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Cited by 13Abdominal vascular conditions and treatmentsAppendicitis Diagnosis and ManagementIntestinal and Peritoneal Adhesions

Results after intraoperative open and endovascular revascularization of acute mesenteric ischemia requiring a laparotomy

Open access
Kapalla, Marvin, Choubey, Rahul, Weitz, Jürgen, Reeps, Christian, Wolk, Steffen·2023·Langenbeck's Archives of Surgery
DOI 10.1007/s00423-023-03035-8PMC PMC10415437

Published version of a preprint

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Abstract

Background: Acute mesenteric ischemia (AMI) is a dreaded condition with a difficult diagnosis and high mortality. Due to different baseline situations, the frequently performed comparison between endovascular and open surgical treatment is interfered with selection bias. The purpose of this study was to review outcomes in AMI treatment with an open or endovascular approach in association with laparotomy and to evaluate the endovascular-first strategy in similar clinical situations. Methods: The clinical data of 74 patients treated for AMI from 2007 to 2021 were retrospectively reviewed and compared. In-hospital mortality was appointed as the primary study endpoint. Risk factors for mortality were identified by using univariate and multivariate analysis. Results: In total, 61 patients (82%) were treated open surgically (OT) and, 13 patients (18%) with an endovascular approach (ET) in combination with laparatomy. The etiology of AMI was 49% arteriosclerotic and 51% thromboembolic occlusions. The total in-hospital mortality manifested at 43% ( n =32) (OT 41% vs. ET 53.8%; P =0.54). As independent risk factors for in-hospital mortality, pneumatosis intestinalis ( P =0.01), increased lactate concentration ( P =0.04), and ischemic intestinal sections ( P =0.01) were identified. Additionally, on univariate analysis patient age, congestive heart failure (> NYHA II) and atrial fibrillation were related with higher mortality. Conclusions: Morbidity and mortality of AMI remains at a high level. Conventional open or intraoperative endovascular therapy achieved similar results in patients with indication for laparotomy. Advanced disease stage with ischemic intestinal sections at presentation and cardiovascular comorbidities were associated with adverse outcome.

AI snapshot

Written from the paper’s full text.

TL;DR

In this retrospective single-center study of 74 patients with acute mesenteric ischemia requiring laparotomy, in-hospital mortality was 43.3% and did not differ significantly between open (41%) and intraoperative endovascular (53.8%) revascularization. Pneumatosis intestinalis, increased lactate, and remaining ischemic intestinal sections independently predicted mortality.

Key findings

  • Overall in-hospital mortality was 43.3% (n = 32); open treatment 41% (n = 25) vs. endovascular treatment 53.8% (n = 7), P = 0.54.
  • Independent risk factors for in-hospital mortality were pneumatosis intestinalis (OR 1.4; 95% CI 1.1–6.7; P = 0.01), increased lactate concentration (OR 1.5; 95% CI 1.1–13; P = 0.04), and ischemic intestinal sections (OR 3.5; 95% CI 1.3–13.9; P = 0.01).
  • Etiology was arteriosclerotic in 49% and thromboembolic in 51%; all endovascular-treated occlusions were arteriosclerotic (100%, P < 0.001), and endovascular-treated occlusions were shorter (2.07 ± 0.63 cm vs. 3.89 ± 1.98 cm; P = 0.01).
  • Endovascular technical failure occurred in 38.5% (5/13), all converted to immediate open revascularization; failure had no significant influence on survival (66.7% vs. 33.3%; P = 0.59). Kaplan-Meier 1-year and 5-year survival were 85.5% and 58.8%.

Methods

  • Retrospective review of patients treated for acute mesenteric ischemia between 01/2007 and 01/2021 at the Carl Gustav Carus University Hospital, Dresden; 74 patients analyzed, identified by ICD code K55.0. Inclusion required clinical symptoms and CTA evidence of thromboembolic or arteriosclerotic occlusion of at least one mesenteric main stem vessel; endovascular patients were included only if treated intraoperatively with laparotomy.
  • Primary endpoint was in-hospital mortality; secondary outcomes included technical success, morbidity, long-term survival, and revision rates.
  • Statistical analysis used univariate tests, binary logistic regression for perioperative mortality, and Kaplan-Meier estimates with log-rank tests; two-sided P < 0.05 was significant.

Limitations

  • The paper states it is a retrospective single-center study with bias linked to retrospective data collection; the long study period included progress in medical therapy and endovascular technology that may have affected outcomes; the small number of endovascular-treated patients and limited follow-up precluded a comprehensive comparison, and selection bias cannot be avoided.
  • The text also makes evident an internal inconsistency: one Results sentence reports 76 patients, while the abstract, tables, and analysis use 74 patients.
  • The endovascular group was small (n = 13) and included only arteriosclerotic occlusions, limiting comparability with the open group; time from symptom onset to treatment could not be reliably recorded.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1007/s00423-023-03035-8

Cites

25 of 25 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 31 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    85.1% (n=63) of patients developed complications greater than grade IIIa according to the Clavien-Dindo classification.

    “According to the Clavien-Dindo classification, 85.1% (n =63) patients developed complications greater than grade IIIa (Table 3) [13].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213 source

      Not checked in the free run.

  • Findingown data

    The mean follow-up was 19 months (range 6.5-46 months).

    “The mean follow-up was 19 months (range 6.5–46 months) and available in 30/42 patients (65.3%).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Increased lactate concentration was an independent risk factor for in-hospital mortality (P=0.04).

    “As independent risk factors for in-hospital mortality, pneumatosis intestinalis (P=0.01), increased lactate concentration (P=0.04), and ischemic intestinal sections (P=0.01) were identified.”
    Quote in the paperSubstantial claim
  • Findingown data

    22 patients (29.7%) who had already undergone an initial resection required additional resection from remaining ischemic intestinal sections in the postoperative course.

    “Furthermore, in the postoperative course 22 patients (29.7%) which have already undergone an initial resection, required additional resection from remaining ischemic intestinal sections.”
    Quote in the paperNot a substantial claim
  • Findingown data

    For the entire cohort, intensive care unit stay was 11 days (range 5-26 days).

    “For the entire cohort, hospital stay was 23 days (range 14–37 days) and intensive care unit stay was 11 days (range 5–26 days).”
    Quote in the paperNot a substantial claim
  • May combine two claims. 24
  • Classified as probably not a substantial claim. 15

  • May combine two claims.

    Findingown data

    Kaplan-Meier estimates for 1-year and 5-year survival were 85.5% and 58.8%.

    “Kaplan-Meier estimates for 1-year and 5-year survival were 85.5% and 58.8% (Fig. 3).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The etiology of acute mesenteric ischemia was approximately 49% arteriosclerotic and 51% thromboembolic occlusions.

    “The etiology of AMI was 49% arteriosclerotic and 51% thromboembolic occlusions.”
    • Also stated in: § Clinical presentation and treatment of AMI · plain
      “The etiology was acute atherosclerotic occlusion in 48.6% and thrombo-embolic in 51.4% of the patients.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In-hospital mortality was 41% in the open treatment group versus 53.8% in the endovascular treatment group, with P=0.54.

    “The total in-hospital mortality manifested at 43% (n =32) (OT 41% vs. ET 53.8%; P=0.54).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The most common postoperative complications were acute kidney injury (44.6%), sepsis (56.8%), pulmonary complications (28.4%), and wound healing disorders (14.9%).

    “The most common complications were acute kidney injury (44.6%), sepsis (56.8%), pulmonary complications (28.4%), and wound healing disorders (14.9%).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Seventy-six patients were included in the study.

    “Seventy-six patients (male n = 53, 71.6%; female n = 21, 28.4%) with a mean age of 73.6 ± 11.7 years were included.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingown data

    The clinical data of 74 patients treated for acute mesenteric ischemia from 2007 to 2021 were retrospectively reviewed and compared.

    “The clinical data of 74 patients treated for AMI from 2007 to 2021 were retrospectively reviewed and compared.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In total, 61 patients (82%) were treated open surgically (OT) and 13 patients (18%) with an endovascular approach (ET) in combination with laparotomy.

    “In total, 61 patients (82%) were treated open surgically (OT) and, 13 patients (18%) with an endovascular approach (ET) in combination with laparatomy.”
    • Also stated in: § Study population and patient characteristics · plain
      “The therapy of AMI was open treatment (OT) in 61 patients (82.4%) and endovascular treatment (ET) in 13 (17.6%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In our study, thromboembolic patients (51%) showed higher rates of atrial fibrillation (71%; P<0.01) and a more fulminant clinical symptomatology.

    “In our study, these patients (51%) showed higher rates of atrial fibrillation (71%; P < 0.01) and a more fulminant clinical symptomatology.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Patients with pneumatosis intestinalis, remaining ischemic intestinal sections, acute kidney injury, septic multiorgan failure, and longer intensive care unit stays showed poorer survival.

    “Further on, patients with pneumatosis intestinalis (71% vs. 29%; P = 0.01) as well as patients with remaining ischemic intestinal sections (60% vs. 40%; P = 0.02), postoperative complications such as acute kidney injury (61% vs. 39%; P < 0.01), septic multiorgan failure (92% vs. 8%; P < 0.01) and longer intensive care unit stays (P < 0.01) showed a poorer survival.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Univariate analysis identified age, increased BMI, atrial fibrillation, increased lactate, and decreased blood pH values as negative predictors for survival.

    “Univariate analysis identified age (77.1 ± 10.1 years vs. 71 ± 12.2 years; P = 0.03), increased BMI (27.5 ± 6.6kg/cm2 vs. 24.3 ± 6.1kg/cm2; P = 0.04), atrial fibrillation (69% vs. 31%; P = 0.03), increased lactate (P = 0.04) and decreased blood pH values (P = 0.03) as negative predictors for survival (Table 4).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    One patient required reintervention after three months due to kinking stenosis and another patient after 28 months due to re-stenosis in the anastomotic region.

    “One patient required the reintervention after three months due to kinking stenosis and another patient after 28 months due to re-stenosis in the anastomotic region.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Patients with a thromboembolic nature of the occlusion tended to survive better (thromboembolic 59.5% vs. 40.6% and arteriosclerotic 40.5% vs. 59.4%), but at a non-significant level (P=0.11).

    “Patients with a thromboembolic nature of the occlusion tended to survive better (thromboembolic 59.5% vs. 40.6% and arteriosclerotic 40.5% vs. 59.4%), but at a non-significant level (P = 0.11).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The cause of death was malignancy in three, myocardial infarction in two, and unknown in two patients.

    “The cause of death was malignancy in three, myocardial infarction in two, and unknown in two patients.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Congestive heart failure or increased BMI had a negative influence on patient survival.

    “Furthermore, we observe that congestive heart failure or increased BMI had a negative influence on patient survival.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Only two further OT patients received endovascular stent implantation during follow-up into the inserted bypass.

    “Only further two OT patients received endovascular stent implantation during follow-up into the inserted bypass.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Further findings in preoperative diagnostic associated with mortality were pneumatosis intestinalis, increased lactate and LDH concentration as well as decreased blood pH-values.

    “Further findings in preoperative diagnostic associated with mortality were pneumatosis intestinalis, increased lactate and LDH concentration as well as decreased blood pH-values (Tables 4 and 5).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Most patients presented with unspecific symptom complex of abdominal pain (100%), peritonism (31%), vomiting (26%) and diarrhea (16%), and 11% were already mechanically ventilated at presentation.

    “Clinically, most patients presented with unspecific symptom complex of abdominal pain (100%), peritonism (31%), vomiting (26%) and diarrhea (16%), but also 11% of the patients were already mechanically ventilated at the time of presentation.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Further analysis of patients with unsuccessful endovascular interventions was performed as intention-to-treat (ITT).

    “Further analysis of these patients was performed as intention-to-treat (ITT).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Advanced disease stage with ischemic intestinal sections at presentation and cardiovascular comorbidities were associated with adverse outcome.

    “Advanced disease stage with ischemic intestinal sections at presentation and cardiovascular comorbidities were associated with adverse outcome.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    Given the small number of patients treated with ET and the limited follow up, a comprehensive comparison was not believed appropriate, and selection bias cannot be avoided.

    “Given the small number of patients treated with ET and the limited follow up, we did not believe that a comprehensive comparison would be appropriate, and also due to the fact that a selection bias cannot be avoided.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Hou et al. reported conversion rates for endovascular treatment of 40-72%.

    “As reported in a recent meta-analysis by Hou et al. conversion rates for endovascular treatment are 40-72% [8].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [8] Hou L et al (2022) Outcomes of different acute mesenteric ischemia therapies in the last 20 years: A meta-analysis and systematic review. Vascular 30(4):669–680 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    The heterogeneous study designs and lacking reporting standards for AMI lead to limited comparability of mortality in the treatment modalities.

    “In conclusion, the heterogeneous study designs and lacking reporting standards for AMI lead to limited comparability of mortality in the treatment modalities.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Only arteriosclerotic occlusions were treated by ET, so the endovascular failure can be explained by the heavily calcified visceral aortas and mesenteric vessel orifices.

    “In fact, only arteriosclerotic occlusions were treated by ET so that the endovascular failure can be explained by the heavily calcified visceral aortas and mesenteric vessel orifices [11, 23].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [11] Arthurs ZM et al (2011) A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia. J Vasc Surg 53(3):698–705 source

      Not checked in the free run.

    • cites [23] Zacharias N et al (2016) Chronic mesenteric ischemia outcome analysis and predictors of endovascular failure. J Vasc Surg 63(6):1582–1587 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The existing laboratory diagnostic for AMI is only rarely specific and therefore only to be regarded as additive.

    “Overall and as already confirmed in many studies, the existing laboratory diagnostic for AMI is only rarely specific and therefore only to be regarded as additive [20].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Acosta S, Nilsson T (2012) Current status on plasma biomarkers for acute mesenteric ischemia. J Thromb Thrombolysis 33(4):355–361 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Study design and conductnone given

    During the long study period, progress in medical therapy and endovascular technology may have affected patients' outcomes.

    “Furthermore, during the long study period, there has been a progress in medical therapy and endovascular technology that may have affected patients’ outcomes.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    We focused our study exclusively on patients who received open or intraoperative endovascular surgery with subsequent laparotomy to limit the bias of the results.

    “Therefore, we focused our study exclusively on patients who received open or intraoperative endovascular surgery with subsequent laparotomy to limit the bias of the results.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Eckstein et al. mentioned the increased use of anticoagulants, the decreasing incidence of rheumatic valvular diseases, and the higher incidence of degenerative vascular diseases in the rising average age of the population as reasons for the increase in arteriosclerotic occlusions.

    “As reasons for this Eckstein et al. mentioned the increased use of anticoagulants and the decreasing incidence of rheumatic valvular diseases as well as the higher incidence of degenerative vascular diseases in the rising average age of the population [15].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] Eckstein HH (2003) Acute mesenteric ischemia. Resection or reconstruction? Chirurg 74(5):419–431 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The CTA was the imaging modality of choice in all cases and has proven to be highly sensitive and specific for the diagnosis of AMI.

    “The CTA was the imaging modality of choice in all cases and has proven to be highly sensitive and specific for the diagnosis of AMI [4, 18].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [4] Björck M et al (2017) Management of the Diseases of Mesenteric Arteries and Veins: Clinical Practice Guidelines of the European Society of Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 53(4):460–510 source

      Not checked in the free run.

    • cites [18] Aschoff AJ et al (2009) Evaluation of acute mesenteric ischemia: accuracy of biphasic mesenteric multi-detector CT angiography. Abdom Imaging 34(3):345–357 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    According to Bala et al., the SMA is predestined for embolic events due to the large vessel diameter and sharp angulation.

    “According to Bala et al. the SMA is predestined for embolic events due to the large vessel diameter and sharp angulation [19].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] Bala M et al (2017) Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery. World J Emerg Surg 12(1):38 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Schermerhorn et al. found that mainly elderly patients with high comorbidities of cardiovascular diseases were affected by AMI and identified age and atrial fibrillation as predictors of poor survival.

    “Consistent with our results, Schermerhorn et al. evaluated in the so far largest data analyses from the Nationwide Inpatient Sample (NIS), that mainly elderly patients with high comorbidities of cardiovascular diseases were affected by AMI and identified also age and atrial fibrillation as a predictor of poor survival [14].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] Schermerhorn ML et al (2009) Mesenteric Revascularization: Management and Outcomes in the United States 1988–2006. J Vasc Surg 50(2):341–348.e1 source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    We focused exclusively on surgically or endovascular treated patients with subsequent need for laparotomy and excluded purely endovascularly treated patients due to their better initial condition, which certainly worsens our mortality outcomes.

    “As mentioned above, we focused exclusively on surgically or endovascular treated patients with subsequent need for laparotomy and excluded purely endovascularly treated patients due to their better initial condition, which certainly worsens our mortality outcomes.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    In our practical experience, most patients are already in critical condition at diagnosis or in a too advanced stage of disease for primary initial endovascular treatment as recommended.

    “But in our practical experience, most patients are already in critical condition at diagnosis or in a too advanced stage of disease for primary initial endovascular treatment as recommended.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    These morphological constitutions represent a minority, so in actual practice open surgical revascularization plays a major role.

    “However, these morphological constitutions represent a minority, so in actual practice open surgical revascularization plays a major role.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    This study is a retrospective single center study, generating bias linked to a retrospective data collection.

    “This study has some limitations. It is a retrospective single center study, generating bias linked to a retrospective data collection.”
    Quote in the paperNot a substantial claim
34 of 34

  • The paper relies on this without support.

    Most comparative series of endovascular versus open treatment for acute mesenteric ischemia are limited by small case numbers or short-term follow-up, so the quality of supporting data is restricted and the effect on outcomes remains unclear.

    “Nevertheless, most comparative series are limited by small case numbers or short-term follow-up, so the quality of the supporting data is still restricted and the effect on the outcomes remains unclear.”

  • The paper relies on this without support.

    Most patients with acute mesenteric ischemia are already in critical condition at diagnosis or in too advanced a stage of disease for primary initial endovascular treatment, leading to a discrepancy between theory and clinical practice.

    “Additionally, most patients are already in critical condition at diagnosis or in a too advanced stage of disease for primary initial endovascular treatment, leading to a discrepancy between the theory in the literature and actual clinical practice.”

  • The paper relies on this without support.

    Restricting the comparison to patients who required laparotomy yields groups similar enough to compare open and endovascular treatment outcomes.

    “The purpose of this study was to review outcomes in AMI treatment with an open or endovascular approach in association with laparotomy and to evaluate the endovascular-first strategy in similar clinical situations.”

  • The paper relies on this without support.

    A wrong referral diagnosis is a valid proxy for delayed diagnosis and treatment of AMI.

    “Primary referral diagnosis of AMI was placed correctly in only 62% of the patients. Even so, patients with a wrong referral diagnosis had worse survival than patients with a correct referral diagnosis (38% vs. 63%; P= 0.07).”
    “Due to our retrospective study design, we were not able to record the time between symptom-onset and treatment begin reliably.”

  • The paper relies on this without support.

    The follow-up data available in 30/42 patients (65.3%) are representative of the entire cohort for the Kaplan-Meier survival estimates.

    “The mean follow-up was 19 months (range 6.5–46 months) and available in 30/42 patients (65.3%).”
    “Kaplan-Meier estimates for 1-year and 5-year survival were 85.5% and 58.8% (Fig. 3).”
5 of 5

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Wrong-referral-diagnosis P-values differ

    Major

    The text reports P = 0.07 for the survival comparison involving a wrong initial diagnosis, while Table 4 reports P = 0.54 for wrong referral diagnosis.

  • Additional bowel resection count differs between text and table

    Major

    The postoperative-course text reports 22 patients requiring additional resection, whereas Table 3 reports 25.

  • Intensive-care stay differs between text and table

    Major

    The outcome text reports a median intensive-care stay of 11 days, range 5-26, while Table 3 reports 13 days, range 5-29.

  • Short-range occlusion percentage does not match its count

    Minor

    The reported 26 short-range occlusions among 74 patients represent 35.1%, not 31.1%.

    Reported 31.1 · recomputed 35.135135

  • Count above Clavien-Dindo grade IIIa includes grade IIIa cases

    Minor

    The table lists 59 patients in grades IIIb through V, not 63. Its total reaches 63 only if the four grade IIIa patients are included, despite the text saying greater than grade IIIa.

    Reported 63 · recomputed 59

  • Long-range SMA occlusion count differs between text and table

    Minor

    The text reports 51 long-range SMA occlusions, but Table 2 reports 48. The table's count also matches the stated 65% of 74 patients.

  • Chronic kidney disease prevalence differs in discussion

    Minor

    The discussion describes chronic renal insufficiency in 35% of the cohort, whereas the patient-characteristics section reports 29.7% and Table 1 reports 22 of 74 patients.

  • Follow-up availability percentage is incorrect

    Minor

    Follow-up available for 30 of 42 patients corresponds to 71.4%, not 65.3%.

    Reported 65.3 · recomputed 71.428571

  • SMA-origin mortality percentage is incorrect

    Minor

    Table 4 lists 21 deceased and 17 surviving patients with SMA-origin occlusion. The deceased share is therefore 21 of 38, or 55.3%, rather than the reported 44%.

    Reported 44 · recomputed 55.263158

  • Initial bowel resection percentage does not match its count

    Minor

    Fifty-three of 74 patients represent 71.6%, not the reported 70.3%.

    Reported 70.3 · recomputed 71.621622

  • The stated cohort size does not match the sex counts

    Minor

    The reported 53 male and 21 female patients total 74, not 76. The treatment-group counts and tables also use 74 patients.

    Reported 76 · recomputed 74

  • Acute kidney injury percentage in Table 3 is incorrect

    Minor

    Table 3 reports acute kidney injury in 36 of 74 patients as 45%; that count represents 48.6%.

    Reported 45 · recomputed 48.648649

  • Hospital-stay range differs between text and table

    Minor

    The outcome text gives a hospital-stay range of 14-37 days, while Table 3 gives 11-42 days.

13 of 13

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Björck M et al (2017) Editor's Choice - Management of the Diseases of Mesenteric Arteries and Veins: Clinical Practice Guidelines of the European Society of Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 53(4):460–510 · DOI · Paper page
  2. Eckstein HH (2003) Acute mesenteric ischemia. Resection or reconstruction? Chirurg 74(5):419–431 · DOI · Paper page

Cited by

Sorted by citations

Related

Authors
Kapalla, M., Choubey, R., Weitz, J., Reeps, C., & Wolk, S.
Affiliations
University Hospital Carl Gustav Carus (DE)
Corresponding author
Kapalla, Marvin
ORCID
Venue
Langenbeck's Archives of Surgery
Publisher
Springer Science and Business Media LLC
Published
2023-08-10
Volume
408
Issue
1
Pages
303-303
ISSN
  • 0023-8236 (ISSN-L)
  • 1435-2451
DOI
10.1007/s00423-023-03035-8
PMC
PMC10415437
OpenAlex
W4385716210
Cited by
13
References
25
Citations by year
2026: 2 · 2025: 6 · 2024: 5
FWCI
3.48
Type
journal article
Language
en
Open access
Licence
Locations
  • Langenbeck s Archives of Surgery (publishedVersion, cc-by)
  • Research Square (acceptedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Qucosa (Saxon State and University Library Dresden) (submittedVersion, cc-by)
Funders
Universitätsklinikum Carl Gustav Carus Dresden an der Technischen Universität Dresden
Topics
  • Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
  • Health Sciences › Medicine › Emergency Medicine › Appendicitis Diagnosis and Management
  • Health Sciences › Medicine › Surgery › Intestinal and Peritoneal Adhesions
Keywords
acute mesenteric ischemia, endovascular revascularization, open surgical revascularization, laparotomy, in-hospital mortality, mortality risk factors, pneumatosis intestinalis, lactate, thromboembolic occlusion, cardiovascular comorbidity
MeSH terms
Acute Disease, Humans, Ischemia, Laparotomy, Retrospective Studies, Risk Factors, Treatment Outcome, Endovascular Procedures, Mesenteric Ischemia

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-07.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-07.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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