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1.
Eur J Radiol ; 138: 109652, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33740626

RESUMO

PURPOSE: Acute mesenteric ischemia (AMI) may be underdiagnosed when not clinically suspected before CT is performed. We assessed the influence of a clinical suspicion of AMI on the CT accuracy. METHOD: This retrospective single-centre study included patients who underwent CT in 2014-2019 and had clinically suspected AMI and/or confirmed AMI. CT protocols were adapted based on each patient's presentation and on findings from unenhanced images. The CT protocol was considered optimal for AMI when it included arterial and portal venous phases. CT protocols, accuracy of reports, and outcomes were compared between the groups with and without suspected AMI before CT. RESULTS: Of the 375 events, 337 (90 %) were suspected AMI and 66 (18 %) were AMI, including 28 (42 %) with and 38 without suspected AMI. These two groups did not differ significantly regarding the medical history, clinical presentation, or laboratory tests. The CT protocol was more often optimal for AMI in the group with suspected AMI (26/28 [93 %] vs. 28/38 [74 %], p = 0.046). Diagnostic accuracy was not different between groups with and without suspected AMI (26/28 [93 %] vs. 34/38 [90 %], p = 1.00). However, it was lower in the group without suspicion of AMI when the CT protocol was not optimal for AMI (27/28 [96 %] vs 7/10 [70 %], p = 0.048). CONCLUSIONS: The negative influence of not clinically suspecting AMI can be mitigated by using a tailored CT protocol.


Assuntos
Isquemia Mesentérica , Doença Aguda , Artérias , Humanos , Isquemia , Isquemia Mesentérica/diagnóstico por imagem , Veia Porta , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
2.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-33563693

RESUMO

A 54 year-old man was admitted after being found on the floor of his home, thought to have been there for approximately 5 days. He was diagnosed with a non-ST elevation myocardial infarction and bilateral cerebral ischaemic infarcts, as well as an acute kidney injury driven by rhabdomyolysis. The following day, bilateral lower limb ischaemia was observed. A full body CT angiogram revealed a complete thromboembolic shower with bilateral arterial occlusion in the lower limbs, bilateral pulmonary emboli, a splenic infarct and mesenteric ischaemia. An echocardiogram revealed a large thrombus in the left ventricle as the likely thromboembolic source. Bilateral lower limb amputations were recommended, commencing a complex discussion regarding the best course of management for this patient. The discussion was multifaceted, owing to the patient's lack of capacity, and input from multiple teams and the patient's relatives was required. Both ethical and clinical challenges arise from this case of a thromboembolic shower.


Assuntos
Tromboembolia/diagnóstico por imagem , Tromboembolia/terapia , Amputação , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/terapia , Biomarcadores/sangue , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/terapia , Angiografia por Tomografia Computadorizada , Trombose Coronária/diagnóstico por imagem , Trombose Coronária/terapia , Diagnóstico Diferencial , Ecocardiografia , Eletrocardiografia , Humanos , Masculino , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/terapia , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/terapia , Infarto do Baço/diagnóstico por imagem , Infarto do Baço/terapia
4.
Curr Opin Crit Care ; 27(2): 183-192, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33395084

RESUMO

PURPOSE OF REVIEW: To summarize current evidence on acute mesenteric ischemia (AMI) in critically ill patients, addressing pathophysiology, definition, diagnosis and management. RECENT FINDINGS: A few recent studies showed that a multidiscipliary approach in specialized centers can improve the outcome of AMI. Such approach incorporates current knowledge in pathophysiology, early diagnosis with triphasic computed tomography (CT)-angiography, immediate endovascular or surgical restoration of mesenteric perfusion, and damage control surgery if transmural bowel infarction is present. No specific biomarkers are available to detect early mucosal injury in clinical setting. Nonocclusive mesenteric ischemia presents particular challenges, as the diagnosis based on CT-findings as well as vascular management is more difficult; some recent evidence suggests a possible role of potentially treatable stenosis of superior mesenteric artery and beneficial effect of vasodilator therapy (intravenous or local intra-arterial). Medical management of AMI is supportive, including aiming of euvolemia and balanced systemic oxygen demand/delivery. Enteral nutrition should be withheld during ongoing ischemia-reperfusion injury and be started at low rate after revascularization of the (remaining) bowel is convincingly achieved. SUMMARY: Clinical suspicion leading to tri-phasic CT-angiography is a mainstay for diagnosis. Diagnosis of nonocclusive mesenteric ischemia and early intestinal injury remains challenging. Multidisciplinary team effort may improve the outcome of AMI.


Assuntos
Isquemia Mesentérica , Doença Aguda , Angiografia , Humanos , Intestinos , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/terapia , Tomografia Computadorizada por Raios X
5.
Clin Imaging ; 73: 86-95, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33341452

RESUMO

BACKGROUND: Limited data is available addressing gastrointestinal (GI) ischemia in coronavirus disease 2019 (COVID-19). We reviewed the clinical and radiologic features of GI ischemia and its related complications in thirty-one COVID-19 patients reported in literature. METHODS: A systematic literature review was performed using a search strategy on all studies published from January 1, 2020, to June 13, 2020, and updated on September 6, 2020, on databases from PubMed, Scopus, Embase, Web of Science, and Google Scholar. Every study with at least one presentation of COVID-19-related GI ischemia complication and one GI imaging finding was included. RESULTS: In total, twenty-two studies and thirty-one patients with the mean age of 59 ± 12.7 (age range: 28-80) years old were included, of which 23 (74.2%) patients were male, 7 (22.5%) female, and one unknown gender. The significant GI imaging findings include mesenteric arterial or venous thromboembolism, followed by small bowel ischemia. Nine patients (29%) presented with arterial compromise due to superior mesenteric thromboembolism, resulting in bowel ischemia. Also, 6 patients (19.3%) demonstrated occlusive thrombosis of the portal system and superior mesenteric vein. More than two-thirds of patients (20, 64.5%) required laparotomy and bowel resection. Eventually, five (16.1%) patients were discharged, of whom four cases (12.9%) readmitted. Five (16.1%) patients remained ICU hospitalized at the report time and 12 (38.7%) patients died. CONCLUSION: Macrovascular arterial/venous thrombosis is identified in almost half of COVID-19 patients with bowel ischemia. Overall mortality in COVID-19 patients with GI ischemia and radiologically evident mesenteric thrombotic occlusion was 38.7% and 40%, retrospectively.


Assuntos
Gastroenteropatias , Isquemia Mesentérica , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Gastroenteropatias/diagnóstico por imagem , Gastroenteropatias/etiologia , Humanos , Isquemia/diagnóstico por imagem , Isquemia/etiologia , Masculino , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/etiologia , Pessoa de Meia-Idade , Estudos Retrospectivos
8.
Kyobu Geka ; 73(10): 783-788, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-33130766

RESUMO

Mesenteric malperfusion is reported as a complication associated with acute aortic dissection(AAD) in 3~5% cases, and one of the adverse risk factors for survival. The mortality rate associated with malperfusion due to AAD is higher than that without malperfusion. To improve the clinical outcome, it is important to address the mesenteric malperfusion appropriately. Mesenteric malperfusion remains a diagnostic challenge. Abdominal pain is the most common symptom, but a nonspecific of acute mesenteric ischemia. Computed tomography(CT) including CT angiography is the gold standard in the diagnosis of aortic dissection and the mesenteric malperfusion. No single serum marker, including lactate, is reliable enough to diagnosis mesenteric ischemia. The optimal treatment for mesenteric malperfusion due to AAD is to restore blood flow to the ischemic area as early as possible, while minimizing the risk of thoracic aortic rupture. Those patients with malperfusion but no significant organ ischemia should be treated with immediate surgical repair. Those patients with malperfusion and significant organ ischemia and hemodynamically stable should be treated with mesenteric reperfusion, followed by surgical repair. The management of mesenteric malperfusion associated with AAD requires a tailored approach to improve outcomes. After successful restoration of mesenteric perfusion, patients should be monitored closely, and the bowel should be inspected when there is doubt regarding its viability.


Assuntos
Aneurisma Dissecante , Aneurisma Aórtico , Procedimentos Endovasculares , Isquemia Mesentérica , Doença Aguda , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/cirurgia , Humanos , Isquemia/etiologia , Isquemia/cirurgia , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/cirurgia , Resultado do Tratamento
10.
Zhonghua Wai Ke Za Zhi ; 58(11): 864-869, 2020 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-33120450

RESUMO

Objective: To examine the ultrasound features and clinical characteristics of the intestinal ischemia secondary to acute mesenteric venous thrombosis (AMVT). Methods: From January 2016 to June 2019, 11 patients were diagnosed as intestinal ischemia secondary to AMVT confirmed by surgical pathology or CT in Peking Union Medical College Hospital. The patients included 7 males and 4 females, aging of (52.8±11.9) years (range: 34 to 81 years).The clinical characters and ultrasound features were retrospectively reviewed. Results: Abdomen pain was the chief complaint of all patients. Other complaints include 2 cases of blood in the stool, 1 case of hematemesis, 2 cases of vomiting, 1 case of diarrhea. Six patients showed rebound pain on physical examination. All patients had elevated white blood cell account and D-Dimer. Nine patients had a thrombosis in the portal vein simultaneously. All 11 patients underwent the CT scan including 10 contrast-enhanced CT. Mesenteric venous thrombosis was detected in 10 cases who underwent contrast-enhanced CT imaging. On CT imaging, 11 patients demonstrated intestinal wall thicken, 5 patients showed intestinal dilation. Eight patients underwent superior mesenteric venous ultrasound examination. Of them, 7 patients were correctly diagnosed as AMVT. Of the 10 patients who underwent abdominal ultrasound, 5 patients showed intestinal lesions including intestinal wall thicken in 4 patients and intestinal dilation in 1 patient. Peritoneal fluid was detected in 10 patients by ultrasound, which was consistent with CT. Ten patients underwent surgical procedures while 1 patient received conservative treatment. Conclusion: Ultrasound is an accurate imaging method in diagnosing superior mesenteric vein thrombosis and can detect intestinal wall thickening, intestinal dilation, and peritoneal fluid.


Assuntos
Isquemia Mesentérica , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/etiologia , Veias Mesentéricas/diagnóstico por imagem , Pessoa de Meia-Idade , Veia Porta/diagnóstico por imagem , Estudos Retrospectivos , Ultrassonografia , Trombose Venosa/complicações , Trombose Venosa/diagnóstico por imagem
12.
Artigo em Inglês | MEDLINE | ID: mdl-32707629

RESUMO

Computed tomography showing portal and mesenteric venous gas and intestinal pneumatosis, rare radiological signs that, together, favor the diagnosis of mesenteric ischemia (70% of cases). When present, mortality is around 40-90%. Surgical exploration is mandatory with assessment of the extent of intestinal ischemia and appropriate treatment.


Assuntos
Isquemia Mesentérica , Pneumatose Cistoide Intestinal , Humanos , Isquemia , Isquemia Mesentérica/diagnóstico por imagem , Veias Mesentéricas , Veia Porta , Radiografia
13.
Ann Vasc Surg ; 68: 559-562, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32561244

RESUMO

BACKGROUND: The purpose of this study was to describe the use of the OUTBACK catheter to overcome aortic reentry issues in acute mesenteric ischemia (AMI) treated by retrograde open mesenteric stenting (ROMS). TECHNIQUE: The technique is demonstrated in two female patients presenting with late AMI related to flush occlusion of the superior mesenteric artery (SMA). In such cases of thrombotic AMI with clear preoperative evidence of intestinal necrosis, ROMS is the first-line revascularization technique in our intestinal stroke center. Following an open approach of the SMA through laparotomy, the SMA was punctured in a retrograde fashion. Retrograde mesenteric subintimal recanalization was initiated. In case of aortic reentry issue, the OUTBACK Elite (Cordis, Hialeah, Fl) catheter was advanced through the occlusion over a 0.014 guidewire. The aortic reentry was created by puncture of the aortic wall with the OUTBACK needle, positioned in the desired position. After low-profile balloon angioplasty of the reentry site and 0.035 guidewire exchange, ROMS was performed using balloon-expandable covered stent. CONCLUSIONS: The OUTBACK catheter appears to be a safe and effective tool to overcome aortic reentry issues in ROMS. This technical tip might therefore increase the technical success rate of challenging ROMS and decrease the need for bailout bypass in the septic context of AMI.


Assuntos
Angioplastia com Balão/instrumentação , Artéria Mesentérica Superior , Isquemia Mesentérica/terapia , Oclusão Vascular Mesentérica/terapia , Stents , Dispositivos de Acesso Vascular , Idoso , Angioplastia com Balão/efeitos adversos , Feminino , Humanos , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/fisiopatologia , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/fisiopatologia , Oclusão Vascular Mesentérica/diagnóstico por imagem , Oclusão Vascular Mesentérica/fisiopatologia , Desenho de Prótese , Circulação Esplâncnica , Resultado do Tratamento , Grau de Desobstrução Vascular
14.
J Surg Res ; 254: 7-15, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32402834

RESUMO

BACKGROUND: Acute mesenteric ischemia is a life-threatening acute condition, which requires an interdisciplinary approach, including vascular recanalization and surgical treatment. Visual evaluation of intestinal perfusion might be misleading, and therefore, additional tools are necessary to reliably be able to resect the ischemic intestine. Hyperspectral imaging (HSI) has been shown to be feasible and safe for real-time assessment of tissue perfusion in visceral surgery but has never been used in cases of acute mesenteric ischemia. Therefore, we applied HSI in acute mesenteric ischemia to evaluate it for potential aid in the objectively discriminating ischemic and well-perfused intestine during explorative laparotomy. METHODS: We recorded HSI measurements in 11 cases of acute mesenteric ischemia during explorative laparotomy. We evaluated the recorded images for macroscopic visual perfusion quality and divided it into three groups. Of those three groups, we calculated and compared the HSI indexes of tissue saturation, near-infrared perfusion index, organ hemoglobin index, and tissue water index, as well as the reflectance spectra. RESULTS: We found significant differences in tissue saturation (0.7% versus 0.45%; P = 0.002) and near-infrared perfusion index (0.58 versus 0.23; P < 0.001) in poorly perfused intestinal segments compared with the viable intestine. Furthermore, we could detect an increasing peak at 630 nm of the reflectance spectra in less viable tissues, indicating a maximum in necrotic tissues. We attributed this peak to an increase in met-hemoglobin content in necrotic tissues, which is supported by the increase in the HSI organ hemoglobin index. CONCLUSIONS: HSI is able to discriminate tissue perfusion in acute mesenteric ischemia reliably and therefore might be helpful for resection. In addition, HSI gives information on tissue viability via reflectance spectra.


Assuntos
Diagnóstico por Imagem/métodos , Intestinos/irrigação sanguínea , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/cirurgia , Idoso , Idoso de 80 Anos ou mais , Colectomia , Corantes , Feminino , Humanos , Verde de Indocianina , Intestino Delgado/cirurgia , Masculino , Isquemia Mesentérica/mortalidade , Pessoa de Meia-Idade , Imagem Óptica , Complicações Pós-Operatórias , Estudos Prospectivos , Síndrome do Intestino Curto/etiologia
15.
Vasc Endovascular Surg ; 54(6): 477-481, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32419653

RESUMO

PURPOSE: The antegrade recanalization of an occlusion or high-grade stenosis of the celiac artery via the aorta often represents a technical challenge. A retrograde approach via the superior mesenteric artery and the pancreaticoduodenal arcade may be an alternative approach. Based on our experience, we assess the technical success and the short- and mid-term outcomes of this bailout procedure. METHODS: We performed a retrospective analysis of all consecutive patients who underwent recanalization and stent implantation in the celiac artery between January 2010 and December 2018. Data on vascular access, the materials used including stents, as well as the length of the intervention, radiation exposure, and follow-up were assessed. RESULTS: Recanalization in combination with stent implantation into the celiac artery was performed in 43 patients. In 39 (91%) of 43 patients, the recanalization was successful with an antegrade approach via the aorta, whereas in 4 (9%) of 43 patients the passage of the stenosis was possible only through a retrograde approach through the superior mesenteric artery and the pancreaticoduodenal arcade followed be advancement of the microwire through the celiac artery into the aorta. The tip of the microwire was captured in the aorta with a snare and pulled out in the femoral introducer sheath and used as a guide for the antegrade implantation of a balloon-expandable stent. CONCLUSIONS: The retrograde recanalization of the celiac artery via the pancreaticoduodenal arcade may be technically challenging yet represents a feasible alternative in case of a failed antegrade approach.


Assuntos
Cateterismo , Artéria Celíaca , Duodeno/irrigação sanguínea , Procedimentos Endovasculares , Isquemia Mesentérica/terapia , Oclusão Vascular Mesentérica/terapia , Pâncreas/irrigação sanguínea , Idoso , Idoso de 80 Anos ou mais , Cateterismo/efeitos adversos , Artéria Celíaca/diagnóstico por imagem , Artéria Celíaca/fisiopatologia , Circulação Colateral , Constrição Patológica , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Estudos de Viabilidade , Feminino , Humanos , Masculino , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/fisiopatologia , Oclusão Vascular Mesentérica/diagnóstico por imagem , Oclusão Vascular Mesentérica/fisiopatologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Circulação Esplâncnica , Stents , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
16.
Ann Vasc Surg ; 68: 226-233, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32428638

RESUMO

BACKGROUND: Endovascular therapy for chronic mesenteric ischemia (CMI) is the mainstay of treatment. Duplex velocity criteria within stented mesenteric vessels are not well established. We describe single-center outcomes of mesenteric stenting for CMI and analyze duplex velocities associated with in-stent restenosis (ISR). METHODS: We performed a single-center retrospective review of patients undergoing mesenteric stenting for CMI (2012-2018). Primary outcome was reintervention for recurrence of CMI symptoms. Secondary outcomes were occlusion or bypass grafting. Duplex velocities in those with recurrent symptoms, corresponding with clinically significant ISR, were identified. Receiver operating characteristic (ROC) curves were created to identify velocity thresholds for ISR. RESULTS: Mesenteric stents were placed in 61 patients (71 arteries). Mean age was 72 years (range, 49-92), and the majority were female (55%). Thirty-two (45%) celiac (CA) stents and 39 (55%) superior mesenteric artery (SMA) stents were placed. Ten patients had SMA and CA stents placed. Twenty-five stents were covered (35%). Freedom from reintervention at 1, 2, and 3 years was 83%, 73%, and 60%. Freedom from occlusion or bypass grafting at 1, 2, and 3 years was 100%, 86%, and 86%. No significant difference in patency was seen between covered and bare-metal stents (OR 0.45; 95% CI: 0.15-1.33; P = 0.1383). Median survival was 6.1 years. For CA stents, a peak systolic velocity (PSV) of 440 cm/s corresponded with clinically significant ISR with 100% sensitivity and 86% specificity. For SMA stents, a PSV of 341 cm/s corresponded with clinically significant ISR with only 80% sensitivity and 52% specificity. CONCLUSIONS: A PSV of 440 cm/s for CA stents was indicative of clinically significant ISR with excellent sensitivity and specificity. This should be used in conjunction with clinical findings to identify patients that may benefit from repeat intervention. A similar threshold could not be identified for SMA stents and warrants further collaborative investigation.


Assuntos
Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Isquemia Mesentérica/terapia , Oclusão Vascular Mesentérica/terapia , Stents , Ultrassonografia Doppler Dupla , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo , Doença Crônica , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Masculino , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/mortalidade , Isquemia Mesentérica/fisiopatologia , Oclusão Vascular Mesentérica/diagnóstico por imagem , Oclusão Vascular Mesentérica/mortalidade , Oclusão Vascular Mesentérica/fisiopatologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recidiva , Estudos Retrospectivos , Circulação Esplâncnica , Fatores de Tempo , Resultado do Tratamento
17.
AJR Am J Roentgenol ; 215(1): 29-38, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32374661

RESUMO

OBJECTIVE. The purpose of this article is to provide an overview of the diagnostic and prognostic roles of CT in the management of acute mesenteric ischemia. CONCLUSION. Acute mesenteric ischemia is defined as inadequate blood supply to the gastrointestinal tract resulting in ischemic and inflammatory injury. The prognosis is poor without treatment. Contrast-enhanced CT has become the cornerstone of diagnosis to identify features of vascular disorders and of intestinal ischemic injury and to visualize bowel necrosis.


Assuntos
Meios de Contraste , Isquemia Mesentérica/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Emergências , Humanos , Isquemia Mesentérica/etiologia , Doses de Radiação
18.
Vasc Health Risk Manag ; 16: 87-97, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32256075

RESUMO

Background: Laparoscopic aortomesenteric bypass may be performed to treat the chronic mesenteric ischemia patients who are not suitable for endovascular treatment. This study presents an initial experience with a limited series of laparoscopic mesenteric artery revascularization for the treatment of mesenteric ischemia. Methods: Chronic mesenteric ischemia (CMI) patients with previous unsuccessful endovascular treatment or with arterial occlusion and extensive calcification precluding safe endovascular treatment were offered laparoscopic mesenteric revascularization. From October 2015 until November 2018, nine patients with CMI underwent laparoscopic revascularization. In addition to demographic data and perioperative results of the treatment, graft patency was assessed with Duplex ultrasound at 1, 3, 6 and 12 months, and annually thereafter. A descriptive analysis of the data was performed. Results: All bypasses were constructed with an 8 mm ring enforced expanded polytetrafluoroethylene graft in a retrograde fashion (from infrarenal aorta or iliac artery) to either superior mesenteric artery or splenic artery (2 cases). Median operation time was 356 mins (range 247-492 mins). Five patients had a history of unsuccessful endovascular treatment. Laparoscopic technical success was 78%, and the primary open conversion rate was 22%. All laparoscopic revascularization procedures remained patent after discharge during a median follow-up time of 26 months (range 18-49 months). The primary graft patency at 30 days was 78%. Primary assisted, and secondary graft patency was 78% and 100%, respectively. Median weight gain was 2 kg (range 2-18 kg), and all patients achieved relief from postprandial pain and nausea. No mortality was observed during the follow-up period. Conclusion: Laparoscopic aortomesenteric revascularization procedures for chronic mesenteric ischemia are feasible but require careful patient selection. These procedures should only be performed at referral centers by vascular surgeons with prior experience in laparoscopic vascular surgery.


Assuntos
Implante de Prótese Vascular , Laparoscopia , Artérias Mesentéricas/cirurgia , Isquemia Mesentérica/cirurgia , Oclusão Vascular Mesentérica/cirurgia , Idoso , Implante de Prótese Vascular/efeitos adversos , Doença Crônica , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/fisiopatologia , Oclusão de Enxerto Vascular/cirurgia , Humanos , Laparoscopia/efeitos adversos , Masculino , Artérias Mesentéricas/diagnóstico por imagem , Artérias Mesentéricas/fisiopatologia , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/fisiopatologia , Oclusão Vascular Mesentérica/diagnóstico por imagem , Oclusão Vascular Mesentérica/fisiopatologia , Pessoa de Meia-Idade , Estudos Prospectivos , Reoperação , Circulação Esplâncnica , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
19.
Ann Vasc Surg ; 67: 105-114, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32240729

RESUMO

BACKGROUND: This study was performed to determine the association of frailty and comorbidity status with postoperative morbidity and mortality in patients with acute mesenteric ischemia (AMI). METHODS: Patients diagnosed with AMI between April 2006 and September 2019 were enrolled in this study. Frailty was evaluated by sarcopenia which was diagnosed by third lumbar vertebra psoas muscle area (PMA). Comorbidity status was evaluated by the Charlson Comorbidity Index (CCI) score. Univariate and multivariate analyses evaluating the risk factors for postoperative morbidity and mortality were performed. RESULTS: Of the 174 patients, 86 were managed conservatively and 88 underwent surgery. In surgically managed patients, 39.8% developed complications within 30 days of surgery. Ten patients died within 30 days of the operation. In the univariate analyses, white blood cell >10 g/L, low PMA, CCI score ≥2, and bowel resection were associated with postoperative complications. Multivariate analysis revealed that low PMA, CCI score ≥2, and bowel resection were independent predictors of postoperative complications. CONCLUSIONS: This study demonstrated that low PMA, CCI score ≥2, and bowel resection were independent risk factors for postoperative complications in patients with AMI. Preoperative assessment of frailty using PMA and the evaluation of comorbidity status using CCI may serve as helpful tools in preoperative risk assessment and should be integrated into scoring systems for surgically treated AMI.


Assuntos
Regras de Decisão Clínica , Tratamento Conservador , Idoso Fragilizado , Fragilidade/diagnóstico por imagem , Isquemia Mesentérica/terapia , Oclusão Vascular Mesentérica/terapia , Músculos Psoas/diagnóstico por imagem , Sarcopenia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Procedimentos Cirúrgicos Vasculares , Doença Aguda , Adulto , Fatores Etários , Idoso , Composição Corporal , Tomada de Decisão Clínica , Comorbidade , Tratamento Conservador/efeitos adversos , Tratamento Conservador/mortalidade , Procedimentos Cirúrgicos Eletivos , Feminino , Fragilidade/mortalidade , Fragilidade/fisiopatologia , Nível de Saúde , Humanos , Masculino , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/mortalidade , Oclusão Vascular Mesentérica/diagnóstico por imagem , Oclusão Vascular Mesentérica/mortalidade , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Músculos Psoas/fisiopatologia , Medição de Risco , Fatores de Risco , Sarcopenia/mortalidade , Sarcopenia/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidade
20.
Ann Vasc Surg ; 67: 532-541.e3, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32220617

RESUMO

BACKGROUND: Active inflammatory bowel disease (IBD) is associated with considerable risk for thromboembolism; however, arterial thromboembolism is rare and associated with considerable morbidity and mortality. Their management requires careful coordination between multiple providers, and as a consequence, much of the published literature is limited to case reports published across specialties. METHODS: We examined our recent institutional experience with aortoiliac, mesenteric, and peripheral arterial thromboembolisms in patients with either Crohn's disease or ulcerative colitis. To supplement our experience, a comprehensive literature review was performed using MEDLINE and EMBASE databases from 1966 to 2019. Patient demographics, flare/thromboembolism management, and outcomes were abstracted from the selected articles and our case series. RESULTS: Fifty-two patients with IBD, who developed an arterial thromboembolism, were identified (49 from published literature and 3 from our institution). More than 82% of patients presented during an active IBD flare. Surgical intervention was attempted in 77% of patients, which included open thromboembolectomy, catheter-directed thrombolysis, or bowel resection. Thromboembolism resolution was achieved in 76% of patients with comparable outcomes with either catheter-directed thrombolysis or open thrombectomy (83.3% vs. 68.2%). Nearly one-third of patients underwent small bowel resection or colectomy. In 2 patients, thromboembolism resolution was achieved only after total abdominal colectomy for severe pancolitis. Multiple thromboembolectomies were associated with higher risk for amputation. Overall mortality was 11.5% but was greatest for occlusive aortoiliac and mesenteric thromboembolism (14.3% and 57%, respectively). All survivors of occlusive superior mesenteric artery thromboembolism suffered short gut syndrome requiring small bowel transplant. CONCLUSIONS: Patients with IBD, who develop an arterial thromboembolism, can expect overall poor outcomes. Catheter-directed thrombolysis achieved comparable outcomes with open thromboembolectomy without undue bleeding risk. Total abdominal colectomy for moderate-to-severe pancolitis is an emerging strategy in the management of refractory arterial thromboembolism. Successful surgical management may include open thromboembolectomy, catheter-directed thrombolysis, and bowel resection when indicated.


Assuntos
Colectomia , Colite Ulcerativa/cirurgia , Doença de Crohn/cirurgia , Embolectomia , Isquemia Mesentérica/terapia , Oclusão Vascular Mesentérica/terapia , Trombectomia , Tromboembolia/terapia , Terapia Trombolítica , Adulto , Amputação , Colectomia/efeitos adversos , Colectomia/mortalidade , Colite Ulcerativa/complicações , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/mortalidade , Doença de Crohn/complicações , Doença de Crohn/diagnóstico , Doença de Crohn/mortalidade , Embolectomia/efeitos adversos , Embolectomia/mortalidade , Feminino , Humanos , Salvamento de Membro , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/etiologia , Isquemia Mesentérica/mortalidade , Oclusão Vascular Mesentérica/diagnóstico por imagem , Oclusão Vascular Mesentérica/etiologia , Oclusão Vascular Mesentérica/mortalidade , Pessoa de Meia-Idade , Fatores de Risco , Trombectomia/efeitos adversos , Trombectomia/mortalidade , Tromboembolia/diagnóstico por imagem , Tromboembolia/etiologia , Tromboembolia/mortalidade , Terapia Trombolítica/efeitos adversos , Terapia Trombolítica/mortalidade , Fatores de Tempo , Resultado do Tratamento
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