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.ejvs.2022.04.028

Cited by 2 publications

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“…Over the last decade, the treatment of AMI has shifted from open surgical approaches with embolectomy, bypass, and resection of avital intestine to a multidisciplinary approach comprising hybrid and endovascular interventional procedures for restoration of blood flow with adequate results [42,43] followed by laparoscopy or laparotomy viability assessment and resection of necrotic bowel as well as damage control surgery if necessary [1,15,[44][45][46]. Surgical bypass in the acute setting is performed seldomly nowadays, while the value of newer techniques such as retrograde open mesenteric stenting (ROMS) remains to be evaluated [47,48].…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors in patients with acute mesenteric ischemia—novel tools for determining patient outcomes

et al. 2022

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Background Acute mesenteric ischemia (AMI) is a devastating disease with poor prognosis. Due to the multitude of underlying factors, prediction of outcomes remains poor. We aimed to identify factors governing diagnosis and survival in AMI and develop novel prognostic tools. Methods This monocentric retrospective study analyzed patients with suspected AMI undergoing imaging between January 2014 and December 2019. Subgroup analyses were performed for patients with confirmed AMI undergoing surgery. Nomograms were calculated based on multivariable logistic regression models. Results Five hundred and thirty-nine patients underwent imaging for clinically suspected AMI, with 216 examinations showing radiological indication of AMI. Intestinal necrosis (IN) was confirmed in 125 undergoing surgery, 58 of which survived and 67 died (median 9 days after diagnosis, IQR 22). Increasing age, ASA score, pneumatosis intestinalis, and dilated bowel loops were significantly associated with presence of IN upon radiological suspicion. In contrast, decreased pH, elevated creatinine, radiological atherosclerosis, vascular occlusion (versus non-occlusive AMI), and colonic affection (compared to small bowel ischemia only) were associated with impaired survival in patients undergoing surgery. Based on the identified factors, we developed two nomograms to aid in prediction of IN upon radiological suspicion (C-Index = 0.726) and survival in patients undergoing surgery for IN (C-Index = 0.791). Conclusion As AMI remains a condition with high mortality, we identified factors predicting occurrence of IN with suspected AMI and survival when undergoing surgery for IN. We provide two new tools, which combine these parameters and might prove helpful in treatment of patients with AMI.

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Section: Discussionmentioning

confidence: 99%

Prognostic factors in patients with acute mesenteric ischemia—novel tools for determining patient outcomes

et al. 2022

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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 2 publications

References 0 publications

Prognostic factors in patients with acute mesenteric ischemia—novel tools for determining patient outcomes

Prognostic factors in patients with acute mesenteric ischemia—novel tools for determining patient outcomes

Acute mesenteric ischaemia

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