Alicja Zientara1, Anja-Rebeka Domenghino2, Igor Schwegler2, Hans Bruijnen3, Annelies Schnider4, Markus Weber4, Stefan Gutknecht4, Nicolas Attigah5. 1. Department of Cardiothoracic Surgery, Royal Brompton and Harefield Hospital, Harefield, UK. 2. Department of Vascular Surgery, Triemli Hospital, 497, 8063, Zurich, Switzerland. 3. Augsburg City Hospital, Augsburg, Germany. 4. Department of Visceral Surgery, Triemli Hospital, Zürich, Switzerland. 5. Department of Vascular Surgery, Triemli Hospital, 497, 8063, Zurich, Switzerland. nicolas.attigah@triemli.zuerich.ch.
Abstract
BACKGROUND: Mesenteric ischemia is associated with poor outcome and high overall mortality. The aim was to analyze an interdisciplinary treatment approach of vascular and visceral specialists focusing on the in-hospital outcome and follow-up in patients with acute and acute-on-chronic mesenteric ischemia. METHODS: From 2010 until 2017, 26 consecutive patients with acute or acute on chronic mesenteric ischemia were treated by an interdisciplinary team. Data were prospectively collected and retrospectively evaluated. Throughout the initial examination, the extent of bowel resection was determined by the visceral surgeon and the appropriate mode of revascularization by the vascular surgeon. The routine follow-up included clinical examination and ultrasound- or CT-imaging for patency assessment and overall survival as primary endpoint of the study. RESULTS: Out of 26 patients, 18 (69.2%) were rendered for open repair. Ten patients (38.5%) received reconstruction of the superior mesenteric artery with an iliac-mesenteric bypass. Seven patients (26.9%) underwent thrombembolectomy of the mesenteric artery. One patient received an infra-diaphragmatic aorto-celiac-mesenteric bypass. Out of the 8 patients, who were not suitable for open revascularization, 2 patients (7.7%) were treated endovascularly and 6 (23.1%) underwent explorative laparotomy. The in-hospital mortality was 23% (n = 6). The mean survival of the revascularized group (n = 20) was 51.8 months (95% CI 39.1-64.5) compared to 15.7 months in the non-revascularized group (n = 6) (95% CI - 4.8-36.1; p = 0.08). The median follow-up was 64.6 months. Primary patency in the 16 patients after open and 2 after interventional revascularization was 100% and 89.9% in the follow-up. CONCLUSION: The interdisciplinary treatment of mesenteric ischemia improves survival if carried out in time. Hereby open revascularization measures are advantageous as they allow bowel assessment, resection, and revascularization in a one-stop fashion especially in advanced cases.
BACKGROUND: Mesenteric ischemia is associated with poor outcome and high overall mortality. The aim was to analyze an interdisciplinary treatment approach of vascular and visceral specialists focusing on the in-hospital outcome and follow-up in patients with acute and acute-on-chronic mesenteric ischemia. METHODS: From 2010 until 2017, 26 consecutive patients with acute or acute on chronic mesenteric ischemia were treated by an interdisciplinary team. Data were prospectively collected and retrospectively evaluated. Throughout the initial examination, the extent of bowel resection was determined by the visceral surgeon and the appropriate mode of revascularization by the vascular surgeon. The routine follow-up included clinical examination and ultrasound- or CT-imaging for patency assessment and overall survival as primary endpoint of the study. RESULTS: Out of 26 patients, 18 (69.2%) were rendered for open repair. Ten patients (38.5%) received reconstruction of the superior mesenteric artery with an iliac-mesenteric bypass. Seven patients (26.9%) underwent thrombembolectomy of the mesenteric artery. One patient received an infra-diaphragmatic aorto-celiac-mesenteric bypass. Out of the 8 patients, who were not suitable for open revascularization, 2 patients (7.7%) were treated endovascularly and 6 (23.1%) underwent explorative laparotomy. The in-hospital mortality was 23% (n = 6). The mean survival of the revascularized group (n = 20) was 51.8 months (95% CI 39.1-64.5) compared to 15.7 months in the non-revascularized group (n = 6) (95% CI - 4.8-36.1; p = 0.08). The median follow-up was 64.6 months. Primary patency in the 16 patients after open and 2 after interventional revascularization was 100% and 89.9% in the follow-up. CONCLUSION: The interdisciplinary treatment of mesenteric ischemia improves survival if carried out in time. Hereby open revascularization measures are advantageous as they allow bowel assessment, resection, and revascularization in a one-stop fashion especially in advanced cases.
Entities:
Keywords:
Acute mesenteric ischemia; Bowel resection; Iliac-mesenteric bypass; Intestinal ischemia; Mesenteric revascularization; Thrombembolectomy of superior mesenteric artery
Authors: M Björck; M Koelemay; S Acosta; F Bastos Goncalves; T Kölbel; J J Kolkman; T Lees; J H Lefevre; G Menyhei; G Oderich; P Kolh; G J de Borst; N Chakfe; S Debus; R Hinchliffe; S Kakkos; I Koncar; J Sanddal Lindholt; M Vega de Ceniga; F Vermassen; F Verzini; B Geelkerken; P Gloviczki; T Huber; R Naylor Journal: Eur J Vasc Endovasc Surg Date: 2017-04 Impact factor: 7.069
Authors: Anil K Pillai; Sanjeeva P Kalva; Steven L Hsu; T Gregory Walker; James E Silberzweig; Ganesan Annamalai; Mark O Baerlocher; Jason W Mitchell; Mehran Midia; Boris Nikolic; Sean R Dariushnia Journal: J Vasc Interv Radiol Date: 2018-03-21 Impact factor: 3.464
Authors: Zachary M Arthurs; Jessica Titus; Mohsen Bannazadeh; Matthew J Eagleton; Sunita Srivastava; Timur P Sarac; Daniel G Clair Journal: J Vasc Surg Date: 2011-01-14 Impact factor: 4.268
Authors: T Bulut; R Oosterhof-Berktas; R H Geelkerken; M Brusse-Keizer; E J Stassen; J J Kolkman Journal: Eur J Vasc Endovasc Surg Date: 2017-02-21 Impact factor: 7.069
Authors: Jussi M Kärkkäinen; Petri Saari; Hannu-Pekka Kettunen; Tiina T Lehtimäki; Ritva Vanninen; Hannu Paajanen; Hannu Manninen Journal: J Gastrointest Surg Date: 2015-11-09 Impact factor: 3.452
Authors: Roxana Carmen Geana; Platon Pavel; Reza Nayyerani; Iulia Kulcsar; Adrian Tulin; Oana Honciuc; Irina Balescu; Nicolae Bacalbasa; Ovidiu Stiru; Vlad Anton Iliescu; Catalina Andreea Parasca Journal: SAGE Open Med Case Rep Date: 2021-06-03