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

Li, Wenrui; Cao, Saisai; Zhang, Zhiwen; Zhu, Rong; Chen, Xueming; Liu, Bin; Feng, Hao

doi:10.3389/fsurg.2022.833464

Cited by 15 publications

(11 citation statements)

References 23 publications

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“…For most ATOS patients, more aggressive treatment is necessary, and we have both endovascular and open options. The use of endovascular therapy has been increasing in the past decade, such as percutaneous mechanical thrombectomy, which has been reported for the treatment of ATOS in the form of case reports and case series; these initial studies demonstrate feasibility, but there still remains a large discrepancy in practice patterns [ 7 , 10 ]. Hypothetically, endovascular treatment has many advantages over open surgery; patients can be treated without the inherent risks of general anesthesia, and it allows immediate and complete assessment of the blood supply before and after intervention [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Treatment outcomes in patients with acute thromboembolic occlusion of the superior mesenteric artery

Li,

Liu,

Jin

et al. 2024

J Cardiothorac Surg

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Objectives The goals of this study were to investigate the treatment outcomes of acute thromboembolic occlusion of the superior mesenteric artery (ATOS) and identify prognostic factors after treatment. Methods The clinical data of 62 patients with ATOS between 2013 and 2021 were retrospectively reviewed. Patients were stratified by the treatment strategy, complications and mortality were compared in different group. Results Sixty-two consecutive patients were identified with ATOS. The median patient age was 69 years (interquartile range 58–79 years). Endovascular therapy was initiated in 21 patients, and 4 patients received conservative treatment. Open surgery was performed first in the remaining 37 patients. The technical success rates of the endovascular first group and open surgery group were 90.5% and 97.3%, respectively. One patient in the conservative treatment group had progression of ischemia to extensive bowel necrosis. There was no difference in 30-day mortality between these groups. Predictors of 30-day mortality included initial neutrophil count > 12* 103/dL, age over 60 years old and history of chronic renal insufficiency. Conclusions Endovascular treatment or conservative treatment may be adopted in selected patients who do not exhibit signs and symptoms of bowel necrosis, and close monitoring for bowel necrosis is important. The increase in preoperative neutrophil count, age over 60 years old and history of chronic renal insufficiency were poor prognostic factors.

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Section: Discussionmentioning

confidence: 99%

Treatment outcomes in patients with acute thromboembolic occlusion of the superior mesenteric artery

Li,

Liu,

Jin

et al. 2024

J Cardiothorac Surg

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“…Of course, AAMI is rare compared to ischemia in other organs [ 42 ], but more probably, this can be explained by the focus on bowel resection in historical surgical series [ 43 ]. As a result of improved understanding of the time-dependent pathophysiology of AAMI and identification of early forms of ischemia (i.e., with low probability of necrosis) that can benefit from endovascular revascularization, more recent studies discuss the primary importance of revascularization in clinical practice and research [ 2 , 14 , 44 , 45 ]. This explains why the study population included mostly patients with a low risk of necrosis (i.e., Clichy score 0 or 1) that were referred by the on-call expert group to first-line endovascular revascularization [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Reperfusion injury on computed tomography following endovascular revascularization of acute mesenteric ischemia: prevalence, risk factors, and patient outcome

et al. 2022

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Background Data about reperfusion injury (RI) following acute arterial mesenteric ischemia (AAMI) in humans are scarce. We aimed to assess the prevalence and risk factors of RI following endovascular revascularization of AMI and evaluate its impact on patient outcomes. Methods Patients with AAMI who underwent endovascular revascularization (2016–2021) were included in this retrospective cohort. CT performed < 7 days after treatment was reviewed to identify features of RI (bowel wall hypoattenuation, mucosal hyperenhancement). Clinical, laboratory, imaging, and treatments were compared between RI and non-RI patients to identify factors associated with RI. Resection rate and survival were also compared. Results Fifty patients (23 men, median 72-yrs [IQR 60–77]) were included, and 22 were diagnosed with RI (44%) after a median 28 h (22–48). Bowel wall hypoattenuation and mucosal hyperenhancement were found in 95% and 91% of patients with post-interventional RI, respectively. Patients with RI had a greater increase of CRP levels after endovascular treatment (p = 0.01). On multivariate analysis, a decreased bowel wall enhancement on baseline CT (HR = 8.2), an embolic cause (HR = 7.4), complete SMA occlusion (HR = 7.0), and higher serum lactate levels (HR = 1.4) were associated with RI. The three-month survival rate was 78%, with no difference between subgroups (p = 0.99). However, the resection rate was higher in patients with RI (32% versus 7%; p = 0.03). Conclusion RI is frequent after endovascular revascularization of AAMI, especially in patients who present with decreased bowel wall enhancement on pre-treatment CT, an embolic cause, and a complete occlusion of the SMA. However, its occurrence does not seem to negatively impact short-term survival.

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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%

“…Epidemiology and outcome of AMI, based on available evidence [2][3][4][5]8,[10][11][12][13][14][15][16][17][18][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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Outcome Comparison of Endovascular and Open Surgery for the Treatment of Acute Superior Mesenteric Artery Embolism: A Retrospective Study

Cited by 15 publications

References 23 publications

Treatment outcomes in patients with acute thromboembolic occlusion of the superior mesenteric artery

Treatment outcomes in patients with acute thromboembolic occlusion of the superior mesenteric artery

Reperfusion injury on computed tomography following endovascular revascularization of acute mesenteric ischemia: prevalence, risk factors, and patient outcome

Acute mesenteric ischaemia

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