Arterial Endovascular Interventions in Acute Mesenteric Ischemia

2018 ◽  
Vol 02 (03) ◽  
pp. 210-216
Author(s):  
Geoffrey Miller ◽  
James Stone ◽  
Luke Wilkins
Keyword(s):  
Mesenteric Ischemia ◽  
Treatment Plan ◽  
Treatment Options ◽  
Traumatic Injury ◽  
Acute Mesenteric Ischemia ◽  
Medical Emergency ◽  
Cross Sectional ◽  
Bowel Infarction ◽  
Endovascular Interventions ◽  
Sudden Decrease

AbstractAcute mesenteric ischemia (AMI) is a true medical emergency and requires a multi-disciplinary treatment approach. AMI occurs when there is a sudden decrease in blood flow resulting in hypoperfusion to the intestines and may lead to bowel infarction. There are many potential etiologies of AMI that include arterial embolus, arterial, or venous thrombosis; traumatic injury; aortic dissection; intestinal obstruction; non-occlusive mesenteric ischemia, and vasculitis. Given mortality rates that approach 90%, rapid diagnosis is essential to decrease risk of bowel infarction. While surgical management has traditionally been the treatment of choice, endovascular management is being used with increasing frequency. Further, utilizing endovascular treatment options together with surgical intervention has shown promising results. The endovascular approach to treatment of AMI will depend on the underlying etiology. In addition, the acuity of patient presentation, presence, or absence of bowel infarction; patient stability; and availability of a hybrid operating room will influence the treatment plan of a patient with AMI. Early diagnosis with advanced cross-sectional imaging along with assessment of the underlying risk factors will optimize chances of early intervention and improve patient outcomes.

Identifying education, knowledge and communication gaps in biomarker testing between YO-CRC patients, caregivers, and their medical team.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16115-e16115
Author(s):  
Kim Lynn Newcomer ◽  
Danielle Peterson ◽  
Ronit Yarden ◽  
Keyword(s):  
Online Survey ◽  
Medical Information ◽  
Treatment Plan ◽  
Treatment Options ◽  
Stage Iv ◽  
Public Health Issue ◽  
Medical Team ◽  
Cross Sectional ◽  
Patient Reported ◽  
Biomarker Testing

e16115 Background: The proportion of new young-onset colorectal cancer (YO-CRC) cases diagnosed in young people (20-49) had doubled over the past 3 decades, and it is becoming an alarming public health issue. YO-CRC patients face unique clinical challenges, as many are diagnosed at advanced stages of the disease and subjected to aggressive treatments. With the increase of targeted therapies and precision medicine available, NCCN and ASCO guidelines recommend that all stage IV, metastatic CRC patients be tested for 4 biomarkers in addition to MSI-H. However, not all eligible patients benefit from biomarker testing and biomarker-driven therapies. Methods: We conducted an online survey to assess patients, survivors and caregivers’ knowledge and understanding of biomarker testing and whether they feel empowered to discuss with their doctor different treatment options based on their unique tumor characteristics and their preferences. Results: The cross-sectional study was completed by patients and survivors (N = 885) and unrelated caregivers of YO-CRC patients (N = 203). The median age of patients and survivors was 42, and the median age of caregivers was also 42. The majority of the participants were college graduates. Although 82% of stage IV, YO-CRC patients felt informed before treatment began, only 70% indicated their tumor was tested for biomarkers, and 54% of them received biomarker testing before treatment initiation. Only 33% of patients reported they became aware of biomarkers by their medical team while others indicated resources such as internet searches, family and friends, or patient navigators. Many of the caregivers who reported that they served as a liaison between patients and medical information retrieval felt that they did not fully understand the critical aspects of the patients' medical treatment plan. Conclusions: Multiple studies have shown that patient-centered care improves patients’ outcomes. Our organization encourages patients and their families to use medical information to navigate their journey. Our patient-reported study suggests that there are gaps in patients’ and caregiver’s understanding of biomarker testing that may hinder patient's empowerment for reaching evidence-based shared-decision treatment plan together with their physicians.

scholarly journals The Utility of Biomarkers in Diagnosing and Predicting Outcomes in Acute Mesenteric Ischemia

2021 ◽  
Vol 17 (2) ◽  
pp. 119-126
Author(s):  
Cătălin Alexandru Pirvu ◽  
Felix Bratosin ◽  
Cristian Nica ◽  
Dan Cârțu ◽  
Patrascu Ștefan ◽  
...  
Keyword(s):  
Mesenteric Ischemia ◽  
Complete Blood Count ◽  
Significant Risk ◽  
Acute Mesenteric Ischemia ◽  
Cross Sectional ◽  
Vascular Intervention ◽  
Predicted Probability ◽  
General Surgeons ◽  
Cross Sectional Design ◽  
Acute Condition

Background: Acute intestinal ischemia stands as the most lethal acute condition encountered by general surgeons and one of the deadliest pathologies in medicine triggered by thromboembolic events. The patients’ survival decreases dramatically to a lower than 30% rate when diagnosed after 24 hours, thus early diagnosis with proper surgical or vascular intervention is mandatory. This study aims to determine the utility of biomarkers and routine blood tests in assessing the severity and mortality risk for patients with acute mesenteric ischemia. Methods: The study was developed on a prospective cross-sectional design over a period of five years, finding a total of 147 patients who underwent emergency surgery after a high suspicion of acute mesenteric ischemia. The available biomarkers used in our Clinic comprised a complete blood count, total bilirubin, CK, CK-MB, LDH, AST, ALT, amylase, and cholinesterase. Results: The leukocyte count (OR=1.105), hemoglobin (OR=3.912), LDH (OR=1.144), NLR (OR=1.154), and LLR (OR=1.286) were all independent and significant risk factors for AMI diagnosis. These covariates proved a good and reliable tool for diagnosing AMI with a 75.3% predicted probability. Conclusion: The prediction tool proved reliable, although it should only be considered in the clinical context where the surgeon suspects a case of acute mesenteric ischemia. The proposed model should be further investigated and validated in larger studies.

scholarly journals Endovascular Therapy of 103 Aneurysms in the Internal Carotid Artery with Flow Re-Direction Endoluminal Device

2021 ◽  
Author(s):  
Vinicius Fialho Teixeira ◽  
Albedy Moreira Bastos ◽  
Rafael Brito Santos
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Treatment Options ◽  
Cross Sectional ◽  
Vascular Abnormalities ◽  
Endovascular Interventions ◽  
Effective Option ◽  
Aneurysm Occlusion ◽  
Carotid Aneurysms

Abstract Objective Intracranial aneurysms (AIs) are acquired vascular abnormalities that cause sacculations in the arterial wall and are present in ∼2 to 5% of the population. Among the treatment options are endovascular interventions with the use of flow-redirecting stents. In the present study, we analyzed the flow re-direction endoluminal device (FRED). Methods The present study aims to describe the results obtained from treatment with FRED in a series of patients affected by aneurysms in intracranial segments of the internal carotid artery. This is a cross-sectional, epidemiological, and observational study, whose data were obtained from the medical records of 81 patients from July 2018 to July 2019. Results One hundred and three internal carotid artery aneurysms were observed in 81 patients, with a prevalence of women (91.35%), small (< 10 mm) (89.33%), and located at the C6 level (73.78%) of the internal carotid artery. Of the 81 patients, 16 had multiple aneurysms in the same artery. One hundred and three FRED stents were used in the treatment. These patients underwent angiography 6 months after the surgery, using the O'Kelly-Marotta classification (OKM) to assess the effectiveness of the device, and it was observed that: in 91 of the 103 procedures (88.34%), the FRED was fully open and well positioned, thus restoring the arterial flow and leading to a statistically significant result. In addition, a low complication rate (4.85%) was found, with ischemic stroke being the main complication (1.94%). Conclusion This device can be an effective option in the treatment of internal carotid aneurysms since the aneurysm occlusion rate is excellent with a low rate of complications.

Mesenteric Ischemia

2016 ◽  
Author(s):  
Ugo A. Ezenkwele
Keyword(s):  
Abdominal Pain ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia ◽  
Computed Tomographic Angiography ◽  
Low Flow ◽  
Chronic Mesenteric Ischemia ◽  
Flow State ◽  
Nonocclusive Mesenteric Ischemia ◽  
Vasodilator Therapy ◽  
Bowel Infarction

Acute mesenteric ischemia is interruption of intestinal blood flow by embolism, thrombosis, or a low-flow state. Bowel infarction is the end result of a process initiated by mediator release and inflammation. On clinical assessment, the early hallmark is severe abdominal pain but minimal physical findings. The abdomen remains soft, with little or no tenderness. Mild tachycardia may be present. Early diagnosis is difficult, but selective mesenteric angiography and computed tomographic angiography have the most sensitivity; other imaging studies and serum markers can show abnormalities but lack sensitivity and specificity early in the course of the disease, when diagnosis is most critical. Treatment is by embolectomy, anticoagulation, revascularization of viable segments, or resection; sometimes vasodilator therapy is successful. If diagnosis and treatment take place before infarction occurs, mortality is low; after intestinal infarction, mortality approaches 30 to 70%. For this reason, in the emergency department, clinical diagnosis should supersede diagnostic tests, which may delay treatment. This review contains 6 highly rendered figures, 4 tables, and 33 references. Key words: acute mesenteric ischemia; bowel necrosis; chronic mesenteric ischemia; mesenteric occlusive disease; mesenteric venous thrombosis; nonocclusive mesenteric ischemia; postprandial abdominal pain; superior mesenteric artery thromboembolism

scholarly journals Post-traumatic hollow viscus perforation with mesenteric and bowel ischemia

2021 ◽  
Author(s):  
Niharika Prasad
Keyword(s):  
Mesenteric Ischemia ◽  
Young Male ◽  
Acute Mesenteric Ischemia ◽  
Exploratory Laparotomy ◽  
Bowel Ischemia ◽  
Hollow Viscus ◽  
Cross Sectional ◽  
Occlusive Mesenteric Ischemia ◽  
Partial Colectomy ◽  
Hollow Viscus Perforation

Abstract BackgroundHollow viscus perforation and acute mesenteric ischemia are life-threatening conditions that must be recognized and managed appropriately. Computed tomography (CT) helps to visualize the bowel wall directly, as well as in the timely diagnosis of secondary signs of bowel ischemia.Case PresentationA young male presented with blunt trauma to the upper abdomen. A supine radiograph was suspicious of pneumoperitoneum and CT was performed to rule out perforation. The above finding was confirmed on CT, in addition, lack of enhancement of a segment of colon and non-occlusive mesenteric ischemia was evident. He was managed with exploratory laparotomy and repair of the perforation with partial colectomy.ConclusionsThe radiologist should be familiar with signs of pneumoperitoneum on supine radiographs for detection of hollow viscus perforation. These must be viewed with an index of high suspicion in symptomatic patients, post-trauma, and, further cross-sectional imaging may still be required.

scholarly journals Accuracy of citrulline, I-FABP and d-lactate in the diagnosis of acute mesenteric ischemia

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Alexandre Nuzzo ◽  
Kevin Guedj ◽  
Sonja Curac ◽  
Claude Hercend ◽  
Claude Bendavid ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Mesenteric Ischemia ◽  
Acute Abdominal Pain ◽  
Acute Mesenteric Ischemia ◽  
Cross Sectional Study ◽  
Diagnostic Study ◽  
Cross Sectional ◽  
Fatty Acid Binding ◽  
Stroke Center ◽  
New Biomarkers

AbstractEarly diagnosis of acute mesenteric ischemia (AMI) remains a clinical challenge, and no biomarker has been consistently validated. We aimed to assess the accuracy of three promising circulating biomarkers for diagnosing AMI—citrulline, intestinal fatty acid-binding protein (I-FABP), and d-lactate. A cross-sectional diagnostic study enrolled AMI patients admitted to the intestinal stroke center and controls with acute abdominal pain of another origin. We included 129 patients—50 AMI and 79 controls. Plasma citrulline concentrations were significantly lower in AMI patients compared to the controls [15.3 μmol/L (12.0–26.0) vs. 23.3 μmol/L (18.3–29.8), p = 0.001]. However, the area under the receiver operating curves (AUROC) for the diagnosis of AMI by Citrulline was low: 0.68 (95% confidence interval = 0.58–0.78). No statistical difference was found in plasma I-FABP and plasma d-lactate concentrations between the AMI and control groups, with an AUROC of 0.44, and 0.40, respectively. In this large cross-sectional study, citrulline, I-FABP, and d-lactate failed to differentiate patients with AMI from patients with acute abdominal pain of another origin. Further research should focus on the discovery of new biomarkers.

Acute Portomesenteric Venous Thrombosis: Diagnosis and Treatment

2018 ◽  
Vol 02 (03) ◽  
pp. 249-255
Author(s):  
Stephen Allison ◽  
David Shin ◽  
Guy Johnson
Keyword(s):  
Venous Thrombosis ◽  
Endovascular Therapy ◽  
Medical Management ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia ◽  
Diagnosis And Treatment ◽  
Bowel Infarction ◽  
Radiologic Imaging ◽  
Portomesenteric Venous Thrombosis

AbstractAcute portomesenteric venous thrombosis (PMVT) is an unusual cause of acute mesenteric ischemia. Because of its rarity and nonspecific presentation, radiologic imaging plays a key role in the diagnosis of acute PMVT. Medical management with anticoagulation is the mainstay of therapy, with surgery reserved for patients suspected of having peritonitis or bowel infarction. However, endovascular therapy has an evolving role and may serve as an important adjunct to anticoagulation in selected patients with acute PMVT.

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