Is open surgery or endovascular therapy best to treat acute mesenteric occlusive disease?

Abstract

A best evidence topic in vascular surgery was written according to a structured protocol. The question addressed whether endovascular treatment improved peri-operative outcomes when compared to an open approach to restore arterial perfusion in acute mesenteric occlusive disease. Four hundred and ninety seven papers were identified using the reported search; of which 4 represented the best evidence to answer the question and are discussed. The evidence on this subject is limited, comprising largely of non-randomised retrospective cohort studies. The evidence suggests that endovascular treatment is associated with reduced mortality and has better short-term peri-operative outcomes, as well as longer-term survival - however many endovascular cases require subsequent open surgery. There is also conflicting evidence to suggest endovascular therapy is associated with longer ICU stays. Aside from procedural complications, factors such as patient status, time delay to diagnosis and treatment may play a greater role in determining mortality rates. In summary, endovascular therapy appears to be a feasible treatment option with post-operative complications and inpatient mortality rates lower than those seen in open surgery.

Acute superior mesenteric arterial thromboembolic occlusion-catheter directed thrombolysis-be on time, still be cautious!

“…Few studies have shown that surgery followed by endovascular management would result in less bowel resection compared to direct open surgery. 12,13 The classic clinical scenario is a patient complaining of severe acute abdominal pain without any significant examination findings. 14 Other clinical presentations are nausea, vomiting, diarrhoea and bleeding per rectum.…”

Endovascular Treatment for Acute Thromboembolic Occlusion of the Superior Mesenteric Artery and the Outcome Comparison between Endovascular and Open Surgical Treatments: A Retrospective Study

“…There have been a few related studies reporting small sample sizes [ 8 – 12 , 19 , 20 ]. However, whether or not interventional therapy should be the primary treatment for ATOS is still controversial [ 14 , 15 ]. In this study, we reported the endovascular treatment outcomes of 18 patients with ATOS in China and showed that endovascular treatment exhibited advantages in the lower laparotomy requirement, shorter average length of bowel resection, and lower 30-day mortality compared with open surgical treatment.…”

“…Over the last years, a few studies reported the employment of endovascular revascularization in the treatment of ATOS [ 8 – 12 ], with rapid blood supply reestablished and relatively small resultant trauma. It was shown by very few studies that endovascular treatment resulted in significantly less bowel resection and shorter bowel syndrome and mortality than open surgery [ 13 ]; however, whether or not endovascular interventional therapy should be the primary treatment for ATOS is still controversial [ 14 , 15 ].…”

Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery

“…No randomized control trial has been performed to assess and compare open surgery to an endovascular approach, as patients with AMI are very heterogenic and physiologically different [ 97 ]. Much controversy surrounds the use of endovascular techniques as primary management of AMI [ 98 ]. Some studies report lesser need for laparotomy, less bowel resection, and significantly lower mortality rate with endovascular techniques compared to surgery [ 99 ].…”