauma, or local inflammatory changes that may include pancreatitis, diverticulitis, or inflammation or infection in the biliary system. 5 Patients typically have a response to anticoagulation in combination with treatment for the underlying local or systemic processes. Surgical intervention is reserved for patients who are critically ill or whose condition is deteriorating; it is rarely required. The mesenteric circulation is a high-resistance vascular bed in which impaired regional perfusion owing to vasospasm can develop. The resulting ischemia is referred to as nonocclusive mesenteric ischemia. Although the incidence of nonocclusive mesenteric ischemia may be decreasing as awareness of the condition increases and as supportive therapies improve, it accounts for 5 to 15% of all cases of mesenteric ischemia. 6 It is most often associated with cardiac insufficiency

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Section: Endovascular Repairmentioning

confidence: 99%

Mesenteric Ischemia

2016

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“…Despite the recent therapeutic advances of endovascular techniques for early revascularization, mortality continues to be 30–68% [2] [3] [4]. During intestinal ischemia, the sudden decrease in intestinal blood flow may cause bowel infarction.…”

Section: Introductionmentioning

confidence: 99%

Harvest tissue source does not alter the protective power of stromal cell therapy after intestinal ischemia and reperfusion injury

Jensen

Manning

Khaneki³

et al. 2016

Journal of Surgical Research

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Background Transplantation of mesenchymal stromal cells (MSCs) may be a novel treatment for intestinal ischemia. The optimal stromal cell source that could yield maximal protection following injury, however, has not been identified. We hypothesized that: 1) MSCs would increase survival and mesenteric perfusion, preserve intestinal histological architecture, and limit inflammation following intestinal ischemia and reperfusion injury (I/R), and 2) MSCs harvested from different sources of tissue would have equivalent protective properties to the intestine following I/R. Methods Adult male mice were anesthetized and a midline laparotomy performed. The intestines were eviscerated, the small bowel mesenteric root identified, and baseline intestinal perfusion was determined using Laser Doppler Imaging (LDI). Intestinal ischemia was established by temporarily occluding the superior mesenteric artery for 60 minutes with a non-crushing clamp. Following ischemia, the clamp was removed and the intestines were allowed to recover. Prior to abdominal closure, 2 × 106 human umbilical (USCs), bone-marrow (BMSCs) derived MSCs, or keratinocytes in 250μl of phosphate-buffered saline (PBS) vehicle were injected into the peritoneum. Animals were allowed to recover for 12 or 24 hours (perfusion, histology, inflammatory studies), or 7 days (survival studies). Survival data was analyzed using log rank test. Perfusion was expressed as percentage of baseline and 12 and 24 hour data was analyzed using one way ANOVA and student’s t-test. Non parametric data was compared using Mann-Whitney-U test. A p-value of less than 0.05 was significant. Results All MSCs increased seven day survival following I/R and were superior to vehicle or keratinocytes (P<0.05). All MSCs increased mesenteric perfusion above vehicle at 12 and 24 hours following injury (P<0.05). All MSCs provided superior perfusion compared to keratinocytes at 24 hours post-injury (P<0.05). Administration of each MSC line improved intestinal histology after I/R (P<0.05). Multiple pro-inflammatory chemokines were down-regulated following application of MSCs suggesting a decreased inflammatory response following MSC therapy. Conclusion Transplantation of MSCs following intestinal I/R, irrespective of source tissue, significantly increases survival and mesenteric perfusion while limiting intestinal damage and inflammation. Further studies are needed to identify the mechanism that these cells utilize to promote improved outcomes following injury.

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“…The goal of optimal management should be rapid identification and revascularization of viable GI tissues[301,394] which requires early recognition. Thus, a low threshold for investigating patients at high risk of AMI is likely to increase the detection of the condition and therefore initiate earlier treatment.…”

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confidence: 99%

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

et al. 2021

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Aim There is a requirement for an expansive and up to date review of the management of emergency colorectal conditions seen in adults. The primary objective is to provide detailed evidence‐based guidelines for the target audience of general and colorectal surgeons who are responsible for an adult population and who practise in Great Britain and Ireland. Methods Surgeons who are elected members of the Association of Coloproctology of Great Britain and Ireland Emergency Surgery Subcommittee were invited to contribute various sections to the guidelines. They were directed to produce a pathology‐based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. Each author was asked to provide a set of recommendations which were evidence‐based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after two votes were included in the guidelines. Results All aspects of care (excluding abdominal trauma) for emergency colorectal conditions have been included along with 122 recommendations for management. Conclusion These guidelines provide an up to date and evidence‐based summary of the current surgical knowledge in the management of emergency colorectal conditions and should serve as practical text for clinicians managing colorectal conditions in the emergency setting.

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Acute mesenteric ischemia of arterial origin: Importance of early revascularization

Abstract: Acute mesenteric ischemia of arterial origin is associated with high morbidity and mortality. Optimal management should include early revascularization.

Cited by 15 publications

References 12 publications

Mesenteric Ischemia

Mesenteric Ischemia

Harvest tissue source does not alter the protective power of stromal cell therapy after intestinal ischemia and reperfusion injury

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

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