Acute mesenteric ischemia (AMI): absence of renal insufficiency and performance of early bowel resection may indicate improved outcomes
- 12 Downloads
Acute mesenteric ischemia (AMI) is still associated with very high morbidity and mortality while the rareness and heterogeneity hamper the establishment of evidence-based guidelines. We sought to help standardize contemporary treatment by a cohort study at our tertiary center in the rising endovascular age.
A retrospective cohort study was conducted from 2005 to 2015. Patients with occlusive (OMI), non-occlusive (NOMI), and venous mesenteric ischemia (VMI) were compared with respect to clinical and treatment parameters as well as outcome.
The study cohort consisted of 48 patients composed of 27 males and 21 females with an average age of 63 years and an average BMI of 25.1 kg/m2. In 48% of patients (N=23), an acute arterial OMI had occurred while NOMI was present in 31% (N=15) and VMI in 21% (N=10). Interventional and intraoperative recanalizations were significantly more often required in OMI patients compared with other entities (p=0.003). Patients with venous mesenteric ischemia had a significant better overall survival than patients with OMI or NOMI in the univariate analysis (p=0.027). Patients with renal failure had a 14.7-fold higher relative risk (Cox p=0.013) and patients without bowel resection during primary surgery had a 17.8-fold higher relative risk (Cox p=0.047) to die of AMI in the postoperative course.
AMI remains a rare but oftentimes fatal disease. Our study provides evidence that outcome may depend on the AMI subtype, presence of renal insufficiency, and early bowel resection. Further research should help individualize treatment for optimized outcomes.
KeywordsMesenteric ischemia Acute abdomen Visceral artery occlusion Venous thrombosis
All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Hanno Matthaei, Arne Koscielny, and Alina Klein. The first draft of the manuscript was written by Hanno Matthaei and Arne Koscielny. Vittorio Branchi contributed to drafting of figures. All authors commented on previous versions of the manuscript. Jörg C. Kalff co-supervised the study together with Arne Koscielny. All authors read and approved the final manuscript.
Compliance with ethical standards
Ethical standards of the University of Bonn were fully acknowledged.
- 2.Branco BC, Montero-Baker MF, Aziz H, Taylor Z, Mills JL (2015) Endovascular therapy for acute mesenteric ischemia: an NSQIP analysis. Am SurgGoogle Scholar
- 3.Ierardi AM, Tsetis D, Sbaraini S et al (2017) The role of endovascular therapy in acute mesenteric ischemia. Ann Gastroenterol. https://doi.org/10.20524/aog.2017.0164
- 8.Tilsed JVT, Casamassima A, Kurihara H, Mariani D, Martinez I, Pereira J, Ponchietti L, Shamiyeh A, al-Ayoubi F, Barco LAB, Ceolin M, D’Almeida AJG, Hilario S, Olavarria AL, Ozmen MM, Pinheiro LF, Poeze M, Triantos G, Fuentes FT, Sierra SU, Soreide K, Yanar H (2016) ESTES guidelines: acute mesenteric ischaemia. Eur J Trauma Emerg Surg 42:253–270. https://doi.org/10.1007/s00068-016-0634-0 CrossRefGoogle Scholar
- 10.Sardar P, Giri J, Jaff MR, Parikh SA, Kundu A, White CJ, Chatterjee S, Kennedy KF, Desai NR, Hyder ON, Mukherjee D, Shishehbor MH, Abbott JD, Aronow HD (2019) Strength of evidence underlying the American Heart Association/American College of Cardiology Guidelines on endovascular and surgical treatment of peripheral vascular disease. Circ Cardiovasc Interv 12. https://doi.org/10.1161/CIRCINTERVENTIONS.118.007244
- 11.Bala M, Kashuk J, Moore EE, Kluger Y, Biffl W, Gomes CA, Ben-Ishay O, Rubinstein C, Balogh ZJ, Civil I, Coccolini F, Leppaniemi A, Peitzman A, Ansaloni L, Sugrue M, Sartelli M, di Saverio S, Fraga GP, Catena F (2017) Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery. World J Emerg Surg 12. https://doi.org/10.1186/s13017-017-0150-5
- 16.Studer P, Vaucher A, Candinas D, Schnüriger B (2015) The value of serial serum lactate measurements in predicting the extent of ischemic bowel and outcome of patients suffering acute mesenteric ischemia. J Gastrointest Surg 19:751–755. https://doi.org/10.1007/s11605-015-2752-0 CrossRefGoogle Scholar
- 21.Althoff FC, Neb H, Herrmann E, Trentino KM, Vernich L, Füllenbach C, Freedman J, Waters JH, Farmer S, Leahy MF, Zacharowski K, Meybohm P, Choorapoikayil S (2019) Multimodal patient blood management program based on a three-pillar strategy. Ann Surg 269:794–804. https://doi.org/10.1097/sla.0000000000003095 CrossRefGoogle Scholar
- 22.Guillaume A, Pili-Floury S, Chocron S, Delabrousse E, de Parseval B, Koch S, Samain E, Capellier G, Piton G (2017) Acute mesenteric ischemia among postcardiac surgery patients presenting with multiple organ failure. Shock. 47:296–302. https://doi.org/10.1097/SHK.0000000000000720 CrossRefGoogle Scholar
- 26.Crawford RS, Harris DG, Klyushnenkova EN, Tesoriero RB, Rabin J, Chen H, Diaz JJ (2016) A statewide analysis of the incidence and outcomes of acute mesenteric ischemia in Maryland from 2009 to 2013. Front Surg 3. https://doi.org/10.3389/fsurg.2016.00022