Vasodilatory Drugs in the Management of Nonocclusive Bowel Ischemia

Athanasoulis, Christos A.; Wittenberg, J; Bernstein, R. K.; Williams, Lester F.

doi:10.1016/s0016-5085(75)80060-6

Cited by 35 publications

(4 citation statements)

References 6 publications

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“…At this time, interventional therapy is recommended by several boards [ 5 ]. These recommendations are based on few case reports with only a very limited number of patients [ 6 – 8 ]. Besides, these studies differ even concerning the type of vasodilator and the dosage used [ 9 ]; no comparative studies on different treatment protocols have been reported.…”

Section: Introductionmentioning

confidence: 99%

Local Intra-arterial Vasodilator Infusion in Non-Occlusive Mesenteric Ischemia Significantly Increases Survival Rate

Winzer

Fedders

Backes

et al. 2020

Cardiovasc Intervent Radiol

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Purpose To investigate the outcome of local intra-arterial papaverine infusion therapy in patients with non-occlusive mesenteric ischemia (NOMI), and factors influencing survival, in comparison with a conservative approach. Methods From 2013 to 2019, patients with NOMI confirmed by imaging were included in a retrospective two-center study. According to different in-house standard procedures, patients were treated in each center either conservatively or interventionally by a standardized local infusion of intra-arterial papaverine into the splanchnic arteries. Thirty-day mortality and factors influencing the outcome, such as different demographics and laboratories, were compared between groups using Kaplan–Meier survival analysis and Cox regression, respectively. Results A total of 66 patients with NOMI were included, with n = 35 treated interventionally (21 males, mean age 67.7 ± 12.3 years) and n = 31 treated conservatively (18 females, mean age 71.6 ± 9.6 years). There was a significant difference in 30-day mortality between the interventional (65.7%; 12/35 survived) and the conservative group (96.8%; 1/31 survived) (hazard ratio 2.44; P = 0.005). Thresholds associated with a worse outcome of interventional therapy are > 7.68 mmol/l for lactate, < 7.31 for pH and < − 4.55 for base excess. Conclusion Local intra-arterial papaverine infusion therapy in patients with NOMI significantly increases survival rate in comparison with conservative treatment. High lactate levels, low pH and high base excess, and high demand for catecholamines are associated with a poor outcome. Level of Evidence Level III.

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Section: Introductionmentioning

confidence: 99%

Local Intra-arterial Vasodilator Infusion in Non-Occlusive Mesenteric Ischemia Significantly Increases Survival Rate

Winzer

Fedders

Backes

et al. 2020

Cardiovasc Intervent Radiol

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“…In these cases, the sooner the surgery is performed, the better the long-term results. 29 80 patients underwent urgent surgery which confirmed the suspected diagnosis of bowel ischaemia. In 47 cases the surgeons performed bowel resection of the intestine segments with signs of transmural ischaemia and in these cases, mesenteric ischaemia was confirmed histologically.…”

Section: Clinical Outcomementioning

confidence: 95%

Non-occlusive mesenteric ischaemia: CT findings, clinical outcomes and assessment of the diameter of the superior mesenteric artery

Pérez-García

Campos

Gonzalo

et al. 2017

The British Journal of Radiology

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Acknowledgment of characteristic bowel necrosis CT findings is crucial for determining the therapeutic attitude and the use of previous CT scans to compare the SMA diameter may help the radiologist to achieve an early diagnosis of NOMI in an often critically ill patient population. Advances in knowledge: Diagnosis of NOMI can be difficult in cases of partial mural ischaemia, thus objective data (diameter of the SMA) should be useful for the radiologist to include NOMI as the first diagnostic option in the differential diagnosis.

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“…24 The therapeutic concept of local intra-arterial application of vasodilatory drugs (local vasodilatory treatment [LVT]) to attenuate intestinal vessel vasospasm was introduced first by Aakhus and Brabrand in 1967 when they successfully used tolazoline, an a2-agonist. 28 Not much later, Boley et al 29 and Athanasoulis et al 30 described successful LVT of NOMI employing 2 additional vasodilatory drugs, papaverine and phenoxybenzamine, a phosphodiesterase inhibitor and an a1antagonist, respectively. Since then, a multitude of case reports and small case series have reported a probable treatment effect of LVT in patients with NOMI.…”

Section: Introductionmentioning

confidence: 99%

Nonocclusive Mesenteric Ischemia and Interventional Local Vasodilatory Therapy: A Meta-Analysis and Systematic Review of the Literature

Stahl

Rittgerodt

Busch

et al. 2019

J Intensive Care Med

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Background: Intensive care patients with nonocclusive mesenteric ischemia (NOMI) show mortality rates of 70% to 90%. Besides emergency surgery, different interventional local vasodilatory treatment (LVT) attempts have been described. We performed a systematic review and a meta-analysis to evaluate feasibility, efficacy, and tolerability of LVT in patients with life-threatening NOMI. Methods: Searches of PubMed, EMBASE, Web of Science, and Cochrane Library databases were performed until February 2019. Measured outcomes included immediate technical success rates (as indicated by mesenteric vasodilation on angiography or clinical improvement) and adverse events (AEs). Therapeutic efficacy was measured by the assessment of overall mortality. Results: Twelve studies (335 patients, 245 received LVT) from 1977 to 2018 were included. All studies were retrospective (4 comparative and 8 noncomparative). Different intra-arterial vasodilators (4× papaverine, 6× prostaglandin E1, 1× tolazoline/heparin, 1× tolazoline + iloprost) were reported. Initial technical success rate was 75.9% (95% confidence interval [CI], 55.1%-89%, P = .017) with an AE rate of 2.9% (95% CI: 1.3%-6.6%; P = .983). Overall mortality in LVT patients was 40.3% (95% CI: 28.7%-53%, P = .134). In 4 studies, outcomes were compared between patients receiving LVT to those who received standard of care (odds ratio for death in LVT patients was 0.261 [95% CI: 0.095-0.712, P = .009]). Conclusions: Local vasodilatory treatment appears to be safe in patients with NOMI and might have the potential to at least partially reverse mesenteric vasoconstriction features in control angiographies. However, with no randomized and prospective studies available yet, the overall quality of published studies has to be considered as low; therefore, it is not possible to draw generalizable conclusions from the present data concerning clinical end points. Its application might hold promise as a rescue treatment strategy and deserves further evaluation in randomized controlled trials.

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Vasodilatory Drugs in the Management of Nonocclusive Bowel Ischemia

Cited by 35 publications

References 6 publications

Local Intra-arterial Vasodilator Infusion in Non-Occlusive Mesenteric Ischemia Significantly Increases Survival Rate

Local Intra-arterial Vasodilator Infusion in Non-Occlusive Mesenteric Ischemia Significantly Increases Survival Rate

Non-occlusive mesenteric ischaemia: CT findings, clinical outcomes and assessment of the diameter of the superior mesenteric artery

Nonocclusive Mesenteric Ischemia and Interventional Local Vasodilatory Therapy: A Meta-Analysis and Systematic Review of the Literature

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