scholarly journals Factors Associated With in-Hospital Death in Patients with Acute Mesenteric Artery Ischemia

2018 ◽  
Vol 4 (3) ◽  
pp. 133-139
Author(s):  
Előd Etele Élthes ◽  
Alexandra Lavinia Cozlea ◽  
Árpád Török
Keyword(s):  
Emergency Department ◽  
Mesenteric Artery ◽  
Mesenteric Ischemia ◽  
Surgical Intervention ◽  
Acute Mesenteric Ischemia ◽  
Mesenteric Arteries ◽  
Hospital Death ◽  
Acute Ischemia ◽  
Factors Associated ◽  
Hospitalization Period

ABSTRACT Objective: The aim of the study was to assess the factors associated with increased mortality in patients with acute mesenteric ischemia, emphasizing the importance of an early diagnosis and a prompt surgical intervention in order to avoid lesion progression. Materials and method: A retrospective analytical study was conducted on a study population of 50 male and female patients with acute ischemia of the mesenteric arteries, aged between 36-92 years. Demographic and pathological history characteristics were assessed, together with presented symptoms, laboratory and CT findings, as well as surgical outcome and time-related aspects between presentation in the emergency department and time of surgery, as well as the hospitalization period until discharge or death. Results: Muscular defense (OR = 23.05) and shock (OR = 13.24) as symptoms were strongly associated with a poor prognosis, while elevated values of lactate dehydrogenase (p = 0.0440) and creatine kinase (p = 0.0025) were associated with higher death rates. The time elapsed during investigations in the emergency room was significantly higher in patients who deceased (p = 0.0023), similarly to the total time from the onset of symptoms to the beginning of surgery (p = 0.0032). Surgical outcomes showed that patients with segmental ischemia of the small bowel had significantly higher chances of survival (p <0.0001). Conclusion: Increased mortality rates in patients presenting in the emergency department for acute mesenteric ischemia were observed in patients with occlusion of the superior mesenteric artery, with higher levels of CK and LDH, as well as with longer periods of stay in the emergency department for diagnostic procedures until the commencement of the surgical intervention. Therefore, proper investigations in a timely manner followed by a specific and prompt surgical intervention may avoid unfavorable evolution of patients towards death.

Combined Endovascular and Surgical Retrograde Superior Mesenteric Artery Recanalization

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.

scholarly journals Necessity of revascularization for acute mesenteric ischemia in symptomatic patients with spontaneous isolated dissection of the superior mesenteric artery

Vascular ◽  
2019 ◽  
Vol 28 (1) ◽  
pp. 109-114
Author(s):  
Hiroyuki Otsuka ◽  
Atsushi Uehata ◽  
Keiji Sakurai ◽  
Toshiki Sato ◽  
Hiromichi Aoki ◽  
...  
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Mesenteric Ischemia ◽  
Laboratory Data ◽  
Acute Mesenteric Ischemia ◽  
True Lumen ◽  
Bowel Necrosis ◽  
Abnormal Laboratory ◽  
Number Of Patients ◽  
Residual Ratio

Objectives We evaluated the necessity of revascularization for acute mesenteric ischemia in symptomatic patients with spontaneous isolated dissection of the superior mesenteric artery. Methods This retrospective study included 28 consecutive, symptomatic patients with spontaneous isolated dissection of the superior mesenteric artery treated at our hospital between December 2005 and December 2017. Patients with concomitant aortic dissection were excluded. We reviewed the patients’ clinical presentation; laboratory evaluations; computed tomography findings, including the true lumen residual ratio (i.e., the minimum true lumen size compared to the diameter of the transverse section of the dissected artery) at the time of admission; the number of patients who were suspected of having bowel ischemia; and the number of patients who required surgical or endovascular treatment and their outcomes. Additionally, to evaluate the true lumen residual ratio in symptomatic patients with bowel ischemia, the true lumen residual ratio in those with abnormal laboratory data were compared with that in those without abnormal laboratory data. Initial true lumen residual ratio values were also compared with final values. Furthermore, we assessed the clinical details of patients who had bowel necrosis. Categorical variables were compared using the χ2 test or Fisher’s exact test, and continuous values were presented as either the mean ± standard deviation or median (interquartile range 25–75%). Variables were analyzed using Student’s t-test or the Mann–Whitney U test. Results The patients’ age ranged between 41 and 85 years, and 25 were men. Although nine patients were suspected of having acute mesenteric ischemia, only one underwent bowel resection. None of the patients had an indication for revascularization. The true lumen residual ratio of the nine patients with abnormal laboratory data were significantly lower than those of the 19 without abnormal laboratory data (10 [0–25]% vs. 40 [20–50]%, p = 0.005). The patient who underwent bowel resection had a true lumen residual ratio of 10%; however, there was no obvious abnormal laboratory data suggestive of bowel necrosis. Dissections were managed conservatively in all patients. True lumen residual ratio increased from initial value of 30 (10–48)% to 98 (60-100)%at the final imaging study ( p < 0.0001). There were no adverse events related to the mesenteric circulation during the follow-up period of 2–11 years. Conclusions Reintervention is rarely required for spontaneous isolated dissection of the superior mesenteric artery, even in symptomatic patients, and spontaneous resolution of the luminal compromise is the rule.

Results of retrograde revascularizations of the superior mesenteric artery for acute mesenteric ischemia

2017 ◽  
Vol 44 ◽  
pp. 27-28
Author(s):  
Arnaud Roussel ◽  
Nellie Della Schiava ◽  
Raphael Coscas ◽  
Quentin Pellenc ◽  
Tarek Boudjelit ◽  
...  
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia

scholarly journals Problems of the Diagnosis and Treatment of Acute Mesenteric Ischemia: a SingleCenter Experience

2018 ◽  
Vol 3 (4) ◽  
Keyword(s):  
Blood Flow ◽  
Mortality Rate ◽  
Early Diagnosis ◽  
High Mortality ◽  
Mesenteric Ischemia ◽  
Intestinal Resection ◽  
Acute Mesenteric Ischemia ◽  
Mesenteric Arteries ◽  
Diagnosis And Treatment ◽  
Number Of Patients

Objective: To improve the diagnosis and treatment of acute mesenteric ischemia by using available methods of early diagnosis and modern methods of treatment. Summary Background Data: The number of patients with disorders of the mesenteric circulation is increasing all over the world. In comparison with the occlusion of the coronary, cerebral arteries and peripheral veins, acute obstruction of the mesenteric arteries and veins is diagnosed much later, which causes a high mortality rate from 53 to 100%. Methods: In this study the experience of treatment of 162 patients with acute mesenteric ischemia was analyzed. All patients underwent treatment in Institute of Urgent and Recovery Surgery (IURS NAMS, Donetsk, Ukraine) from 2002 to 2017. Results: From 162 patients: 112 patients were with acute occlusive and 50 patients with acute nonocclusive mesenteric ischemia. The intravital diagnosis was not confirmed in 26 patients (16 %). 119 of patients died, the level of mortality was 73, 5%. 104 patients were operated, 32 patients were discharged (30,8 %), 72 patients died, a mortality rate was 69,2 %. Operations with restore of blood flow were performed in 14 patients, 5 patients died, 9 patients left the hospital. Conservative therapy was performed in 22 patients, in 11 patients with good results (50 %). Conclusions: The early diagnosis of this pathology is crucial and it can reduce the high mortality rate of patients with AMI. Treatment of OAMI should be carried out in a community of general, vascular and endovascular surgeons. Restoration of blood flow through mesenteric vessels with the help of endovascular technology and implementation of thrombembolectomy during open surgical intervention in a number of cases allows to avoid intestinal resection.

scholarly journals Nonocclusive Mesenteric Ischemia Rescued by Immediate Surgical Exploration in a Boy with Severe Neurodevelopmental Disability

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Manami Mizumoto ◽  
Fumihiro Ochi ◽  
Toshihiro Jogamoto ◽  
Kentaro Okamoto ◽  
Mitsumasa Fukuda ◽  
...  
Keyword(s):  
Mesenteric Ischemia ◽  
Cardiopulmonary Arrest ◽  
Hypovolemic Shock ◽  
Acute Mesenteric Ischemia ◽  
Underlying Disease ◽  
Sudden Onset ◽  
Mesenteric Arteries ◽  
Nonocclusive Mesenteric Ischemia ◽  
Surgical Exploration ◽  
Neurodevelopmental Disability

Background. Nonocclusive mesenteric ischemia (NOMI) defines acute mesenteric ischemia without occlusion of the mesenteric arteries. The most common cause of NOMI is vasoconstriction or vasospasm of a mesenteric artery. NOMI generally affects patients >50 years of age, and few cases have been reported in children. Case Presentation. A 15-year-old boy with severe neurodevelopmental disability developed sudden-onset fever, abdominal distention, and dyspnea. Laboratory and radiological findings indicated acute intestinal obstruction and prerenal failure. He developed transient cardiopulmonary arrest and hypovolemic shock. Emergent laparotomy was performed, which revealed segmentally necrotic intestine from the jejunum to the ascending colon with pulsation of peripheral intestinal arteries, leading to a diagnosis of NOMI. The necrotic intestine was resected, and stomas were created. He was discharged on postoperative day 334 with short bowel syndrome as a complication. Conclusions. NOMI should be considered a differential diagnosis for intestinal symptoms with severe general conditions in both adults and children with underlying disease. Immediate surgical exploration is essential with NOMI to save a patient’s life.

Stenting of stenotic mesenteric arteries for symptomatic chronic mesenteric ischemia

VASA ◽  
2012 ◽  
Vol 41 (6) ◽  
pp. 425-431 ◽  
Author(s):  
Aschenbach ◽  
Bergert ◽  
Kerl ◽  
Zangos ◽  
Neumeister ◽  
...  
Keyword(s):  
Weight Loss ◽  
Abdominal Pain ◽  
Gastrointestinal Bleeding ◽  
Mesenteric Artery ◽  
Mesenteric Ischemia ◽  
Celiac Artery ◽  
Lower Gastrointestinal Bleeding ◽  
Mesenteric Arteries ◽  
Chronic Mesenteric Ischemia ◽  
Technical Failure

Background: We report the results of our single center series of patients with chronic mesenteric ischemia (CMI) to determine the role of stenting in the management of patients. Patients and methods: We retrospectively reviewed all patients with CMI treated endovascularly with stent revascularisation from January 2008 to January 2011.CMI diagnosis was made according to clinical symptoms, including postprandial abdominal pain, food fear, and weight loss. Additionally, the diagnosis was confirmed by duplex ultrasonography and/or computed tomography angiography and/or contrast-enhanced magnetic resonance angiography. Results: All 45 patients presented with typical CMI symptoms: 45/45 (100 %) had postprandial pain, 31/45 (68.8 %) had a weight loss of more than 10 kilograms, and 11/45 (24.4 %) suffered from ischemic colitis combined with lower gastrointestinal bleeding. In three patients occlusion could not be crossed, therefore considered as technical failure. A total of 55 arteries were stented in the remaining 42 patients. Nineteen patients underwent SMA stenting alone, eight underwent celiac stenting, alone and three patients underwent stenting of inferior mesenteric artery (IMA) alone. We performed combined stenting of the celiac artery and superior mesenteric artery in ten patients, and one patient underwent a combined stenting of the celiac artery and the IMA. All three mesenteric arteries were stented in only one patient. Primary technical success was achieved in 42/45 (94.8 %) patients. Clinical symptom relief was achieved in 39/45 (86.6 %) patients with abdominal pain. Increased body weight was observed in 28/31 (90.3 %) patients with an average weight gain of 8.8 kilograms (5 - 12 kilograms), and 10/11 (90.9 %) patients recovered from ischaemic colitis/lower gastrointestinal bleeding. Conclusions: Stent revascularisation can be considered as the first-line therapy for patients with chronic mesenteric ischemia.

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