Still time to perform intestinal revascularization in patients with acute mesenteric ischemia with peritonitis: An analysis of bowel viability in resections

Objective: Acute mesenteric ischemia is often fatal, and many survivors develop short bowel syndrome. To avoid massive bowel resection, revascularization is recommended for acute mesenteric ischemia patients. However, whether acute mesenteric ischemia patients with clinical peritonitis can be revascularized remains uncertain. Therefore, this study aimed to evaluate the histopathological potential reversibility of resected bowel in acute mesenteric ischemia patients with peritonitis. Methods: We retrospectively reviewed the medical records of acute mesenteric ischemia patients treated at the Kameda Medical Center between January 2001 and March 2015. Pathological evaluation regarding bowel resection was performed. Patients with and without peritonitis were compared. The primary outcome was the proportion of patients with reversible or irreversible ischemia. Patients with reversible and irreversible ischemia were characterized. Results: Of 41 patients, 17 underwent laparotomy, 6 endovascular surgery, and 18 palliative care. Among 23 patients receiving curative treatment, 7 had peritonitis and 13 did not. Seven patients of each group received bowel resection, but 85.7% of those with peritonitis had reversible ischemia. We categorized patients with ischemia into reversible and irreversible groups. The median time between symptom onset and diagnosis in the reversible group was >27 h. Systemic inflammatory response syndrome was found in 72.2% and 66.7% of the reversible and irreversible groups, respectively. Conclusion: Acute mesenteric ischemia patients with clinical peritoneal signs may have potentially reversible ischemia. As a result, revascularization should be considered, even in the case of peritonitis.

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Late Vascular Intervention for Acute Mesenteric Ischemia Is Associated with Early Mortality and Extensive Bowel Resection

Journal of Vascular Surgery ◽

10.1016/j.jvs.2020.12.043 ◽

2021 ◽

Vol 73 (3) ◽

pp. 48-49

Author(s):

Lillian M. Tran ◽

Elizabeth Andraska ◽

Rafael Ramos-Jiminez ◽

Andrew-Paul Deeb ◽

Natalie Sridharan ◽

...

Keyword(s):

Mesenteric Ischemia ◽

Bowel Resection ◽

Acute Mesenteric Ischemia ◽

Early Mortality ◽

Vascular Intervention

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A patient with acute mesenteric ischemia who was managed with bowel resection and superior mesenteric artery bypass.

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) ◽

10.3919/jjsa.62.1930 ◽

2001 ◽

Vol 62 (8) ◽

pp. 1930-1934

Author(s):

Masashi INABA ◽

Hisashi UCHIDA ◽

Susumu KOSHIKO

Keyword(s):

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Mesenteric Ischemia ◽

Bowel Resection ◽

Artery Bypass ◽

Acute Mesenteric Ischemia

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AN EMERGENT MANAGEMENT OF ACUTE SUPERIOR MESENTERIC ARTERY EMBOLISM WITH ILEAL GANGRENE

10.36106/ijsr/6403142 ◽

2021 ◽

pp. 3-4

Author(s):

Nishant Agarwal ◽

Abhishek Kaushal ◽

Shrey Aren ◽

Srikanth Muraleedhar ◽

Sudhir Kumar Panigrahi

Keyword(s):

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Mesenteric Ischemia ◽

Intestinal Ischemia ◽

Hospital Admissions ◽

Bowel Resection ◽

Acute Mesenteric Ischemia ◽

Artery Embolism ◽

Visceral Arteries ◽

Bowel Gangrene

Acute mesenteric ischemia (AMI) occuring due to sudden, partial or complete interruption of blood ow in main visceral arteries of the abdomen eventually resulting in intestinal ischemia and/or bowel gangrene is a surgical emergency. It represents 0.1% of hospital admissions and 2% of the revascularization operations for atheromatous lesions. 50% of AMI is caused by embolic phenomenon, 25% by thrombotic episode and rest 25% by both. The most common vessel involved in AMI is superior mesenteric artery. Acute mesenteric embolic ischemia (AMEI) arises typically from a cardiac emboli in patients with atrial brillation or following MI. Patients usually presents with central abdominal pain, out of proportion to the physical ndings initially, later becoming diffuse associated with bloody diarrhoea during the episode. An early diagnosis, an aggressive resuscitation, intravascular or surgical restoration of blood ow and subsequent bowel resection based on bowel viability helps reduce morbidity and mortality.

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Effectiveness and safety of regdanvimab in patients with mild-to-moderate COVID-19: A retrospective cohort study

10.21203/rs.3.rs-846378/v1 ◽

2021 ◽

Author(s):

Jeonghun Heo ◽

Susin Park ◽

Nam Kyung Je ◽

Dong Wan Kim ◽

Miran Park

Keyword(s):

Medical Records ◽

Primary Outcome ◽

Adverse Reactions ◽

Medical Center ◽

Controlled Trial ◽

Hospital Death ◽

Phase 2 ◽

Clinical Recovery ◽

Randomized Controlled ◽

Risk Of Disease

Abstract Regdanvimab has decreased the time to clinical recovery from coronavirus disease 2019 (COVID-19) and lowered the rate of oxygen therapy according to the results from Phase 2 randomized controlled trial. More information is needed about the effects and safety of regdanvimab. We analyzed the medical records of patients with high-risk mild or moderate COVID-19 being admitted to Busan Medical Center between December 1, 2020, and April 16, 2021. A propensity score (PS) matched analysis was conducted to compare patients with and without regdanvimab. The primary outcome was in-hospital death or disease aggravation. Among 1,617 selected patients, 970 (60.0%) were indicated for regdanvimab. Among a 1:1 PS-matched cohort of 377 patients each treated with and without regdanvimab, regdanvimab significantly reduced the primary endpoint (odds ratio [OR], 0.194; 95% confidence interval [CI], 0.112–0.320; p < 0.001). Regdanvimab was associated with a significantly lower risk of disease aggravation without increasing adverse reactions.

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Mortality of acute mesenteric ischemia remains unchanged despite significant increase in utilization of endovascular techniques

Vascular ◽

10.1177/1708538115577730 ◽

2015 ◽

Vol 24 (1) ◽

pp. 44-52 ◽

Cited By ~ 24

Author(s):

Mohammad H Eslami ◽

Denis Rybin ◽

Gheorghe Doros ◽

James T McPhee ◽

Alik Farber

Keyword(s):

Mortality Rate ◽

Confidence Interval ◽

Hospital Mortality ◽

Odds Ratio ◽

Mesenteric Ischemia ◽

Bowel Resection ◽

Acute Mesenteric Ischemia ◽

Fold Increase ◽

Endovascular Techniques ◽

Contemporary Study

Introduction In this study, we evaluated if increase in utilization of endovascular surgery has affected in-hospital mortality rates among patients with acute mesenteric ischemia. Methods The National Inpatient Sample (2003–2011) was queried for acute mesenteric ischemia using ICD-9 code for acute mesenteric ischemia (557.1). This cohort was divided into patients treated with open vascular surgery (open vascular group) and by endovascular therapies (endovascular group) based on the ICD-9CM procedure codes. Multivariable logistic regression was used to determine temporal trend for mortality while adjusting for confounding variables. Results There was 1.45-fold increase in utilization of endovascular techniques in this study. In-hospital mortality rate, total median charges and length of stay were significantly lower among the endovascular group than the open vascular group despite having significantly higher Elixhauser comorbidities index (3 ± 0.1 vs. 2.7 ± 0.1, p = .003). Over the course of the study period, there was no change in the overall mortality rate despite higher endovascular utilization. Factors associated with increased mortality included age, open surgical repair (Odds ratio: 1.45, 95% Confidence Interval: 1.10–1.91, p = .016) and bowel resection Odds ratio: 2.88, 95% Confidence Interval: 2.01–4.12). Conclusion The mortality rate for acute mesenteric ischemia remains unchanged throughout this contemporary study. Open surgical intervention, bowel resection and age were associated with increased mortality. Endovascular group patients had better survival despite higher morbidity indices.

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Acute mesenteric ischemia (AMI): absence of renal insufficiency and performance of early bowel resection may indicate improved outcomes

International Journal of Colorectal Disease ◽

10.1007/s00384-019-03388-x ◽

2019 ◽

Vol 34 (10) ◽

pp. 1781-1790

Author(s):

Hanno Matthaei ◽

Alina Klein ◽

Vittorio Branchi ◽

Jörg C. Kalff ◽

Arne Koscielny

Keyword(s):

Renal Insufficiency ◽

Mesenteric Ischemia ◽

Bowel Resection ◽

Acute Mesenteric Ischemia ◽

Improved Outcomes ◽

And Performance

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Open Procedures for Mesenteric Ischemia

10.2310/vasc.3041 ◽

2017 ◽

Author(s):

Ravi V Dhanisetty ◽

Gregory L. Moneta ◽

Rachel C Danczyk

Keyword(s):

Blood Flow ◽

Key Words ◽

Mesenteric Ischemia ◽

Bowel Resection ◽

Acute Mesenteric Ischemia ◽

Primary Patency ◽

Chronic Mesenteric Ischemia ◽

Hybrid Procedures ◽

Viable Solution ◽

Prompt Diagnosis

Mesenteric ischemia is a relatively rare disease that requires prompt diagnosis and treatment to preserve bowel and prevent mortality. Despite endovascular advances, open revascularization remains essential to reestablish blood flow in patients with either acute or chronic mesenteric ischemia. Open revascularization continues to provide excellent primary patency and durable relief of symptoms with acceptable morbidity and mortality. Acute mesenteric ischemia warrants prompt evaluation of the bowel for signs of infarction, and determining the etiology of the ischemia is critical to planning revascularization. Hybrid procedures provide a viable solution in those patients who are moribund and require revascularization and bowel resection. Key words: duplex graft surveillance, mesenteric bypass, mesenteric ischemia, open revascularization, retrograde open mesenteric stenting

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With Whom Does the Surgeon Spend More Time? A Study of the Orthopaedic Foot and Ankle Clinic

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00434 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0043

Author(s):

Connor J. Wakefield ◽

Kevin Wu ◽

Joe Skipor ◽

Angad Ravanam ◽

Savannah Benko ◽

...

Keyword(s):

Medical Records ◽

Primary Outcome ◽

Medical Center ◽

X Rays ◽

Foot And Ankle ◽

Independent Variables ◽

Included Patient ◽

Clinic Efficiency ◽

Exam Room

Category: Health Sciences Research Introduction/Purpose: In the era of decreasing reimbursement and increasing financial pressure on the orthopaedic foot and ankle surgeon, improving clinic efficiency has value. The purpose of this study was to identify which patients and which types of clinical visits consume the greatest amounts of an attending orthopaedic foot and ankle surgeon’s time. Methods: A prospective, observational study was conducted in an outpatient orthopaedic foot and ankle clinic at a tertiary medical center. 210 adult patients were enrolled from the clinics of two fellowship-trained, board certified orthopaedic surgeons. Time spent in the exam room with the attending surgeon was the primary outcome. Independent variables included patient and appointment characteristics (i.e. age, sex, new/follow-up appointment, etc.). Linear regression was used to test for association between the independent variables and the primary outcome. Results: Mean time spent by the attending surgeon in the exam room (± standard deviation) was 7.4±4.4 minutes (range, 1-20). Predictors of greater time spent in the exam room included patient age≥50 years (+2.0 minutes, 95% confidence interval [CI]=+0.8 to +3.1, p=0.001), female sex (+1.7 minutes, 95% CI=+0.5 to +2.9, p=0.005), outside medical records reviewed (+2.4 minutes, 95% CI=+0.6 to +4.2, p= 0.010), and new (versus follow-up) patient appointment (+1.7 minutes, 95% CI=+0.5 to +2.9; Table 1). In contrast, time spent in the exam room was not associated with the patient arriving late, completion of patient paperwork before the appointment, whether the patient obtained x-rays at the visit, or the type of provider that saw the patient prior to the attending (resident/physician assistant; p>0.05 for each). Conclusion: Patients who are age=≥50, identify as female, bring outside medical records for review, and are presenting to the surgeon for the first time consume the greatest amounts of a surgeon’s time in the examination room. Surgeons can anticipate spending more time in the room with these types of patients and should schedule their clinics accordingly.

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