Evolution in the Presentation, Treatment, and Outcomes of Patients with Acute Mesenteric Ischemia

Chou, Elizabeth L.; Wang, Linda J.; McLellan, Rachel; Feldman, Zach M.; Latz, Christopher A.; LaMuraglia, Glenn M.; Clouse, W. Darrin; Eagleton, Matthew J.; Conrad, Mark F.

doi:10.1016/j.avsg.2021.01.116

Cited by 25 publications

(19 citation statements)

References 23 publications

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“…However, its clinical outcome is reported to be better than mesenteric arterial thrombosis and non-occlusive mesenteric ischemia ( 7 , 9 ). However, mortality rates remain high at 30–54%, excluding patients who received supportive care, according to other studies ( 8 – 10 ). Many etiological factors, such as valvular heart disease, cardiac arrhythmia, left atrial thrombosis, aortic calcification, previous stenotic lesions, iatrogenic causes, and tumors, can cause SMAE, and most emboli originating from the heart are secondary to atrial fibrillation ( 2 ).…”

Section: Discussionmentioning

confidence: 84%

“…To address poor outcomes of SMAE, a multimodal approach focusing on (1) the removal of non-viable segments of ischemic bowel (2) the preservation of the non-necrotic intestine with revascularization, and (3) medical treatment to prevent progression to multiorgan failure ( 1 , 10 ). Consistent with our study, the importance of revascularization is highlighted.…”

Section: Discussionmentioning

confidence: 99%

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Outcome Comparison of Endovascular and Open Surgery for the Treatment of Acute Superior Mesenteric Artery Embolism: A Retrospective Study

Cao

Zhang

et al. 2022

Front. Surg.

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BackgroundFew centers have adopted endovascular revascularization for the treatment of superior mesenteric artery embolism (SMAE). We sought to evaluate the efficacy of endovascular therapy for the treatment of SMAE and identify post-treatment prognostic factors.MethodsThe clinical data of 41 patients with acute SMA embolism between 2013 and 2021 were retrospectively reviewed. Patients with mesenteric artery thrombosis, mesenteric venous thrombosis, and who had only conservative treatment were excluded.ResultsForty-one consecutive patients were identified with SMAE (median age, [range] 35–86 years). Endovascular therapy was initiated in 14 patients with no clinical evidence of bowel necrosis, with mainly mechanical thrombectomy, and technical success was achieved in 93%. Endovascular therapy had advantages in duration surgery time, blood loss, bowel rest time, ICU time, and ventilator use. There was no difference in bowel necrosis, length of necrotic bowel resected, or in-hospital mortality between the two groups. An initial white blood cell (WBC) count >15 × 103/dl and neutrophil count >13 × 103/dl were associated with an increased risk of bowel necrosis, and an initial WBC count, renal function, American Society of Anesthesiologists (ASA >3) and necrotic bowel >2 m were associated with increased mortality.ConclusionsEndovascular treatment has altered the management of SMAE, and it may be adopted in selected patients who are not at risk for bowel necrosis. Avoidance of bowel necrosis patients and close monitoring for bowel necrosis are important.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Outcome Comparison of Endovascular and Open Surgery for the Treatment of Acute Superior Mesenteric Artery Embolism: A Retrospective Study

Cao

Zhang

et al. 2022

Front. Surg.

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“…Acute mesenteric arterial occlusion most commonly results from thrombosis based on atherosclerotic disease, or embolism where the embolus originates from the left atrium as a consequence of atrial fibrillation [ 23 , 24 ]. Interestingly, in our literature review, SMA occlusion also occurred in COVID-19 patients who had no risk factors for thromboembolic diseases, which is consistent with previous review [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Acute superior mesenteric artery occlusion associated with COVID-19 pneumonia: a case report

et al. 2022

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Background The novel 2019 coronavirus disease (COVID-19), which is caused by infection with the severe acute respiratory syndrome coronavirus 2, has spread rapidly around the world and has caused many deaths. COVID-19 involves a systemic hypercoagulable state and arterial/venous thrombosis which induces unfavorable prognosis. Herein, we present a first case in East Asia where an acute superior mesenteric artery (SMA) occlusion associated with COVID-19 pneumonia was successfully treated by surgical intervention. Case presentation A 70-year-old man presented to his local physician with a 3-day history of cough and diarrhea. A real-time reverse transcriptase-polymerase chain reaction test showed positive for COVID-19, and he was admitted to the source hospital with the diagnosis of moderate COVID-19 pneumonia. Eight days later, acute onset of severe abdominal pain appeared with worsening respiratory condition. Contrast CT showed that bilateral lower lobe/middle lobe and lingula ground glass opacification with distribution suggestive of COVID-19 pneumonia and right renal infarction. In addition, it demonstrated SMA occlusion with intestinal ischemia suggesting extensive necrosis from the jejunum to the transverse colon. The patient underwent an emergency exploratory laparotomy with implementing institutional COVID-19 precaution guideline. Upon exploration, the intestine from jejunum at 100 cm from Treitz ligament to middle of transverse colon appeared necrotic. Necrotic bowel resection was performed with constructing jejunostomy and transverse colon mucous fistula. We performed second surgery to close the jejunostomy and transverse colon mucous fistula with end-to-end anastomosis on postoperative day 22. The postoperative course was uneventful and he moved to another hospital for rehabilitation to improve activities of daily living (ADLs) on postoperative day 45. As of 6 months after the surgery, his ADLs have completely improved and he has returned to social life without any intravenous nutritional supports. Conclusions Intensive treatment including surgical procedures allowed the patient with SMA occlusion in COVID-19 pneumonia to return to social life with completely independent ADLs. Although treatment for COVID-19 involves many challenges, including securing medical resources and controlling the spread of infection, when severe abdominal pain occurs in patients with COVID-19, physicians should consider SMA occlusion and treat promptly for life-saving from this deadly combination.

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“…SMA occlusion most commonly results from thrombosis based on atherosclerotic disease, or embolism where the embolus originates from the left atrium as a consequence of atrial fibrillation [1 , 2] . Interestingly, in our literature review, SMA occlusion also occurred in COVID-19 patients, with risk factors for thromboembolic diseases [3] .…”

Section: Discussionmentioning

confidence: 99%

A simultaneous superior mesenteric arterial and venous thrombosis in an elderly woman with a previous COVID-19 pneumonia: A suggestive case report diagnosed at computed tomography angiography

Messina

Calabrese

Tebala

et al. 2022

Radiology Case Reports

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Evolution in the Presentation, Treatment, and Outcomes of Patients with Acute Mesenteric Ischemia

Cited by 25 publications

References 23 publications

Outcome Comparison of Endovascular and Open Surgery for the Treatment of Acute Superior Mesenteric Artery Embolism: A Retrospective Study

Outcome Comparison of Endovascular and Open Surgery for the Treatment of Acute Superior Mesenteric Artery Embolism: A Retrospective Study

Acute superior mesenteric artery occlusion associated with COVID-19 pneumonia: a case report

A simultaneous superior mesenteric arterial and venous thrombosis in an elderly woman with a previous COVID-19 pneumonia: A suggestive case report diagnosed at computed tomography angiography

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