Open and Endovascular Management of Acute Mesenteric Ischaemia: A Systematic Review
Acute mesenteric ischaemia (AMI) is a life-threatening surgical emergency resulting from thromboembolic occlusion of the mesenteric vasculature. Traditional management of AMI has been open revascularisation with or without bowel resection—a procedure which carries considerable morbidity and mortality in an already unwell, compromised patient. Endovascular and more minimally invasive management approaches to AMI have been reported. Proponents of endovascular management suggest this approach may be associated with reduced morbidity and mortality compared with open surgery.
To assess the impact of endovascular approach for AMI on mortality and need for subsequent laparotomy and/or bowel resection.
The search bodies PubMed and Medline were interrogated.
Eligibility Criteria, Participants and Interventions
All studies in English with greater than 10 patients examining outcomes for patients undergoing endovascular intervention for acute mesenteric ischaemia were included. All patients over 18 years presenting with a diagnosis of acute mesenteric ischaemia secondary to an arterial thromboembolic source were included. Studies examining endovascular intervention alone or endovascular and open intervention were selected.
The 30-day mortality for endovascular approach from all 13 studies was 16–42%. Of the 7 comparative studies including results of open revascularisation, the 30-day mortality for patient treated with an endovascular approach was 15–39% versus 33–50% for open revascularisation. Laparotomy rates post-initial endovascular intervention ranged from 13 to 73%. Bowel resection post-endovascular therapy ranged from 14 to 40% among studies. Concerning 7 comparative studies for open versus endovascular revascularisation, the rate of bowel resection in the endovascular group ranged 14–28% and 33–63% in the open cohort. Endovascular intervention also demonstrated lower median length (s) of bowel resected.
Heterogeneity of studies and patient populations studied including selection bias.
Conclusions and implications of findings
Endovascular management may be associated with reduced mortality and need for/length of bowel resection compared with the traditional open approach, but there remains a paucity of robust data to support this. The available literature illustrates that a subgroup of patients without haemodynamic compromise and more insidious onset may garner benefit from endovascular intervention.
The authors declare no source of funding or additional support, financial or other.
Compliance with ethical standards
Conflict of interest
The authors declare no conflict of interest.
- 1.Stone RJ, Cunningham CG (1993) Acute mesenteric ischemia. Surgery 114(3):489–490Google Scholar
- 2.Schoots IG, Koffeman GI, Legemate DA, Levi M, Van Gulik TM (2004) Systematic review of survival after acute mesenteric ischaemia according to disease aetiology. Br J Surg 91(1):17–27Google Scholar
- 3.Acosta S (2015) Mesenteric ischemia. Curr Opin Critic Care 21(2):171–178Google Scholar
- 4.Eckstein HH (2003) Acute mesenteric ischemia. Resection or reconstruction? Chirurg 74(5):419–431Google Scholar
- 5.Gore RM, Yaghmai V, Thakrar KH, Berlin JW, Mehta UK, Newmark GM et al (2008) Imaging in intestinal ischemic disorders. Radiol Clin North Am 46(5):845–875Google Scholar
- 6.Schoots IG, Levi MM, Reekers JA, Lameris JS, van Gulik TM (2005) Thrombolytic therapy for acute superior mesenteric artery occlusion. J Vasc Interv Radiol 16(3):317–329Google Scholar
- 7.Clair DG, Beach JM (2016) Mesenteric ischemia. N Engl J Med 374(10):959–968Google Scholar
- 8.Acosta S (2010) Epidemiology of mesenteric vascular disease: clinical implications. In: Seminars in vascular surgery, vol 23, no 1. WB Saunders, pp 4–8Google Scholar
- 9.Arthurs ZM, Titus J, Bannazadeh M, Eagleton MJ, Srivastava S, Sarac TP, Clair DG (2011) A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia. J Vasc Surg 53(3):698–705Google Scholar
- 10.Park WM, Gloviczki P, Cherry KJ Jr, Hallett JW Jr, Bower TC, Panneton JM, Schleck C, Ilstrup D, Harmsen WS, Noel AA (2002) Contemporary management of acute mesenteric ischemia: factors associated with survival. J Vasc Surg 35(3):445–452Google Scholar
- 11.Cohn DM, Roshani S, Middeldorp S (2007) Thrombophilia and venous thromboembolism: implications for testing. In: Seminars in thrombosis and hemostasis, vol 33, no 06. Copyright© 2007 by Thieme Medical Publishers, Inc., New York, NY, USA, pp 573–581Google Scholar
- 12.Kim HK, Hwang D, Park S, Lee JM, Huh S (2017) Treatment outcomes and risk factors for bowel infarction in patients with acute superior mesenteric venous thrombosis. J Vasc Surg Venous Lymphat Disord 5(5):638–646Google Scholar
- 13.Trompeter M, Brazda T, Remy CT, Vestring T, Reimer P (2002) Non-occlusive mesenteric ischemia: etiology, diagnosis, and interventional therapy. Eur Radiol 12(5):1179–1187Google Scholar
- 14.Kazmers A (1998) Operative management of chronic mesenteric ischemia. Ann Vasc Surg 12(3):299–308Google Scholar
- 15.Park WM, Cherry KJ Jr, Chua HK, Clark RC, Jenkins G, Harmsen WS, Noel AA, Panneton JM, Bower TC, Hallett JW Jr, Gloviczki P (2002) Current results of open revascularization for chronic mesenteric ischemia: a standard for comparison. J Vasc Surg 35(5):853–859Google Scholar
- 16.Yun WS, Lee KK, Cho J, Kim HK, Huh S (2013) Treatment outcome in patients with acute superior mesenteric artery embolism. Ann Vasc Surg 27(5):613–620Google Scholar
- 17.Jia Z, Jiang G, Tian F, Zhao J, Li S, Wang K, Wang Y, Jiang L, Wang W (2014) Early endovascular treatment of superior mesenteric occlusion secondary to thromboemboli. Eur J Vasc Endovasc Surg 47(2):196–203Google Scholar
- 18.Beaulieu RJ, Arnaoutakis KD, Abularrage CJ, Efron DT, Schneider E, Black JH III (2014) Comparison of open and endovascular treatment of acute mesenteric ischemia. J Vasc Surg 59(1):159–164Google Scholar
- 19.Zhang Z, Wang D, Li G, Wang X, Wang Y, Li G, Jiang T (2017) Endovascular treatment for acute thromboembolic occlusion of the superior mesenteric artery and the outcome comparison between endovascular and open surgical treatments: a retrospective study. BioMed Res Int 2017:1964765Google Scholar
- 20.Block TA, Acosta S, Björck M (2010) Endovascular and open surgery for acute occlusion of the superior mesenteric artery. J Vasc Surg 52(4):959–966Google Scholar
- 21.Schermerhorn ML, Giles KA, Hamdan AD, Wyers MC, Pomposelli FB (2009) Mesenteric revascularization: management and outcomes in the United States, 1988–2006. J Vasc Surg 50(2):341–348Google Scholar
- 22.Hawkins BM, Khan Z, Abu-Fadel MS, Exaire JE, Saucedo JF, Hennebry TA (2011) Endovascular treatment of mesenteric ischemia. Catheter Cardiovasc Interv 78(6):948–952Google Scholar
- 23.Ryer EJ, Kalra M, Oderich GS, Duncan AA, Gloviczki P, Cha S, Bower TC (2012) Revascularization for acute mesenteric ischemia. J Vasc Surg 55(6):1682–1689Google Scholar
- 24.Puippe GD, Suesstrunk J, Nocito A, Pfiffner R, Glenck M, Pfammatter T (2015) Outcome of endovascular revascularisation in patients with acute obstructive mesenteric ischaemia—a single-centre experience. Vasa 44(5):363–370Google Scholar
- 25.Kärkkäinen JM, Lehtimäki TT, Saari P, Hartikainen J, Rantanen T, Paajanen H, Manninen H (2015) Endovascular therapy as a primary revascularization modality in acute mesenteric ischemia. Cardiovasc Intervent Radiol 38(5):1119–1129Google Scholar
- 26.Raupach J, Lojik M, Chovanec V, Renc O, Strýček M, Dvořák P, Hoffmann P, Guňka I, Ferko A, Ryška P, Omran N (2016) Endovascular management of acute embolic occlusion of the superior mesenteric artery: a 12-year single-centre experience. Cardiovasc Intervent Radiol 39(2):195–203Google Scholar
- 27.Bulut T, Oosterhof-Berktas R, Geelkerken RH, Brusse-Keizer M, Stassen EJ, Kolkman JJ (2017) Long-term results of endovascular treatment of atherosclerotic stenoses or occlusions of the coeliac and superior mesenteric artery in patients with mesenteric ischaemia. Eur J Vasc Endovasc Surg 53(4):583–590Google Scholar
- 28.Erben Y, Protack CD, Jean RA, Sumpio BJ, Miller SM, Liu S, Trejo G, Sumpio BE (2018) Endovascular interventions decrease length of hospitalization and are cost-effective in acute mesenteric ischemia. J Vasc Surg 68(2):459–469Google Scholar
- 29.Grootjans J, Lenaerts K, Buurman WA, Dejong CH, Derikx JP (2016) Life and death at the mucosal-luminal interface: new perspectives on human intestinal ischemia-reperfusion. World J Gastroenterol 22(9):2760Google Scholar
- 30.Harper D, Chandler B (2015) Splanchnic circulation. Bja Educ 16(2):66–71Google Scholar
- 31.Stone JR, Wilkins LR (2015) Acute mesenteric ischemia. Tech Vasc Interv Radiol 18(1):24–30Google Scholar
- 32.Liu FY, Wang MQ, Fan QS, Duan F, Wang ZJ, Song P (2009) Interventional treatment for symptomatic acute-subacute portal and superior mesenteric vein thrombosis. World J Gastroenterol WJG 15(40):5028Google Scholar
- 33.Atkins MD, Kwolek CJ, LaMuraglia GM, Brewster DC, Chung TK, Cambria RP (2007) Surgical revascularization versus endovascular therapy for chronic mesenteric ischemia: a comparative experience. J Vasc Surg 45(6):1162–1171Google Scholar
- 34.Kasirajan K, Ohara PJ, Gray BH, Hertzer NR, Clair DG, Greenberg RK, Krajewski LP, Beven EG, Ouriel K (2001) Chronic mesenteric ischemia: open surgery versus percutaneous angioplasty and stenting. J Vasc Surg 33(1):63–71Google Scholar