Interdisciplinary approach in emergency revascularization and treatment for acute mesenteric ischemia

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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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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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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Endovascular management of chronic mesenteric ischemia: a single centre experience in Western Rajasthan, India

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20172449 ◽

2017 ◽

Vol 5 (6) ◽

pp. 2572

Author(s):

Pawan Sarda ◽

Goutam Kumar ◽

Deepak Gupta ◽

Sanjeev Sanghvi ◽

Anil Baroopal

Keyword(s):

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Percutaneous Transluminal Angioplasty ◽

Inferior Mesenteric Artery ◽

Mesenteric Ischemia ◽

Celiac Trunk ◽

Transluminal Angioplasty ◽

Chronic Mesenteric Ischemia ◽

Percutaneous Transluminal

Background: Chronic mesenteric ischemia (CMI) or mesenteric angina is a condition characterised by inadequate blood supply to bowel as a result of stenosis affecting one or more of the three mesenteric arteries: the celiac artery (CA), the superior mesenteric artery (SMA) and the inferior mesenteric artery (IMA).Methods: Ten patients with significant lesion, treated with PTA and stenting were selected for study and were followed at 2 weeks, at 2 months then at 6 months after index procedure to see composite of symptomatic improvement, weight gain and revascularization.Results: On mesenteric angiography, significant ostial stenosis of celiac trunk and superior mesenteric artery in 5 patients, 3 patients had significant ostial stenosis of celiac trunk and ostial stenosis of inferior mesenteric artery and 2 patients had significant stenosis of superior mesenteric artery. Percutaneous transluminal angioplasty (PTA) and stenting was done, final result was good and there was no residual stenosis and dissection. After stenting patients were stable and pain free. There were no post-operative complications. Follow up was done after 2 weeks and 2 months and then at six months. There was no postprandial abdominal pain on follow up and almost all patient had gained weight in 2 months and on 6 months of follow up, no case of repeat revascularization was recorded.Conclusions: Percutaneous transluminal angioplasty (PTA) and stenting to mesenteric artery is good alternative management of CMI. In present series, all cases were susses fully revascularized without residual stenosis and dissection.

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Acute and chronic mesenteric ischemia: MDCT findings

Jornal Vascular Brasileiro ◽

10.1590/s1677-54492010000300011 ◽

2010 ◽

Vol 9 (3) ◽

pp. 156-163 ◽

Cited By ~ 4

Author(s):

Bruna Schmitz Serpa ◽

Adriano Tachibana ◽

Ronaldo Hueb Baroni ◽

Ricardo Aun ◽

Marcelo Buarque Gusmão Funari

Keyword(s):

Blood Flow ◽

Mesenteric Ischemia ◽

Three Dimensional ◽

Acute Mesenteric Ischemia ◽

Chronic Mesenteric Ischemia ◽

Mesenteric Blood Flow ◽

Ischemic Bowel ◽

Mesenteric Vessels ◽

Bowel Segments

Mesenteric ischemia is caused by a reduction in mesenteric blood flow. It can be divided into acute and chronic, based upon the rapidity and the degree to which the blood flow is compromised. The authors retrospectively reviewed 22 cases of mesenteric ischemia, diagnosed by multidetector computed tomography (MDCT) in our service, and confirmed by surgery or clinical follow-up. The frequency of the diagnostic findings of chronic and acute mesenteric ischemia was evaluated. The improvement of three-dimensional (3D) MDCT allows accurate assessment of mesenteric vessels. Therefore, it demonstrates changes in ischemic bowel segments helpful in determining the primary cause of the disease, and can identify the complications in patients with acute and chronic mesenteric ischemia.

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Factors predicting long-term outcomes of percutaneous angioplasty and stenting of the superior mesenteric artery for chronic mesenteric ischemia

VASA ◽

10.1024/0301-1526/a000964 ◽

2021 ◽

Author(s):

Joris Awouters ◽

Thomas Jardinet ◽

Martin Hiele ◽

Annouschka Laenen ◽

Steven Dymarkowski ◽

...

Keyword(s):

Mesenteric Artery ◽

Mesenteric Ischemia ◽

Chronic Mesenteric Ischemia ◽

Percutaneous Angioplasty ◽

Long Term Outcomes ◽

Relapse Free Survival ◽

Free Survival ◽

Angioplasty And Stenting

Summary: Background: To analyse the long-term outcomes of percutaneous angioplasty and stenting of the superior mesenteric artery (SMA) in the treatment of chronic mesenteric ischemia (CMI), and to assess predictive factors for a better clinical outcome. Patients and methods: Retrospective analysis of 76 consecutive patients, treated percutaneously for CMI between January 1999 and January 2018 and followed up until the end of 2018. Patients’ pre-, peri- and post-interventional clinical and radiological data were gathered from the institutional electronic medical records. The Kaplan Meier method with log rank test or the Cox model were used to analyse overall survival; the cumulative incidence function with Pepe and Mori test or the Fine and Grey model were used to analyse relapse-free survival, considering death as a competing event. Results: Seventy-six consecutive patients with a mean age of 72 years were included in the study. Catheter-angiography revealed an ostial or non-ostial >90% stenosis in n=23 (29.7%) and n=53 (69.7%) of included patients, respectively. Immediate clinical success was achieved in n=68 (89.5%), and procedural complications were observed in n=13 (17.1%) patients. Long-term follow-up revealed relapse of symptoms in n=21 (28.8%) patients, and overall survival estimates are 81.8%, 57.0% and 28.2% after two, five and ten years of follow-up, respectively. A trend towards longer relapse-free survival was found in the circumferential stenosis group (78.2% at five years) compared with the non-circumferential stenosis group (55.5%) (P=0.063). Conclusions: Angioplasty and stenting of the SMA for CMI is relatively safe and effective despite a substantial number of patients experiencing clinical relapse over time. Patients with focal, circumferential stenosis might have longer relapse-free survival than patients with non-circumferential stenosis.

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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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