Factors that may affect the outcome of acute occlusive mesenteric ischemia. A single-center study.

BACKGROUND: Acute mesenteric ischemia is a rare but lethal disease. Acute occlusive mesenteric ischemia consists of mesenteric artery embolism, mesenteric artery thrombosis, and mesenteric vein thrombosis. This study aimed to investigate the factors that may affect the outcome of acute occlusive mesenteric ischemia. METHODS: Data from acute occlusive mesenteric ischemia patients admitted between May 2016 and May 2022 were reviewed retrospectively. Patients were divided into 2 groups according to whether complications(Clavien‒Dindo ≥ 2) occurred within 6 months of the first admission. Demographics, symptoms, signs, laboratory results, computed tomography angiography features, management and outcomes were analyzed. RESULTS: 59 patients were enrolled in this study. Complications(Clavien‒Dindo ≥ 2) occurred within 6 months of the first admission in 17 patients. Transmural intestinal necrosis, peritonitis, white blood cell count, percentage of neutrophils, percentage of lymphocytes, neutrophil-to-lymphocyte ratio, lactate dehydrogenase, creatine kinase isoenzyme, cardiac troponin I, laparoscopic exploration rate, open embolectomy rate, enterostomy rate, length of necrotic small bowel, length of healthy small bowel, surgical time and intraoperative blood loss differed significantly between groups. Creatine kinase isoenzyme (OR = 1.415, 95% CI: 1.060-1.888) and surgical time (OR = 1.014, 95% CI: 1.001-1.026) were independent risk factors associated with complications(Clavien‒Dindo ≥ 2). CONCLUSIONS: Our analysis suggests that acute occlusive mesenteric ischemia patients with a creatine kinase isoenzyme level greater than 2.22 ng/mL or a surgical time longer than 156 min are more likely to experience complications'(Clavien‒Dindo ≥ 2) occurrence within 6 months of the first admission.

Impact of Patient and Procedural Factors on Outcomes Following Mesenteric Bypass.

BACKGROUND: Mesenteric bypass (MB) for patients with acute (AMI) and chronic mesenteric ischemia (CMI) is associated with cardiovascular (CV) and pulmonary morbidity. METHODS: Patients with AMI and CMI from 2008 to 2019 were identified to determine independent predictors of CV (cardiac arrest, MI, DVT, and stroke) and pulmonary (pneumonia and ventilator time>48 h) morbidities in patients undergoing MB. RESULTS: 377 patients were identified. Patients with AMI had higher rates of preoperative SIRS/sepsis (28 vs 12%, P < .0001), were more likely to be ASA class 4/5 (55 vs 42%, P = .005), were more likely to require bowel resection (19 vs 3%, P < .0001), and were more likely to have vein utilized as their bypass conduit (30 vs 14%, P < .0001). There were no differences in use of aortic or iliac inflow (P = .707) nor in return to the OR (24 vs 19%, P = .282). Both postoperative sepsis (12 vs 2.6%, P = .003) and mortality (31.4% vs 9.8%, P < .0001) were significantly increased in patients with AMI. After adjusting for both patient and procedural factors, multivariable logistic regression (MLR) identified international normalized ratio (INR) (OR 3.16; 95% CI 1.56-6.40, P = .001) and chronic heart failure (CHF) (OR 5.88; 95% CI 1.15-29.97, P = .033) to be independent predictors of pulmonary morbidity, while preoperative sepsis (OR 1.96; 95% CI 1.45-2.66, P < .0001) alone was predictive of CV morbidity in all patients undergoing MB. DISCUSSION: Mesenteric bypass for mesenteric ischemia leads to high rates of morbidity and mortality, whether done in an acute or chronic setting. Preoperative sepsis, independent of AMI or CMI, predicts CV morbidity, regardless of bypass configuration or conduit, while elevated INR or underlying CHF carries a higher risk of pulmonary morbidity.

Outcomes of open revascularization for chronic mesenteric ischemia at a tertiary care center in India.

OBJECTIVE: Chronic mesenteric ischemia (CMI) is a rare, debilitating disease associated with higher morbidity and mortality if not treated on time. In the past two decades, there has been a paradigm shift in its management with endovascular modality due to reduced perioperative morbidity and mortality. In the endovascular era, only a few patients require surgical therapy. We conducted this study to report our experience with open surgical revascularization at our hospital. METHODS: We have conducted a retrospective study after obtaining approval from Institutional Ethics Committee. Data regarding patients who underwent open revascularization for CMI with long-segment occlusion from 2016 to 2021 has been retrieved from the institutional database. The demographic data, clinical presentation, type of surgery and graft used, perioperative mortality and morbidity and length of hospital stay were evaluated. Overall survival and disease-free survival were assessed using Kaplan-Meier analysis. RESULTS: Twenty-one patients underwent open surgical revascularization; 16 were males and five females. The median age was 43 years. Fourteen (66.7%) were smokers. The mean duration of follow-up was 28.4 ± 13.6 months. Thirty-day postoperative mortality was 0% and morbidity was 28%. The average duration of hospital stay and postoperative weight gain were 6.9 ± 3.7 days and 11 ± 4.9 kgs, respectively. One patient died at two years of follow-up due to myocardial infarction and one had a recurrence. Long-term survival at 60 months of follow-up was 91.6% and the primary-patency rate was 95.2%. CONCLUSION: Owing to better long-term and reintervention-free patency, open revascularization should be considered in patients who are fit for surgery, particularly in patients with long-segment mesenteric artery occlusion.

Open revascularization in a patient with chronic mesenteric ischemia and a history of aorto-bifemoral bypass - a case report.

INTRODUCTION: This case report describes surgical treatment of chronic mesenteric ischemia in a polymorbid patient with the history of an aorto-bifemoral bypass implant. CASE REPORT: The patient suffered from chronic occlusions of the mesenteric arteries. He experienced postprandial pain and significant weight loss. Endovascular repair of the occlusions failed. Open single retrograde bypass from the left branch of the aorto-bifemoral graft to the superior mesenteric artery was implanted successfully. CONCLUSION: The discussion briefly mentions current trends in the treatment of chronic mesenteric ischemia. Despite the development of interventional radiology, surgical treatment remains a relevant alternative for the management of chronic mesenteric ischemia.

Successful clinical management of mesenteric ischemia caused by superior mesenteric artery obstruction and celiac artery stenosis: a case report.

Acute mesenteric ischemia (AMI) is a rare, yet deadly thromboembolic accident that requires urgent surgery and or revascularization. We report the case of a 67-year-old male patient, who presented with severe abdominal pain and reduced oral intake, causing dehydration and impaired kidney function. The imaging evaluation including arterial Doppler and computed tomography (CT) scan showed AMI caused by superior mesenteric artery (SMA) obstruction and celiac artery stenosis, besides multiple atherosclerotic segments. Given the absence of guidelines in such an uncommon combination, a multidisciplinary management was initiated involving general medicine, general surgery, vascular surgery, and radiology. The agreed plan consisted of anticoagulation, exploratory laparotomy with necrosis resection and anastomosis, followed by percutaneous thrombectomy and angioplasty with stenting. The patient was discharged on day 7 postop with a highly satisfactory outcome and follow up. This case highlights the value of an early multidisciplinary approach in tailoring the management to the specific case of AMI.

Review article: Acute superior mesenteric vessel ischaemia: A review of clinical practice and biomarkers.

A patient with acute occlusion of the superior mesenteric vessels resulting in superior mesenteric vessel ischaemia (SMVI) who presents to the ED with abdominal pain and unremarkable abdominal examination risks delay in diagnosis and treatment with adverse outcome. A comprehensive literature search was performed, and the evidence was reviewed. To-date, there are no accurate biomarkers of SMVI and so, heightened awareness among ED staff and rapidly actioning diagnostic imaging and surgical referral will help fast-track the patient with SMVI to surgical management. Management of SMVI is challenging and requires ongoing communication. Prompt surgical intervention may help reduce mortality and morbidity in SMVI. SMVI is associated with significant mortality and morbidity. With the lack of accurate biomarkers, diagnosis and management is challenging and requires heightened awareness among ED staff for prompt surgical referral and intervention.

Delayed bowel necrosis due to inferior mesenteric artery occlusion in Stanford type A acute aortic dissection.

Although inferior mesenteric artery occlusion due to acute aortic dissection sometimes occurs, it is usually not considered an important finding. Herein, we present an extremely rare case of delayed bowel ischaemia due to inferior mesenteric artery occlusion in Stanford type A acute aortic dissection that highlights the need for cardiac surgeons to be mindful of inferior mesenteric artery occlusion in patients with superior mesenteric artery dissection or vascular anomalies in the mesenteric arteries.

[Gas in superior mesenteric artery and celiac axis as a rare CT-sign of extensive bowel necrosis]. / Gaz v verkhnei bryzheechnoi arterii i chrevnom stvole kak redkii KT-priznak obshirnogo nekroza kishechnika.

The authors report endovascular treatment of acute thromboembolic occlusion of superior mesenteric artery in a 75-year-old patient whose postoperative period was complicated by massive reperfusion and translocation syndrome. Contrast-enhanced CT in 12 hours after successful thrombectomy from superior mesenteric artery revealed CT signs of irreversible bowel lesion, i.e. gas in hepatic veins, intestinal wall and mesenteric veins, bowel wall thinning. In addition, CT revealed extremely rare sign of severe acute mesenteric ischemia (gas in superior mesenteric artery and celiac axis). We found no description of gas in celiac axis following acute mesenteric ischemia in available literature.

Surgical and endovascular revascularization of chronic mesenteric ischemia.

PURPOSE: Chronic mesenteric ischemia (CMI) is a rare but life-threatening disease. This study reviewed outcomes in patients treated surgically for CMI by open treatment (OT) and endovascular treatment (ET), analyzing risk factors for endovascular failure. METHODS: Clinical data for 36 patients treated for CMI from 2007 to 2017 were retrospectively analyzed. The study's primary endpoint was symptom-free survival. The secondary endpoint was the primary technical success for endovascular and open surgical treatments. Risk factors for endovascular failure were identified by using univariate analysis. RESULTS: Patients were analyzed as treated: 21 patients (58.3%) in the ET and 15 (41.6%) in the OT group. Overall, 20 patients (56%) presented with abdominal angina, 9 (25%) with rest pain, and 7 (19%) without symptoms. An ET was initially attempted in 31 patients (86.1%). The conversion rate from ET to OT was 32.3%, which resulted in a primary technical success of 67.6% in ET and 100% in OT. Six patients from the ET group (19.3%) required surgical revision due to restenosis. One-year (OT 91.6% vs. ET 96.8%; n.s.) and three-year primary patency (OT 91.6% vs. ET 80.6%; n.s.) as well as 3-year symptom-free survival did not differ between the groups (OT 62.5% vs. ET 69.4%; n.s). Overall, in-hospital mortality was 2.8% (n = 1), which was not statistically different between the groups (OT 6% vs. ET 0%; n.s.). High-grade stenosis of the superior mesenteric artery tended to be associated with higher technical failure (P = 0.06). CONCLUSIONS: ET showed a comparable perioperative outcome with higher technical failure. OT was distinguished by excellent early and late technical success.

[Endovascular management of chronic mesenteric ischemia : retrospective single-centre study]. / Prise en charge endovasculaire de l'ischémie mésentérique chronique : étude rétrospective monocentrique.

Chronic mesenteric ischemia (CMI) is a clinical entity linked to a gradual decrease in coelio-mesenteric arterial flow caused by occlusive disease of the digestive arterial axes. There are many etiologies of CMI, but most of the time atherosclerosis is the leading cause. Due to the development of collateral networks, clinical manifestations of CMI are very rare although some degree of stenosis of the digestive arteries is frequently found in asymptomatic elderly patients. Symptomatic CMI typically presents with the triad «post-meal abdominal pain - fear of eating - weight loss¼. Open surgical treatment was the gold standard for the management of symptomatic CMI since 1958. However, from 1980 and the introduction of endovascular treatment, percutaneous angioplasty combined with with stenting became the most common revascularization technique for CMI. The objective of this article is to report the results associated with endovascular therapy in patients with CMI at our hospital over the past 8 years.

L'ischémie mésentérique chronique (IMC) est une entité clinique rare liée à la diminution graduelle du flux artériel coelio-mésentérique causée par une maladie occlusive des axes artériels digestifs. De nombreuses étiologies de l'IMC existent, mais la plus fréquente est l'athérosclérose. En raison du développement de réseaux de vicariances, les manifestations cliniques de l'IMC sont rares, même en présence d'une lésion des troncs artériels digestifs. L'IMC symptomatique se présente par la triade classique de douleurs abdominales post-prandiales, sitiophobie (peur de se nourrir) et amaigrissement. La revascularisation chirurgicale était considérée comme le traitement de choix dans la prise en charge des patients symptomatiques depuis 1958, mais au prix d'une morbi-mortalité peropératoire non négligeable. À partir de l'introduction du traitement endovasculaire en 1980, cette procédure, combinant angioplastie percutanée et mise en place de stents, est devenue la technique de choix au vu de ses avantages en termes de morbi-mortalité et de durée de séjour. L'objectif de cet article est de rapporter les résultats associés à la prise en charge endovasculaire des patients atteints d'IMC au sein de notre institut au cours des 8 dernières années.