Contemporary management of acute and chronic mesenteric ischemia: 10-year experience from a multihospital healthcare system

Andraska, Elizabeth; Tran, Lan Mai; Haga, Lindsey; Mak, Allison K.; Madigan, Michael; Makaroun, Michel S.; Eslami, Mohammad H.; Chaer, Rabih A.

doi:10.1016/j.jvs.2021.11.040

Cited by 24 publications

(13 citation statements)

References 26 publications

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“…Sixty-one studies addressed the short-term mortality of occlusive arterial AMI 6 22 25 27 31–35 38 39 42 48 49 59 62 63 66 94 95 97 113–153. Meta-analysis showed an overall mortality of 51.8% (95% CI 46.3 to 57.3) (online supplemental figure 2).…”

Section: Resultsmentioning

confidence: 99%

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Incidence and outcomes of acute mesenteric ischaemia: a systematic review and meta-analysis

et al. 2022

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ObjectiveTo estimate the incidence of acute mesenteric ischaemia (AMI), proportions of its different forms and short-term and long-term mortality.DesignSystematic review and meta-analysis.Data sourcesMEDLINE (Ovid), Web of Science, Scopus and Cochrane Library were searched until 26 July 2022.Eligibility criteriaStudies reporting data on the incidence and outcomes of AMI in adult populations.Data extraction and synthesisData extraction and quality assessment with modified Newcastle-Ottawa scale were performed using predeveloped standard forms. The outcomes were the incidence of AMI and its different forms in the general population and in patients admitted to hospital, and the mortality of AMI in its different forms.ResultsFrom 3064 records, 335 full texts were reviewed and 163 included in the quantitative analysis. The mean incidence of AMI was 6.2 (95% CI 1.9 to 12.9) per 100 000 person years. On average 5.0 (95% CI 3.3 to 7.1) of 10 000 hospital admissions were due to AMI. Occlusive arterial AMI was the most common form constituting 68.6% (95% CI 63.7 to 73.2) of all AMI cases, with similar proportions of embolism and thrombosis.Overall short-term mortality (in-hospital or within 30 days) of AMI was 59.6% (95% CI 55.5 to 63.6), being 68.7% (95% CI 60.8 to 74.9) in patients treated before the year 2000 and 55.0% (95% CI 45.5 to 64.1) in patients treated from 2000 onwards (p<0.05). The mid/long-term mortality of AMI was 68.2% (95% CI 60.7 to 74.9). Mortality due to mesenteric venous thrombosis was 24.6% (95% CI 17.0 to 32.9) and of non-occlusive mesenteric ischaemia 58.4% (95% CI 48.6 to 67.7). The short-term mortality of revascularised occlusive arterial AMI was 33.9% (95% CI 30.7 to 37.4).ConclusionsIn adult patients, AMI is a rarely diagnosed condition with high mortality, although with improvement of treatment results over the last decades. Two thirds of AMI cases are of occlusive arterial origin with potential for better survival if revascularised.PROSPERO registration numberCRD42021247148.

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Section: Resultsmentioning

confidence: 99%

“…Meta-analysis showed an overall mortality of 51.8% (95% CI 46.3 to 57.3) (online supplemental figure 2). The sub-analysis of 24 studies on patients who underwent revascularisation demonstrated a mortality of 33.9% (95% CI 30.7 to 37.4) 6 59 131–148 150–153…”

Section: Resultsmentioning

confidence: 99%

Incidence and outcomes of acute mesenteric ischaemia: a systematic review and meta-analysis

et al. 2022

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“…However, visceral surgery has been preferred, especially in patients with high risks of complications, such as bowel ischemia, perforation, or peritonitis, and has therefore been associated with higher mortality rates [ 61 ]. Comparative studies between open and endovascular approaches have shown similar outcomes in patients with indications for laparotomy [ 53 , 65 ]. Logistically, open approaches have resulted in quicker time to intervention [ 53 ].…”

Section: Discussionmentioning

confidence: 99%

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

Gries,

Sakamoto,

Chen

et al. 2024

JCM

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Mesenteric ischemia is a challenging condition characterized by insufficient blood perfusion to the mesentery and, consequently, intestinal tissues that continues to perplex clinicians. Despite its low prevalence, the condition’s variable clinical presentation and elusive radiographic diagnosis can delay life-saving interventions in the acute setting and deteriorate the quality of life of patients when left undiagnosed or misdiagnosed. Purpose: Review and summarize recent diagnostic updates and emergent intervention strategies for acute and chronic mesenteric ischemia. Methods: A narrative review of all relevant studies from January 2022 through September 2023. Results: A total of 11 studies from MEDLINE, supplemented with 44 studies from Google Scholar, were included in the review. Conclusions: Both acute and chronic mesenteric ischemia propose diagnostic and therapeutic challenges for interventionalists. Computed tomographic angiography remains the diagnostic modality of choice for both. Open surgical intervention remains the gold standard for acute mesenteric ischemia, while endovascular techniques are preferred for chronic mesenteric ischemia.

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“…Epidemiology and outcome of AMI, based on available evidence [2–5,8,10–19], is presented in Table 1.…”

Section: Epidemiologymentioning

confidence: 99%

Acute mesenteric ischaemia

Blaser

Forbes

Björck

2022

Current Opinion in Critical Care

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Purpose of reviewTo summarize the recent evidence on acute mesenteric ischaemia (AMI).Recent findingsThe overall incidence of AMI is below 10/100 000 person years but increases exponentially with age. The overall mortality of AMI remains high, exceeding 50%, despite continuing progress and increasing availability of imaging and endovascular interventions. However, patients with (early) revascularization have significantly better outcomes. The majority of patients surviving the acute event are still alive at 1 year, but evidence on quality of life is scarce.Clinical suspicion of AMI is the key to timely diagnosis, with biphasic computed tomography-angiography the diagnostic method of choice. Currently, no biomarker has sufficient specificity to diagnose AMI.SummaryImproved awareness and knowledge of AMI are needed to raise the suspicion of AMI in relevant patients and thereby to achieve better outcomes.

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Contemporary management of acute and chronic mesenteric ischemia: 10-year experience from a multihospital healthcare system

Cited by 24 publications

References 26 publications

Incidence and outcomes of acute mesenteric ischaemia: a systematic review and meta-analysis

Incidence and outcomes of acute mesenteric ischaemia: a systematic review and meta-analysis

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

Acute mesenteric ischaemia

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