Endovascular revascularization of acute arterial mesenteric ischemia: report of a 3-year experience from an intestinal stroke center unit

Najdawi, MiIan; Garzelli, Lorenzo; Nuzzo, Alexandre; Huguet, Audrey; Raynaud, Lucas; Paulatto, Luisa; Panis, Yves; Abdallah, Iannis Ben; Castier, Yves; Sibert, Annie; Vilgrain, Valérie; Corcos, Olivier; Ronot, Maxime

doi:10.1007/s00330-022-08660-3

Cited by 20 publications

(21 citation statements)

References 21 publications

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“…Of course, AAMI is rare compared to ischemia in other organs [ 42 ], but more probably, this can be explained by the focus on bowel resection in historical surgical series [ 43 ]. As a result of improved understanding of the time-dependent pathophysiology of AAMI and identification of early forms of ischemia (i.e., with low probability of necrosis) that can benefit from endovascular revascularization, more recent studies discuss the primary importance of revascularization in clinical practice and research [ 2 , 14 , 44 , 45 ]. This explains why the study population included mostly patients with a low risk of necrosis (i.e., Clichy score 0 or 1) that were referred by the on-call expert group to first-line endovascular revascularization [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

“…Complete occlusion of the SMA, especially of an embolic origin, offers less perspective for the development of collateral anastomosis due to sudden clotting. These patients are usually treated by thrombus-aspiration and intra-arterial thrombolysis techniques rather than stenting [ 12 , 44 ]. A shorter delay between the initial CT and revascularization was found in patients with RI but only in univariate analysis.…”

Section: Discussionmentioning

confidence: 99%

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Reperfusion injury on computed tomography following endovascular revascularization of acute mesenteric ischemia: prevalence, risk factors, and patient outcome

et al. 2022

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Background Data about reperfusion injury (RI) following acute arterial mesenteric ischemia (AAMI) in humans are scarce. We aimed to assess the prevalence and risk factors of RI following endovascular revascularization of AMI and evaluate its impact on patient outcomes. Methods Patients with AAMI who underwent endovascular revascularization (2016–2021) were included in this retrospective cohort. CT performed < 7 days after treatment was reviewed to identify features of RI (bowel wall hypoattenuation, mucosal hyperenhancement). Clinical, laboratory, imaging, and treatments were compared between RI and non-RI patients to identify factors associated with RI. Resection rate and survival were also compared. Results Fifty patients (23 men, median 72-yrs [IQR 60–77]) were included, and 22 were diagnosed with RI (44%) after a median 28 h (22–48). Bowel wall hypoattenuation and mucosal hyperenhancement were found in 95% and 91% of patients with post-interventional RI, respectively. Patients with RI had a greater increase of CRP levels after endovascular treatment (p = 0.01). On multivariate analysis, a decreased bowel wall enhancement on baseline CT (HR = 8.2), an embolic cause (HR = 7.4), complete SMA occlusion (HR = 7.0), and higher serum lactate levels (HR = 1.4) were associated with RI. The three-month survival rate was 78%, with no difference between subgroups (p = 0.99). However, the resection rate was higher in patients with RI (32% versus 7%; p = 0.03). Conclusion RI is frequent after endovascular revascularization of AAMI, especially in patients who present with decreased bowel wall enhancement on pre-treatment CT, an embolic cause, and a complete occlusion of the SMA. However, its occurrence does not seem to negatively impact short-term survival.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Reperfusion injury on computed tomography following endovascular revascularization of acute mesenteric ischemia: prevalence, risk factors, and patient outcome

et al. 2022

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“…Epidemiology and outcome of AMI, based on available evidence [2–5,8,10–19], is presented in Table 1.…”

Section: Epidemiologymentioning

confidence: 99%

“…More awareness, coupled with routine and established pathways for diagnosis and management are likely to be the key issues for successful management, supported by preliminary evidence reporting considerably better survival rates from a specialist centre [13 ▪▪ ,21].…”

Section: Diagnosismentioning

confidence: 99%

Acute mesenteric ischaemia

Blaser

Forbes

Björck

2022

Current Opinion in Critical Care

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Purpose of reviewTo summarize the recent evidence on acute mesenteric ischaemia (AMI).Recent findingsThe overall incidence of AMI is below 10/100 000 person years but increases exponentially with age. The overall mortality of AMI remains high, exceeding 50%, despite continuing progress and increasing availability of imaging and endovascular interventions. However, patients with (early) revascularization have significantly better outcomes. The majority of patients surviving the acute event are still alive at 1 year, but evidence on quality of life is scarce.Clinical suspicion of AMI is the key to timely diagnosis, with biphasic computed tomography-angiography the diagnostic method of choice. Currently, no biomarker has sufficient specificity to diagnose AMI.SummaryImproved awareness and knowledge of AMI are needed to raise the suspicion of AMI in relevant patients and thereby to achieve better outcomes.

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“…35 Endovascular revascularization techniques include angioplasty with stenting, aspiration thrombectomy, and/or thrombolysis with reported high technical success rates. 36,37 The choice of endovascular therapy will depend on the etiology of the occlusion, anatomy, and available devices and may be used in conjunction with each other. Thrombolysis alone has become less common as it takes time, on the order of 24 to 48 hours, which often is not possible to maintain viable bowel in patients with AMI.…”

Section: Medicalmentioning

confidence: 99%

Acute Mesenteric Ischemia: Evaluation, Management, and Interventions

Kaufman

2022

Digestive Disease Interventions

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Acute mesenteric ischemia (AMI) is a dreaded, highly morbid pathology. Often this is due to acute occlusion of the superior mesenteric artery. This can be from thrombus or embolism; however, AMI can also be the result of mesenteric venous thrombus or nonocclusive mesenteric ischemia. There have been many recent advances in diagnosis and treatment including endovascular therapies. While there is increasing data to support an endovascular first approach, with improved 30-day mortality rates and in-hospital mortality, many patients will still require surgical intervention at some point. This article will review AMI for the interventional radiologist including etiologies, diagnosis, and management.

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Endovascular revascularization of acute arterial mesenteric ischemia: report of a 3-year experience from an intestinal stroke center unit

Cited by 20 publications

References 21 publications

Reperfusion injury on computed tomography following endovascular revascularization of acute mesenteric ischemia: prevalence, risk factors, and patient outcome

Reperfusion injury on computed tomography following endovascular revascularization of acute mesenteric ischemia: prevalence, risk factors, and patient outcome

Acute mesenteric ischaemia

Acute Mesenteric Ischemia: Evaluation, Management, and Interventions

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