Acute and chronic mesenteric ischemia: single center analysis of open, endovascular, and hybrid surgery

Abstract

Background The aim of the study was to analyse the outcome of open surgical, endovascular, and hybrid interventions in the treatment of acute (AMI) and chronic (CMI) mesenteric ischemia. Methods Retrospective review of a cohort of mesenteric ischemia patients at a single tertiary referral center from 2015 to 2021. Primary end point was postoperative in-hospital mortality. Secondary end points were the number of bowel resections, duration of the procedure, length of postoperative intensive care treatment, length of hospital stay, revision surgery (number and type), and the nature and severity of postoperative complications according to Dindo-Clavien. Results A total of 64 patients, 20 with CMI and 44 with AMI, underwent open, hybrid or endovascular surgery. Bowel resection was performed in 45.5% of the patients with AMI (29.5% small intestine, 2.3% colon and 13.6% both). There was no in-hospital mortality in the CMI cohort as compared to 29.5% in the AMI cohort (p = 0.03), with no differences regarding endovascular and open surgery (29.6 vs 29.4%). Severe postoperative morbidity (Dindo-Clavien ≥ 3) was also significantly more frequent in the AMI group when compared to the CMI group (20 vs 77.3%, p < 0.001). ASA classification and intensive care stay were identified as factors associated with mortality in AMI patients. Conclusions Morbidity and in-hospital mortality are low in CMI patients, but substantial in AMI patients. Early diagnosis and open or endovascular treatment may be decisive for the outcome of these patients.

Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review

“…Logistically, open approaches have resulted in quicker time to intervention [ 53 ]. While some small cohort studies have reported better outcomes for endovascular interventions [ 53 , 56 , 58 , 74 ], larger database analyses have consistently shown that these interventions are associated with improved postoperative morbidity and mortality, lower rates of in-hospital mortality, lower rates of bowel resection, decreased need for parenteral nutrition, shorter hospital stays, and lower cost compared to open surgery [ 53 , 74 , 75 , 76 ].…”

Acute Mesenteric Ischemia: Evaluation, Management, and Interventions

“…13 Open surgical approaches vary including just surgical or hybrid approaches with laparotomy and embolectomy, endarterectomy, patch angioplasty, or bypass. 45 Endovascular First?…”

“…10,38,[46][47][48][49][50][51][52][53] Studies have reported the 30day mortality for open surgical intervention for AMI from 32 to 42%. 45,54,55 The 30-day mortality for endovascular intervention has been shown to be lower with a study using the Swedish Vascular Registry showing a rate of 26%. 54 A single-center experience found that successful endovascular intervention had a lower mortality rate of 36% compared with surgery first, 50%, or failed endovascular with subsequent surgery, also 50%.…”

Es ist noch Luft nach oben – zur akuten mesenterialen Ischämie

“…Auch im Jahr 2022 wurden Ergebnisse aus einer weiteren Uniklinik publiziert. Hier lag die Mortalität bei akuter mesenterialer Ischämie „nur“ bei 29,5 %, wobei es zwischen der offenen und interventionellen Rekanalisierung keinen prognostischen Unterschied gab [ 4 ].…”

“…In der erstgenannten Studie machten NOMI 13 % und venöse Thrombosen 4 % aus [ 1 ]. In der Arbeit aus Halle [ 4 ] wurden nur Patienten mit akutem Verschluss der A. mesenterica superior inkludiert, keine NOMI-Patienten. Dies könnte die relativ guten Ergebnisse zumindest mit erklären.…”