A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia

• Published in: Journal of vascular surgery 2011-03, Vol.53 (3), p.698-705
• Main Authors: Arthurs, Zachary M., MD, Titus, Jessica, MD, Bannazadeh, Mohsen, MD, Eagleton, Matthew J., MD, Srivastava, Sunita, MD, Sarac, Timur P., MD, Clair, Daniel G., MD
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - etiology; Aged; Angioplasty, Balloon; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Chi-Square Distribution; Diseases of the aorta; Embolectomy; Embolism - complications; Embolism - therapy; Endovascular Procedures - adverse effects; Endovascular Procedures - mortality; Female; Hospital Mortality; Humans; Ischemia - etiology; Ischemia - mortality; Ischemia - therapy; Male; Medical sciences; Mesenteric Ischemia; Mesenteric Vascular Occlusion - etiology; Mesenteric Vascular Occlusion - mortality; Mesenteric Vascular Occlusion - therapy; Middle Aged; Odds Ratio; Ohio; Respiratory Insufficiency - etiology; Retrospective Studies; Risk Assessment; Risk Factors; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Thrombectomy; Thrombolytic Therapy; Thrombosis - complications; Thrombosis - therapy; Time Factors; Treatment Outcome; Vascular Diseases - etiology; Vascular Diseases - mortality; Vascular Diseases - therapy; Vascular Grafting; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Vascular Surgical Procedures - adverse effects; Vascular Surgical Procedures - mortality
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2010.09.049

Objectives Few centers have adopted endovascular therapy for the treatment of acute mesenteric ischemia (AMI). We sought to evaluate the effect of endovascular therapy on outcomes for the treatment of AMI. Methods A single-center, retrospective cohort review was performed on all consecutive patients with thrombotic or embolic AMI presenting between 1999 and 2008. Patients with mesenteric venous thrombosis, nonocclusive mesenteric ischemia, and ischemia associated with aortic dissection were excluded. Demographic factors, preoperative metabolic status, and etiology were compared. Primary clinical outcomes included endovascular technical success, operative complications, and in-hospital mortality. Results Seventy consecutive patients were identified with AMI (mean age, 64 ± 13 years). Etiology of mesenteric ischemia was 65% thrombotic and 35% embolic occlusions. Endovascular revascularization was the preferred treatment (81%) vs operative therapy (19%). Successful endovascular treatment was achieved in 87%. Endovascular therapy required laparotomy in 69% vs traditional therapy in 100% ( P < .05), with a median 52-cm necrotic bowel resected (interquartile range [IQR], 11-140 cm) vs 160 cm (IQR, 90-250 cm; P < .05), respectively. Acute renal failure and pulmonary failure occurred less frequently with endovascular therapy (27% vs 50%; P < .05 and 27% vs 64%; P < .05). Successful endovascular treatment resulted in a mortality rate of 36% compared with 50% ( P < .05) with traditional therapy, whereas the mortality rate for endovascular failures was 50%. Endovascular therapy was associated with improved mortality in thrombotic AMI (odds ratio, 0.10; 95% confidence interval, 0.10-0.76; P < .05). Conclusions Endovascular therapy has altered the management of AMI, and there are measurable advantages to this approach. Using endovascular therapy as the primary modality for AMI reduces complications and improves outcomes.