Acute mesenteric ischemia (part I) – Incidence, etiologies, and how to improve early diagnosis

Kärkkäinen, Jussi M.; Acosta, Stefan

doi:10.1016/j.bpg.2016.10.018

Cited by 121 publications

(93 citation statements)

References 48 publications

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“…Although chronic mesenteric ischaemia (CMI) is not uncommon in patients older than 75 years, this condition is underdiagnosed and the diagnosis is often delayed due to the low index of suspicion, especially in young adult patients 1. It is generally caused by atherosclerosis, but early and diffuse atherosclerosis conditioning occlusive strictures of major bowel-providing arteries are rare in young adult patients 1 2.…”

Section: Descriptionmentioning

confidence: 99%

Acute-on-chronic mesenteric ischaemia by early and diffuse atherosclerosis in a young adult patient

Gravito-Soares

Tomé

2018

BMJ Case Reports

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Section: Descriptionmentioning

confidence: 99%

Acute-on-chronic mesenteric ischaemia by early and diffuse atherosclerosis in a young adult patient

Gravito-Soares

Tomé

2018

BMJ Case Reports

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“…Accordingly, symptomatic SMA thrombosis most often accompanies celiac occlusion [15]. SMA thrombosis may also occur due to vasculitis, mesenteric dissection, or a mycotic aneurysm.…”

Section: Acute Mesenteric Arterial Thrombosismentioning

confidence: 99%

Acute Mesenteric Ischemia

Bala¹,

Kashuk²

2016

Acute Care Surgery Handbook

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“…4,9 Minimally invasive revascularisation methods have emerged from technological development of endovascular treatment options. 4,5,10 Introduction of intestinal "stroke" units with multimodal treatment options have improved both bowel and life outcomes. 11,12 Despite better results in selected revascularisation series, the total AMI mortality has remained very high, usually cited at 42e69%.…”

Section: Introductionmentioning

confidence: 99%

Choice of First Emergency Room Affects the Fate of Patients With Acute Mesenteric Ischaemia: The Importance of Referral Patterns and Triage

Lemma

Tolonen

Vikatmaa

et al. 2019

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS Although delay is a key modifiable factor in the treatment of acute mesenteric ischaemia (AMI), few studies have sought modifiable targets to reduce this parameter. This study found that the key factor is the type of emergency room (ER) the patient first encounters. If this ER was non-surgical, the time to surgical operation was approximately 15 h and mortality 75%, compared with 10 h and 50% mortality if the first ER was surgical. This study illustrates that patient pathway is a potential target for improvement in the treatment of AMI and the whole pathway needs to be involved and educated.Objectives: Despite modern advances in diagnosis and treatment, acute arterial mesenteric ischaemia (AMI) remains a high mortality disease. One of the key modifiable factors in AMI is the first door to operation time, but the factors attributing to this parameter are largely unknown. The aim of this study was to evaluate the factors affecting delay, with special focus on the pathways to treatment. Methods: This was a single academic centre retrospective study. Patients undergoing intervention for AMI caused by thrombosis or embolism of the superior mesenteric artery between 2006 and 2015 were identified from electronic patient records. Patients not eligible for intervention or with chronic, subacute onset, colonic only, venous, or non-occlusive mesenteric ischaemia were excluded. Patients were divided into two groups according to the first speciality examining the patient (surgical emergency room [SER], surgeon examining the patient first or non-surgical emergency room [non-SER], internist examining the patient first). The primary endpoint was first door to operation time and secondary endpoints were length of stay and 90 day mortality. Results: Eighty-one patients with AMI were included. Fifty patients (62%) died during the first 30 days and 53 (65%) within 90 days. Presenting first in non-SER (vs. SER) was independently associated with a first door to operation time of over 12 h (OR 3.7 [95% CI 1.3e10.2], median time 15.2 h [IQR 10.9e21.2] vs. 10.1 h [IQR 6.9e18.5], respectively, p ¼ .025). The length of stay was shorter (median 6.5 days [4.0e10.3] vs. 10.8 days [7.0e22.3], p ¼ .045) and 90 day mortality was lower in the SER group (50.0% vs. 74.5%, p ¼ .025).Conclusions: The first specialty that the patient encounters seems to be crucial for both delayed management and early survival of AMI. Developing fast/direct pathways to a unit with both gastrointestinal and vascular surgeons offers the possibility of improving the outcome of AMI.

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Acute mesenteric ischemia (part I) – Incidence, etiologies, and how to improve early diagnosis

Cited by 121 publications

References 48 publications

Acute-on-chronic mesenteric ischaemia by early and diffuse atherosclerosis in a young adult patient

Acute-on-chronic mesenteric ischaemia by early and diffuse atherosclerosis in a young adult patient

Acute Mesenteric Ischemia

Choice of First Emergency Room Affects the Fate of Patients With Acute Mesenteric Ischaemia: The Importance of Referral Patterns and Triage

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