Endovascular interventions decrease length of hospitalization and are cost-effective in acute mesenteric ischemia

Erben, Young; Protack, Clinton D.; Jean, Raymond; Sumpio, Brandon J.; Miller, Samuel M.; Liu, Shirley; Trejo, Gerardo; Sumpio, Bauer E.

doi:10.1016/j.jvs.2017.11.078

Cited by 31 publications

(23 citation statements)

References 40 publications

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“…In fact, in recent single-center studies and systematic reviews, the recommendation for endovascular therapy first has been suggested: endovascular interventions improve mortality, lowers length of hospitalization and transfusion requirements, lowers rates of pneumonia and sepsis and decrease cost of care. 8,[23][24][25] In Europe, the ESTES guidelines created in 2016 10 aimed to improve outcomes for patients with AMI. Despite a lack of randomized controlled trials for the management of AMI, recommendations regarding diagnosis, treatment, and follow-up are given at various levels of evidence, including the use of contrast-enhanced computed tomography angiography of the abdomen/pelvis, use of broadspectrum antibiotics, use of endovascular or open embolectomy, use of systemic anticoagulation, and supportive intensive care unit measures.…”

Section: Discussionmentioning

confidence: 99%

“…mortality and improved surgical outcomes. 8,9 However, there is little data regarding the management of patients with AMI once discharged from index hospitalization. Our study sought to investigate whether the patients, who initially survive this devastating event, present to medical facilities for readmission, as well as to explore the course and etiologies of these readmissions.…”

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confidence: 99%

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Acute Mesenteric Ischemia Remains a Highly Morbid Diagnosis after Initial Hospitalization Survival

et al. 2020

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Acute mesenteric ischemia (AMI) remains a vascular emergency. Our aim was to explore readmission for AMI. We identified all patients admitted for AMI from the state of California through the Healthcare and Utilization Project from 2005 to 2011. Our primary end point was the rate and etiology for readmission. Our secondary end points were the length of hospitalization and in-hospital mortality. Cox proportional hazard regression was utilized to assess risk of 30-day readmission. There were 534 (9.9%) readmissions at 30 days. The mean age was 67 ± 17 years and 209 (39.1%) were male. The five most common etiologies for readmission were AMI (7.6%), cardiac events (5.3%), severe sepsis (1.2%), dehydration (1.1%), and acute kidney failure (1.1%). Once readmitted, these patients were most likely to experience cardiac catheterizations (25.4%), red blood cell transfusions (23.6%), intubation and mechanical ventilation (17.6%), biopsy of the large intestine (13.9%), reoperation for small bowel resection (10.9%), administration of total parenteral nutrition (10.5%), and transfusion of other blood products (6.9%). This hospitalization was 8.8 ± 12.7 days long. In-hospital mortality was 36 patients (6.7%). On multivariable Cox-regression analysis, severe (hazard ratio [HR]: 2.1 [1.4–3.2], p = 0.0005) and moderate (HR: 1.5 [1.03–2.13], p = 0.04) Elixhauser Comorbidity Group, complications (HR: 1.5 [1.2–1.9], p = 0.0007), and longer index hospitalization (HR: 1.02 [1.01–1.02], p < 0.0001) were predictors of readmission. Conclusion AMI remains a vascular emergency. Readmissions have a significant rate of morbid invasive procedures and can lead to an in-hospital mortality of 6.7%. The adoption of guidelines similar to the European Society for Trauma and Emergency Surgery should be considered.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Acute Mesenteric Ischemia Remains a Highly Morbid Diagnosis after Initial Hospitalization Survival

et al. 2020

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“…[11][12][13][14][15][16][17][18][19][20][21][22][23][24] It has been commonly used in patients with AMI due to its less invasive nature. [21][22][23][24] Further, many studies have reported the use of stents for patients with AMI caused by SIDSMA. 5,[25][26][27] This approach may be effective for preventing the progression of bowel necrosis.…”

Section: Discussionmentioning

confidence: 99%

“…Endovascular treatment has continued to develop rapidly and has been proven to be clinically successful. 11–24 It has been commonly used in patients with AMI due to its less invasive nature. 21–24 Further, many studies have reported the use of stents for patients with AMI caused by SIDSMA.…”

Section: Discussionmentioning

confidence: 99%

Necessity of revascularization for acute mesenteric ischemia in symptomatic patients with spontaneous isolated dissection of the superior mesenteric artery

et al. 2019

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Objectives We evaluated the necessity of revascularization for acute mesenteric ischemia in symptomatic patients with spontaneous isolated dissection of the superior mesenteric artery. Methods This retrospective study included 28 consecutive, symptomatic patients with spontaneous isolated dissection of the superior mesenteric artery treated at our hospital between December 2005 and December 2017. Patients with concomitant aortic dissection were excluded. We reviewed the patients’ clinical presentation; laboratory evaluations; computed tomography findings, including the true lumen residual ratio (i.e., the minimum true lumen size compared to the diameter of the transverse section of the dissected artery) at the time of admission; the number of patients who were suspected of having bowel ischemia; and the number of patients who required surgical or endovascular treatment and their outcomes. Additionally, to evaluate the true lumen residual ratio in symptomatic patients with bowel ischemia, the true lumen residual ratio in those with abnormal laboratory data were compared with that in those without abnormal laboratory data. Initial true lumen residual ratio values were also compared with final values. Furthermore, we assessed the clinical details of patients who had bowel necrosis. Categorical variables were compared using the χ2 test or Fisher’s exact test, and continuous values were presented as either the mean ± standard deviation or median (interquartile range 25–75%). Variables were analyzed using Student’s t-test or the Mann–Whitney U test. Results The patients’ age ranged between 41 and 85 years, and 25 were men. Although nine patients were suspected of having acute mesenteric ischemia, only one underwent bowel resection. None of the patients had an indication for revascularization. The true lumen residual ratio of the nine patients with abnormal laboratory data were significantly lower than those of the 19 without abnormal laboratory data (10 [0–25]% vs. 40 [20–50]%, p = 0.005). The patient who underwent bowel resection had a true lumen residual ratio of 10%; however, there was no obvious abnormal laboratory data suggestive of bowel necrosis. Dissections were managed conservatively in all patients. True lumen residual ratio increased from initial value of 30 (10–48)% to 98 (60-100)%at the final imaging study ( p < 0.0001). There were no adverse events related to the mesenteric circulation during the follow-up period of 2–11 years. Conclusions Reintervention is rarely required for spontaneous isolated dissection of the superior mesenteric artery, even in symptomatic patients, and spontaneous resolution of the luminal compromise is the rule.

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“…Dr. Erben reported in 2018 that endovascular revascularization for acute mesenteric ischemia is cost-saving, with a lower rate of in-hospital mortality [9].…”

Section: Endovascular Interventions Decrease the Length Of Hospitaliz...mentioning

confidence: 99%

Endovascular Treatment for Acute Mesenteric Ischemia

Hsieh¹

2022

Art and Challenges Involved in the Treatment of Ischaemic Damage

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The current standard care for acute mesenteric ischemia involves urgent revascularization and resection of the necrotic bowel. A dedicated protocol for early treatment and urgent revascularization is pivotal to improving diagnostic rate and patient survival. In this chapter, the critical components of diagnosis and treatment protocol are reviewed. Different treatment choices with endovascular approaches are discussed. After endovascular revascularization, a dedicated team consisting of surgeons and critical care specialists are needed to provide post-intervention care and second-look laparoscopy when necessary. In geographic regions where healthcare resources are lacking, a time-efficient strategy adopted by interventional radiologists or cardiologists should be considered to improve patient survival.

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Endovascular interventions decrease length of hospitalization and are cost-effective in acute mesenteric ischemia

Cited by 31 publications

References 40 publications

Acute Mesenteric Ischemia Remains a Highly Morbid Diagnosis after Initial Hospitalization Survival

Acute Mesenteric Ischemia Remains a Highly Morbid Diagnosis after Initial Hospitalization Survival

Necessity of revascularization for acute mesenteric ischemia in symptomatic patients with spontaneous isolated dissection of the superior mesenteric artery

Endovascular Treatment for Acute Mesenteric Ischemia

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