Acute and chronic mesenteric ischemia: MDCT findings

The aim of the review: to present literature data on the role of laboratory methods in the complex diagnosis of acute mesenteric ischemia. The main provisions. To search for scientific publications, we used the PubMed database, the RSCI, the Google Scholar search engine, as well as cited references. Articles relevant to the purpose of the review were selected for the period from 1999 to 2019 in the following terms: “acute mesenteric ischemia”, “pathogenesis”, “diagnosis”, “biomarkers”. Inclusion criteria were limited to acute arterial mesenteric ischemia. Acute mesenteric ischemia is an emergency condition caused by a sudden violation of the blood flow through the mesenteric vessels, which rapidly progresses to a heart attack of the intestinal wall and is accompanied by high mortality. Four main mechanisms of OMI are distinguished: embolism from the left parts of the heart or aorta, thrombosis of arteries or veins of the intestine, non-occlusive acute mesenteric ischemia (NOMI), due to vascular spasm. In this case, destructive disorders occur in the intestinal wall, starting from the mucous membrane to the serous, which leads to bacterial translocation and the development of a systemic inflammatory response syndrome. Early bowel revascularization is a key factor in reducing complications and mortality associated with it. However, in the initial stages of the disease has no specific signs, which complicate its diagnosis. The only way to detect mesenteric blood flow disorders is MSCT with angiography, and with non-occlusive lesions, mesenteric angiography, which in normal clinical practice is not always possible. Conclusion. It can be assumed that the use of laboratory methods will expand the range of diagnostic measures and will make it possible to conduct timely treatment aimed at restoring the mesenteric blood flow and improve the prognosis in patients with acute mesenteric ischemia.

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Nonoсclusive mesenteric ischemia (literature review)

Paediatric Surgery Ukraine ◽

10.15574/ps.2021.72.76 ◽

2021 ◽

pp. 76-83

Author(s):

V.S. Khomenko ◽

◽

V.P. Perepelitsіa ◽

I.O. Kuchynskyi ◽

A.V. Sirotkin ◽

...

Keyword(s):

Blood Flow ◽

Literature Review ◽

Mesenteric Ischemia ◽

Acute Mesenteric Ischemia ◽

Care Physician ◽

Diagnosis And Treatment ◽

Diagnostic Tools ◽

Mesenteric Blood Flow ◽

Wide Range ◽

Occlusive Mesenteric Ischemia

Non-occlusive mesenteric ischemia is a relatively rare but extremely complex pathology in terms of diagnosis. A wide range of reasons for the development of non-occlusive impression dramatically complicates the diagnosis and differentiation with other abdominal pathology. The vast majority of publications in the domestic literature on acute disorders of mesenteric blood flow, mostly address the problems of diagnosis and treatment of occlusive types of mesenteric ischemia, while the topic of non-occlusive ischemia remains insufficiently covered. Given that in half of the cases NOMI is diagnosed at the stage of irreversible necrotic changes of the intestine – there is a real need to generalize the root causes and mechanisms of neoclustive mesenteric ischemia, modern methods of diagnosis and treatment. Purpose – to analyze of the causes, prevalence, classification, diagnosis and treatment of non-occlusive disorders of mesenteric blood flow. This research, based on literature review, showed that acute non-occlusive mesenteric ischemia (NOMI) is associated with poor prognosis due to the lack of accurate diagnostic measures. First of all, clarity regarding biochemical markers. Therefore, the research and development of the latter is seen as a priority. Contrast methods of examination (computed tomography, angiography) are the only possible diagnostic tools. Pharmacological correction is fundamental and presupposes the use of drugs with a vasodilating effect systemically or locally (catheter-associated). An important issue is the development of pharmacological agents that allow targeted action on the pathogenetic mechanisms of the development of NOMI. A multidisciplinary approach involving a specialized doctor, a surgeon, an X-ray endovascular surgeon and an intensive care physician in the treatment of a patient with suspected NOMI is the foundation for the success of therapy. The question of the use of laparoscopy remains controversial, given the invasiveness of the method and the difficulty of interpreting the changes detected in the early phase of the disease. No conflict of interests was declared by the authors. Key words: acute mesenteric ischemia, non-occlusive disorders of mesenteric blood flow.

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Interdisciplinary approach in emergency revascularization and treatment for acute mesenteric ischemia

BMC Surgery ◽

10.1186/s12893-021-01102-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Alicja Zientara ◽

Anja-Rebeka Domenghino ◽

Igor Schwegler ◽

Hans Bruijnen ◽

Annelies Schnider ◽

...

Keyword(s):

Mesenteric Artery ◽

Mesenteric Ischemia ◽

Acute Mesenteric Ischemia ◽

Interdisciplinary Approach ◽

Primary Patency ◽

Interdisciplinary Treatment ◽

Chronic Mesenteric Ischemia ◽

Initial Examination ◽

Vascular Surgeon

Abstract Background Mesenteric ischemia is associated with poor outcome and high overall mortality. The aim was to analyze an interdisciplinary treatment approach of vascular and visceral specialists focusing on the in-hospital outcome and follow-up in patients with acute and acute-on-chronic mesenteric ischemia. Methods From 2010 until 2017, 26 consecutive patients with acute or acute on chronic mesenteric ischemia were treated by an interdisciplinary team. Data were prospectively collected and retrospectively evaluated. Throughout the initial examination, the extent of bowel resection was determined by the visceral surgeon and the appropriate mode of revascularization by the vascular surgeon. The routine follow-up included clinical examination and ultrasound- or CT-imaging for patency assessment and overall survival as primary endpoint of the study. Results Out of 26 patients, 18 (69.2%) were rendered for open repair. Ten patients (38.5%) received reconstruction of the superior mesenteric artery with an iliac-mesenteric bypass. Seven patients (26.9%) underwent thrombembolectomy of the mesenteric artery. One patient received an infra-diaphragmatic aorto-celiac-mesenteric bypass. Out of the 8 patients, who were not suitable for open revascularization, 2 patients (7.7%) were treated endovascularly and 6 (23.1%) underwent explorative laparotomy. The in-hospital mortality was 23% (n = 6). The mean survival of the revascularized group (n = 20) was 51.8 months (95% CI 39.1–64.5) compared to 15.7 months in the non-revascularized group (n = 6) (95% CI − 4.8–36.1; p = 0.08). The median follow-up was 64.6 months. Primary patency in the 16 patients after open and 2 after interventional revascularization was 100% and 89.9% in the follow-up. Conclusion The interdisciplinary treatment of mesenteric ischemia improves survival if carried out in time. Hereby open revascularization measures are advantageous as they allow bowel assessment, resection, and revascularization in a one-stop fashion especially in advanced cases.

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Acute Mesenteric Ischemia

DeckerMed Surgery ◽

10.2310/surg.2099 ◽

2016 ◽

Author(s):

Mohammad H. Eslami

Keyword(s):

Ct Scan ◽

Mesenteric Ischemia ◽

Three Dimensional ◽

Acute Mesenteric Ischemia ◽

Mesenteric Arteries ◽

Proximal Jejunum ◽

Nonocclusive Mesenteric Ischemia ◽

Total Occlusion ◽

Mesenteric Vessels

Acute mesenteric ischemia (AMI) is an uncommon life-threatening clinical entity with a reported incidence rate of 0.09 to 0.2% per patient-year at tertiary referral centers. Diagnosis is challenging: the initial presentation of abdominal pain is vague, varied, and similar to other, more common, pathologic abdominal conditions. This review covers clinical evaluation, investigative studies, management, intraoperative consultation, determination of bowel viability, mesenteric ischemia and reperfusion, and outcome after surgical treatment of AMI. Figures show computed tomographic (CT) scan of mesenteric vessels, CT scan of a partially occluding thrombus in the superior mesenteric vein, contrast-enhanced three-dimensional magnetic resonance angiography images of aorta and mesenteric vessels, a schematic drawing demonstrating the usual site for superior mesenteric artery (SMA) thrombosis versus that for SMA embolus, selective angiogram of the SMA in anterior projection demonstrating embolus within the vessel at the typical location, lateral contrast angiogram demonstrating near-occlusion of the celiac artery and total occlusion of the SMA, contrast angiograms of the aorta and mesenteric arteries in a patient with nonocclusive mesenteric ischemia, selective angiogram of the SMA demonstrating a partially occluding embolus in the distal vessel, selective angiogram showing a clot beyond the orifice of the SMA, lodged in the SMA of smaller caliber, algorithm illustrating intraoperative determination of bowel salvageability, evaluation of SMA pulses, and assessment of bowel viability after revascularization, and an intraoperative photograph of diffuse bowel ischemia with classic sparing of the proximal jejunum and transverse colon due to embolus of the SMA. This review contains 11 highly rendered figures and 65 references

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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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Interdisciplinary approach in emergency revascularization and treatment for acute mesenteric ischemia

10.21203/rs.3.rs-118711/v1 ◽

2020 ◽

Author(s):

Alicja Zientara ◽

Anja-Rebeka Domenghino ◽

Igor Schwegler ◽

Hans Bruijnen ◽

Annelies Schnider ◽

...

Keyword(s):

Mesenteric Artery ◽

Mesenteric Ischemia ◽

Acute Mesenteric Ischemia ◽

Primary Patency ◽

Interdisciplinary Treatment ◽

Chronic Mesenteric Ischemia ◽

Initial Examination ◽

Vascular Surgeon ◽

Imaging Results

Abstract Background Mesenteric ischemia is associated with poor outcome and high overall mortality. The aim was to analyze an interdisciplinary treatment approach of vascular and visceral specialists focusing on the in-hospital outcome and follow-up in patients with acute and acute-on-chronic mesenteric ischemia. Methods From 2010 until 2017, 26 consecutive patients were treated by an interdisciplinary team. Data were prospectively collected and retrospectively evaluated. Throughout the initial examination, the extent of bowel resection was determined by the visceral and the appropriate mode of revascularization by the vascular surgeon. The routine follow-up included ultrasound- or CT-imaging. Results Out of 26 patients, 18 (69.2%) were rendered for open repair. Ten patients received reconstruction of the superior mesenteric artery with an iliac-mesenteric bypass. Seven patients (26.9%) underwent thrombembolectomy of the mesenteric artery. One patient received an infra-diaphragmatic aorto-celiac-mesenteric bypass. Out of the 8 patients, who were not suitable for open revascularisation, 2 patients (7.7%) were treated endovascularly and 6 (23.1%) underwent explorative laparotomy. The in-hospital mortality was 23% (n=6). The mean survival of the revascularized group (n=20) was 51.8 months (95% CI 39.1-64.5) compared to 15.7 months in the non-revascularized group (n=6) (95% CI -4.8-36.1; p=0.08). The median follow-up was 64.6 months. Primary patency in the 16 patients after open and 2 after interventional revascularisation was 100% and 89.9% in the follow-up. Conclusion The interdisciplinary treatment of mesenteric ischemia improves survival if carried out in time. Hereby open revascularization measures are advantageous as they allow bowel assessment, resection, and revascularization in a one-stop fashion especially in advanced cases.

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Acute Mesenteric Ischemia

10.2310/vasc.2099 ◽

2016 ◽

Author(s):

Mohammad H. Eslami

Keyword(s):

Ct Scan ◽

Mesenteric Ischemia ◽

Three Dimensional ◽

Acute Mesenteric Ischemia ◽

Mesenteric Arteries ◽

Proximal Jejunum ◽

Nonocclusive Mesenteric Ischemia ◽

Total Occlusion ◽

Mesenteric Vessels

Acute mesenteric ischemia (AMI) is an uncommon life-threatening clinical entity with a reported incidence rate of 0.09 to 0.2% per patient-year at tertiary referral centers. Diagnosis is challenging: the initial presentation of abdominal pain is vague, varied, and similar to other, more common, pathologic abdominal conditions. This review covers clinical evaluation, investigative studies, management, intraoperative consultation, determination of bowel viability, mesenteric ischemia and reperfusion, and outcome after surgical treatment of AMI. Figures show computed tomographic (CT) scan of mesenteric vessels, CT scan of a partially occluding thrombus in the superior mesenteric vein, contrast-enhanced three-dimensional magnetic resonance angiography images of aorta and mesenteric vessels, a schematic drawing demonstrating the usual site for superior mesenteric artery (SMA) thrombosis versus that for SMA embolus, selective angiogram of the SMA in anterior projection demonstrating embolus within the vessel at the typical location, lateral contrast angiogram demonstrating near-occlusion of the celiac artery and total occlusion of the SMA, contrast angiograms of the aorta and mesenteric arteries in a patient with nonocclusive mesenteric ischemia, selective angiogram of the SMA demonstrating a partially occluding embolus in the distal vessel, selective angiogram showing a clot beyond the orifice of the SMA, lodged in the SMA of smaller caliber, algorithm illustrating intraoperative determination of bowel salvageability, evaluation of SMA pulses, and assessment of bowel viability after revascularization, and an intraoperative photograph of diffuse bowel ischemia with classic sparing of the proximal jejunum and transverse colon due to embolus of the SMA. This review contains 11 highly rendered figures and 65 references

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Mid-term outcomes of endovascular treatment for symptomatic chronic mesenteric ischemia

Surgical Techniques Development ◽

10.4081/std.2011.e2 ◽

2011 ◽

Vol 1 (1) ◽

pp. 2 ◽

Cited By ~ 1

Author(s):

Eva Schönefeld ◽

Susanne Szesny ◽

Konstantinos P. Donas ◽

Georgios A. Pitoulias ◽

Giovanni Torsello

Keyword(s):

Endovascular Treatment ◽

Mesenteric Ischemia ◽

Primary Patency ◽

Mesenteric Arteries ◽

Primary Study ◽

Symptom Improvement ◽

Initial Symptom ◽

Secondary Patency ◽

Chronic Mesenteric Ischemia

The authors would present the mid-term outcomes with the use of stent-supported angioplasty in the treatment of symptomatic chronic mesenteric ischemia (CMI). The present study is a retrospective analysis of 36 patients undergoing endovascular treatment of symptomatic CMI, between November 2000 and September 2009. Primary study endpoints were defined as primary patency, periprocedural and midterm mortality and complications, and symptom improvement after intervention. Forty-one mesenteric arteries (77.3% stenotic and 22.7% occluded vessels) were treated in 36 patients with 42 stents. In 30 patients (83.3%) one visceral artery and in 6 cases (16.7%) two visceral arteries were treated. Overall mortality was 16.7% (n=6) after a 60-month follow-up (mean follow-up period 30.1 months). Two early (<30-day) deaths were caused by visceral ischemia (n=2: 5.5%). Late death was procedure-related in one patient with re-occlusion of the superior mesenteric artery after 12 months. The other 3 patients died from non procedure-related causes; e.g. twice myocardial infarction. Initial symptom relief was observed in 29 patients (80.5%); 7 patients reported no change. Primary patency was 83.3% after 5 years and secondary patency was 90.5% (38 out of 42 stents) among all patients. Two conversions to open surgery were documented. First-line endovascular approach of CMI is a reasonable strategy. Close follow-up is mandatory due to symptom recurrence and restenosis.

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Combined Endovascular and Surgical Retrograde Superior Mesenteric Artery Recanalization

10.1093/med/9780199986071.003.0027 ◽

2018 ◽

Author(s):

Syed M. Peeran

Keyword(s):

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Mesenteric Ischemia ◽

Atherosclerotic Lesion ◽

Acute Mesenteric Ischemia ◽

Exploratory Laparotomy ◽

Chronic Mesenteric Ischemia ◽

Hybrid Technique ◽

Current Standard ◽

Stent Deployment

Acute mesenteric ischemia is a life-threatening vascular emergency associated with a very high mortality rate. In the setting of necrotic bowel, the current standard of care requires a laparotomy with bowel resection and surgical or endovascular revascularization of the superior mesenteric artery. Unfortunately, mesenteric bypass confers high perioperative mortality, in some reports up to 45%. A hybrid technique that employs an exploratory laparotomy, catheterization of the distal superior mesenteric artery, and stent deployment across the atherosclerotic lesion was first described in 2004 for the treatment of acute-on-chronic mesenteric ischemia. This chapter describes the appropriate clinical indications, the technical aspects of performing this hybrid procedure, as well as the challenges and common pitfalls encountered.

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Can the Preoperative Serum Lactate Level Predict the Extent of Bowel Ischemia in Patients Presenting to the Emergency Department with Acute Mesenteric Ischemia?

BioMed Research International ◽

10.1155/2017/8038796 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 10

Author(s):

Peter C. Ambe ◽

Kai Kang ◽

Marios Papadakis ◽

Hubert Zirngibl

Keyword(s):

Lactate Level ◽

Mesenteric Ischemia ◽

Clinical Decision Making ◽

Elevated Serum ◽

Acute Mesenteric Ischemia ◽

Serum Lactate ◽

Bowel Ischemia ◽

Serum Lactate Level ◽

Ischemic Bowel ◽

Preoperative Serum

Purpose. Early recognition of acute mesenteric ischemia (AMI) can be challenging. Extensive bowel necrosis secondary to AMI is associated with high rates of mortality. The aim of this study was to investigate the association between preoperative serum lactate level and the extent of bowel ischemia in patients with AMI. Methods. Data of patients with abdominal pain and elevated serum lactate undergoing emergency laparotomy for suspected AMI within 24 hours of presentation was retrospectively abstracted. The length of the ischemic bowel segment was compared with the preoperative serum lactate level. Results. 36 female and 39 male patients, with median age 73.1 ± 12.3 years, were included for analysis. The median preoperative lactate was 2.96 ± 2.59 mmol/l in patients with ≤50 cm, 6.86 ± 4.08 mmol/l in patients with 51–100 cm, 4.73 ± 2.76 mmol/l in patients with >100 cm ischemic bowel, and 14.07 ± 4.91 mmol/l in the group with multivisceral ischemia. Conclusion. Although elevated serum lactate might permit an early suspicion and thus influence the clinical decision-making with regard to prioritization of surgery in patients with suspected AMI, a linear relationship between serum lactate and the extent of bowel ischemia could not be established in this study.

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