Mesenteric ischemia after coronary artery bypass grafting: should local continuous intra-arterial perfusion with papaverine be regarded as a treatment?

Eker, Armand; Malzac, Bruno; Teboul, Jacques; Jourdan, J.

doi:10.1016/s1010-7940(98)00260-7

Cited by 20 publications

(7 citation statements)

References 8 publications

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“…Intra-arterial infusion Abboud B et al . AMI after cardiac surgery 5365 of papaverine [155] or tolazoline with heparin [125] are both effective treatments.…”

Section: Therapeutic Optionsmentioning

confidence: 99%

Acute mesenteric ischemia after cardio-pulmonary bypass surgery

Abboud¹,

Daher²,

Boujaoude³

2008

WJG

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Acute mesenteric ischemia (AMI) is a highly-lethal surgical emergency. Several pathophysiologic events (arterial obstruction, venous thrombosis and diffuse vasospasm) lead to a sudden decrease in mesenteric blood flow. Ischemia/reperfusion syndrome of the intestine is responsible for systemic abnormalities, leading to multi-organ failure and death. Early diagnosis is difficult because the clinical presentation is subtle, and the biological and radiological diagnostic tools lack sensitivity and specificity. Therapeutic options vary from conservative resuscitation, medical treatment, endovascular techniques and surgical resection and revascularization. A high index of suspicion is required for diagnosis, and prompt treatment is the only hope of reducing the mortality rate. Studies are in progress to provide more accurate diagnostic tools for early diagnosis. AMI can complicate the post-operative course of patients following cardio-pulmonary bypass (CPB). Several factors contribute to the systemic hypo-perfusion state, which is the most frequent pathophysiologic event. In this particular setting, the clinical presentation of AMI can be misleading, while the laboratory and radiological diagnostic tests often produce inconclusive results. The management strategies are controversial, but early treatment is critical for saving lives. Based on the experience of our team, we consider prompt exploratory laparotomy, irrespective of the results of the diagnostic tests, is the only way to provide objective assessment and adequate treatment, leading to dramatic reduction in the mortality rate.

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“…Intra-arterial infusion Abboud B et al . AMI after cardiac surgery 5365 of papaverine [155] or tolazoline with heparin [125] are both effective treatments.…”

Section: Therapeutic Optionsmentioning

confidence: 99%

Acute mesenteric ischemia after cardio-pulmonary bypass surgery

Abboud¹,

Daher²,

Boujaoude³

2008

WJG

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“…Unless the involved bowel is clearly gangrenous, an attempt of reperfusion is necessary. Papaverine infusion and arterial reconstruction either through aortosuperior mesenteric arterial bypass grafting or through reimplantation of the superior mesenteric artery to the aorta are applied on the case of thrombotic acute mesenteric ischemia (Eker et al 1999;Hladíket al 2005). Papaverine infusion is the mainstay of treatment in non-occlusive mesenteric ischemia.…”

Section: Treatmentmentioning

confidence: 99%

Mesenteric Ischemia: Still a Deadly Puzzle for the Medical Community

Stamatakos

Stefanaki

Mastrokalos

et al. 2008

Tohoku J. Exp. Med.

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The main goal of this article is to update etiology, epidemiology, diagnosis, treatment and outcome of the various causes of mesenteric ischemia in order to elucidate its labyrinthine clinical riddle, by reviewing the current English medical literature. Mesenteric ischemia is a quite uncommon disorder, observed in the emergency department. It is a lifethreatening vascular emergency that requires early diagnosis and intervention to restore mesenteric blood flow and to prevent bowel necrosis and patient death. Consequently, it is a vital diagnosis to make because of its high mortality rate and its thorny complications. The underlying causes vary, and the prognosis depends on the specific findings during clinical examination. Vague and nonspecific clinical findings and limitations of diagnostic studies make the diagnosis a significant challenge. The prognosis of acute mesenteric ischemia of any type is grave. The complications following this medical jigsaw puzzle are also severe. Patients in whom the diagnosis is missed until infarction occurs have a mortality rate of 90%. Even with good treatment, up to 50-80% of patients die. Survivors of extensive bowel resection face lifelong disability. Despite the progress in understanding the pathogenesis of mesenteric ischemia and the development of treatment modalities, the entity remains a diagnostic challenge for clinicians. Delay in diagnosis contributes to a high mortality rate. Early diagnosis and adequate treatment can improve the clinical outcome. Even if diagnostic modalities have improved since the first successful attempts to confront effectively this clinical entity, mesenteric ischemia still remains a lethal diagnostic enigma for the medical community.Mesenteric Ischemia; thrombosis; bowel infarction; atherosclerosis; mesenteric venous thrombosis; mesenteric thromboendarterectomy.Tohoku

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“…Dennoch scheint die etablierte Strategie hier am klarsten und am ÜBERSICHT wenigsten umstritten zu sein, und eine Anzahl kleiner Serien hat über relativ gute Erfolge mit dieser Strategie berichtet [1,4,9,13,20,23,27,44]. In Übe-reinstimmung mit den pathophysiologischen Vorstellungen zur Genese der nicht okklusiven mesenterialen Ischä-mie beruht die Therapie auf zwei Prinzipien: 1. der Korrektur prädisponie-render und auslösender Faktoren und 2. der effektiven Therapie der mesenterialen Vasokonstriktion.…”

Section: Nicht Okklusive Mesenteriale Ischämieunclassified

Die akute mesenteriale Ischämie – häufig übersehen und häufig letal

Lock¹

2002

Med Klin

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Mesenteric ischemia after coronary artery bypass grafting: should local continuous intra-arterial perfusion with papaverine be regarded as a treatment?

Cited by 20 publications

References 8 publications

Acute mesenteric ischemia after cardio-pulmonary bypass surgery

Acute mesenteric ischemia after cardio-pulmonary bypass surgery

Mesenteric Ischemia: Still a Deadly Puzzle for the Medical Community

Die akute mesenteriale Ischämie – häufig übersehen und häufig letal

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