Surgical Outcomes in Acute Mesenteric Ischemia: Has Anything Changed Over the Years?

Abstract

Background Despite increases in knowledge and advances in the management of acute mesenteric ischemia syndrome (AMI), there have been no significant improvements in mortality in recent years. The objective of this study was to assess the changes in clinical characteristics and surgical outcomes in patients who underwent AMI over time. Methods A total of 323 consecutive patients who underwent acute mesenteric ischemia at our institution between 1990 and 2015 were examined. The occurrence of significant changes over this 25-year period in demographic data, comorbidity, clinical characteristics, laboratory results, operative findings, etiology of the AMI, and operative mortality were evaluated. The evolution mortality rates for the studied period were analyzed using the additive logistic regression, and the significant effect was determined using the Akaike Information Criterion (AIC). Results A significant increasing linear trend was observed in recent years in Charlson score values (p = 0.008), antiplatelet drug intake (p \ 0.001), use of CT scan (p \ 0.001), arterial thrombosis (p \ 0.001), and intestinal resection (p = 0.047), while a decreasing linear trend was observed in digoxin intake (p \ 0.001), angiography use (p = 0.004), and embolia (p \ 0.001). The rest of the parameters did not present changes over time. Regarding the evolution of the adjusted surgical mortality, a significant decrease according the AIC criterion was observed. Conclusions In recent years, the characteristics of patients with AMI requiring surgery have changed. Changes in operative mortality have also been detected, showing a tendency toward a progressive and significant decrease.

Multidisciplinary management of acute mesenteric ischemia: Surgery and endovascular intervention

“…The prevalence of AMI has changed in recent decades. Mesenteric arterial embolization was the most common cause of mesenteric ischemia, which previously accounted for 40%-50%, and recently accounts for 25% of cases[ 2 , 6 ]. The most common sources of emboli include the heart and aortic atheromas.…”

“…The most common sources of emboli include the heart and aortic atheromas. Mesenteric arterial thrombosis was the second most common cause of mesenteric ischemia, which previously accounted for 20%-35% and recently accounts for 40%[ 2 , 6 ]. Thrombotic occlusion occurs in a stenotic mesenteric artery when the flow in the artery decreases.…”

“…Early revascularization is important to reduce mortality[ 1 ]. Despite advances in technology and appropriate diagnosis and treatment, mortality remains high[ 2 ]. The management of patients with AMI is still challenging.…”

Effect of Surgical Technique on the Microstructure and Microcirculation of the Small Intestine Stump during Delayed Anastomosis: Multimodal OCT Data

“…Emergency resection of ischemic bowel remains the most common surgical operation in patients with acute mesenteric ischemia (AMI), and its frequency has increased significantly over the past 25 years [1]. According to the generally accepted protocol, the primary operation is not completed by imposing an enteroanastomosis; therefore, the post-surgery period is associated with a more or less prolonged disruption of the intestinal continuity [2,3].…”

Akute (arterielle und venöse) Mesenterialischämie

“…Die akute Mesenterialischämie ist nicht nur eine seltene Ursache des akuten Bauchschmerzes [1], sondern auch eine Erkrankung mit hoher Letalität [2,3]. Auch wenn es Anzeichen für eine Verbesserung der Diagnostik-und Therapieregime gibt [4], so bestehen doch weiterhin große Unsicherheiten bezüglich des optimalen Vorgehens. Verschiedene Subtypen und eine schwierige Diagnosefindung verhindern oftmals eine frühzeitige Therapieeinleitung [3,5].…”