Endovascular Therapy as a Primary Revascularization Modality in Acute Mesenteric Ischemia
Abstract
Purpose To evaluate endovascular therapy (EVT) as the primary revascularization method for acute mesenteric ischemia (AMI). Methods A retrospective review was performed on all consecutive patients treated for AMI during a 5-year period (January 2009 to December 2013). EVT was attempted in all patients referred for emergent revascularization. Surgical revascularization was performed selectively after failure of EVT. Patient characteristics, clinical presentation, and outcomes were studied. Failures and complications of EVT were recorded. Results Fifty patients, aged 79 ± 9 years (mean ± SD), out of 66 consecutive patients with AMI secondary to embolic or thrombotic obstruction of the superior mesenteric artery were referred for revascularization. The etiology of AMI was embolism in 18 (36 %) and thrombosis in 32 (64 %) patients. EVT was technically successful in 44 (88 %) patients. Mortality after successful or failed EVT was 32 %. The rates of emergency laparotomy, bowel resection, and EVT-related complication were 40, 34, and 10 %, respectively. Three out of six patients with failure of EVT were treated with surgical bypass. EVT failure did not significantly affect survival. Conclusions EVT is feasible in most cases of AMI, with favorable patient outcome and acceptable complication rate.
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Steerable sheaths have reduced the need for a brachial approach that is associated with access related complications such as bleeding or occlusion at the puncture site, nerve injury, and stroke.
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- Authors
- Kärkkäinen, J. M., Lehtimäki, T. T., Saari, P., Hartikainen, J., Rantanen, T., Paajanen, H., & Manninen, H.
- Affiliations
- Kuopio University Hospital (FI)
- University of Eastern Finland (FI)
- Corresponding author
- Kärkkäinen, Jussi M.
- Venue
- CardioVascular and Interventional Radiology
- Published
- 2015-03-05
- Volume
- 38
- Issue
- 5
- Pages
- 1119-1129
- ISSN
- 0174-1551 (ISSN-L)
- 1432-086X
- OpenAlex
- W2061209061
- Cited by
- 77
- References
- 3
- Citations by year
- 2026: 2 · 2025: 11 · 2024: 6 · 2023: 6 · 2022: 12 · 2021: 9 · 2020: 2 · 2019: 4 · 2018: 4 · 2017: 12 · 2016: 3 · 2015: 6
- FWCI
- 8.38
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- CardioVascular and Interventional Radiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic Thrombus and Embolism
- Health Sciences › Medicine › Surgery › Vascular anomalies and interventions
- Keywords
- acute mesenteric ischemia, endovascular treatment, superior mesenteric artery occlusion, embolic occlusion, thrombotic occlusion, bypass surgery, bowel resection, mortality, complications
- MeSH terms
- Acute Disease, Aged, Aged, 80 and over, Female, Humans, Male, Retrospective Studies, Risk Factors, Treatment Outcome, Endovascular Procedures, Mesenteric Ischemia
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