Outcome of endovascular revascularisation in patients with acute obstructive mesenteric ischaemia - a single-centre experience

Puippe, Gilbert; Suesstrunk, Julian; Nocito, Antonio; Pfiffner, Roger; Glenck, Michael; Pfammatter, Thomas

doi:10.1024/0301-1526/a000455

Cited by 20 publications

(19 citation statements)

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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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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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“…Given the low incidence of ATOS, it is challenging for any treatment center to provide feedback on ATOS cases within a relatively short period. 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 ].…”

Section: Discussionmentioning

confidence: 99%

“…Surgery for ATOS is associated with a high rate of morbidity and mortality [ 6 , 7 ]. 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 ].…”

Section: Introductionmentioning

confidence: 99%

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

Zhang

Wang

Li³

et al. 2017

BioMed Research International

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We reported our experience with endovascular treatment for patients with acute thromboembolic occlusion of the superior mesenteric artery (ATOS) as well as comparing the efficacy between endovascular and traditional open surgical treatments. Eighteen consecutive patients with ATOS who received endovascular treatment and 12 patients who received open surgical treatment between February 2007 and October 2012 at Tianjin Union Medical Center (Tianjin, China) were retrospectively reviewed. Primary clinical outcomes included the technical success, requirement of laparotomy, length of bowel resection, perioperative mortality within 30 days, and surgical complications. The patients were followed up for 0.1 to 98 months. For patients who underwent endovascular treatment, complete technical success was achieved in 8 (44.4%) patients and partial success was achieved in the remaining 10 (55.6%) patients. Laparotomy was required in 6 (33.3%) patients. The 30-day mortality was 16.7%. In comparison to open surgical therapy, endovascular therapy achieved lower requirement of laparotomy (in 33.3% versus in 58.3% of cases, p = 0.18), significantly shorter average length of bowel resection (88 ± 44 versus 253 ± 103 cm, p = 0.01), and lower mortality rate (16.7% versus 33.3%, p = 0.68). The endovascular therapy is a promising treatment alternative for ATOS.

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“…Recently, with the advancement of endovascular techniques and devices, transcatheter embolus aspiration with adjunctive thrombolysis and stenting has been used with acceptable results in patients with SMAE, with a reported mortality in these series of 10% to 40% [ 5 , 7 , 11 – 13 ]. SMAE usually occurs in older patients who have a high incidence of combined medical comorbidities [ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…The surgery consists of SMA embolectomy, resection of the gangrenous bowel, and a second-look operation if necessary [ 2 ]. Recently, selected endovascular approaches, such as aspiration thrombectomy combined with thrombolysis or stent placement have been reported to have acceptable results with respect to morbidity and mortality [ 4 – 7 ]. However, the remaining concerns about an endovascular-first approach are the difficulty of identifying bowel infarction by clinical and radiologic evaluation, and reperfusion injury in cases of bowel infarction after endovascular revascularization of the SMA.…”

Section: Introductionmentioning

confidence: 99%

Effect of Clinical Suspicion by Referral Physician and Early Outcomes in Patients with Acute Superior Mesenteric Artery Embolism

Kim

Hwang

Park

et al. 2017

VSI

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PurposeTo investigate the pattern of referral of patients with superior mesenteric artery embolism (SMAE) and its effect on outcomes, and to evaluate the risk factors for bowel infarction.Materials and MethodsThis retrospective study included 66 consecutive patients diagnosed with acute SMAE between January 2001 and June 2016. Appropriate diagnosis by the referring physician was defined if the referral letter indicated that acute mesenteric ischemia was suspected or had been diagnosed at the referral center. Surgical delay was defined as the interval between symptom onset and surgery for definitive treatment.ResultsAmong 54 patients transferred from other centers, 26 patients (48.1%) were diagnosed appropriately by the referring physician. The rate of appropriate diagnosis was differed significantly by the use of computed tomography (CT) scan at referral center (25/35 with CT and 1/19 without CT, P=0.00). The surgical delay was significantly longer in patients without appropriate diagnosis compared with the patients with appropriate diagnosis (53.5±52.3 hours vs. 28.8±23.6 hours, P=0.04). Initially, 56 patients received surgical treatment with 31 underwent bowel resection due to infarction, 6 received conservative treatment, and the remaining 4 patients refused any treatment. The surgical delay, abdominal distension, tenderness, rebound tenderness, and level of C-reactive protein were associated with bowel infarction at initial operation. Overall in-hospital mortality was 32%.ConclusionA high index of suspicion with appropriate diagnostic modality, such as CT scan is crucial in patients with SMAE for reducing surgical delay as a risk factor of bowel infarction.

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Outcome of endovascular revascularisation in patients with acute obstructive mesenteric ischaemia - a single-centre experience

Cited by 20 publications

References 0 publications

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

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

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

Effect of Clinical Suspicion by Referral Physician and Early Outcomes in Patients with Acute Superior Mesenteric Artery Embolism

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