Interdisciplinary approach in emergency revascularization and treatment for acute mesenteric ischemia [post]

Alicja Zientara, Anja-Rebeka Domenghino, Igor Schwegler, Hans Bruijnen, Annelies Schnider, Markus Weber, Stefan Gutknecht, Nicolas Attigah
2020 unpublished
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 were treated by an interdisciplinary team. Data were prospectively collected and retrospectively evaluated. Throughout the initial
more » ... on, the extent of bowel resection was determined by the visceral and the appropriate mode of revascularization by the vascular surgeon. The routine follow-up included ultrasound- or CT-imaging. Results Out of 26 patients, 18 (69.2%) were rendered for open repair. Ten patients 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 revascularisation, 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 revascularisation 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.
doi:10.21203/ fatcat:hlek75khjvcg5khyuvenvgzhpm