Effects of a Multimodal Management Strategy for Acute Mesenteric Ischemia on Survival and Intestinal Failure
Abstract
Background & aims Acute mesenteric ischemia (AMI) is an emergency with a high mortality rate; survivors have high rates of intestinal failure. We performed a prospective study to assess a multidisciplinary and multimodal management approach, focused on intestinal viability.Methods In an Intestinal Stroke Center, we developed a multimodal management strategy involving gastroenterologists, vascular and abdominal surgeons, radiologists, and intensive care specialists; it was tested in a pilot study on 18 consecutive patients with occlusive AMI, admitted to a tertiary center from July 2009 to November 2011. Patients with left ischemic colitis, nonocclusive AMI, chronic mesenteric ischemia, and other emergencies were excluded. Patients received specific medical management: revascularization of viable small bowel and/or resection of nonviable small bowel; 12 patients received arterial revascularization. We evaluated the percentages of patients who survived for 30 days or 2 years, the number with permanent intestinal failure, and morbidity. Lengths and rates of intestinal resection were compared with or without revascularization, and in patients with early or late-stage disease.Results Patients were followed up for a mean of 497 days (range, 7-2085 d); 95% survived for 30 days, 89% survived for 2 years, and 28% had morbidities within 30 days. Intestinal resection was necessary for 7 cases (39%), with mean lengths of intestinal resection of 30 cm and 207 cm, with or without revascularization, respectively (P = .03). Among patients with early or late-stage AMI, rates of resection were 18% and 71%, respectively (P = .049). Patients with early stage disease had shorter lengths of intestinal resection than those with late-stage disease (7 vs 94 cm; P = .02), and spent less time in intensive care (2.5 vs 49.8; P = .02).Conclusions A multidisciplinary and multimodal management approach might increase survival of patients with AMI and prevent intestinal failure.
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Data from the past decade suggest that some improvement in acute mesenteric ischaemia outcomes may have taken place as a result of a multidisciplinary approach and developments in many medical fields.
“Data from the past decade suggest that some improvement may have taken place as a result of a multidisciplinary approach and developments in many medical fields (eg, better diagnostics, endovascular procedures, management of short bowel syndrome, home parenteral nutrition).6–8”
From Incidence and outcomes of acute mesenteric ischaemia: a systematic review and meta-analysis (2022) · cites this paper as [7]
Utilizing this approach, Corcos et al. reported a 30-day survival of 95% in a small single-center study involving 18 patients presenting with occlusive AMI.
“Utilizing this approach, Corcos et al. reported a 30-day survival of 95% in a small single-center study involving 18 patients presenting with occlusive AMI [146].”
From Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery. (2022) · cites this paper as [146]
Some preliminary evidence suggests that a multidisciplinary approach implemented in a special unit can achieve high survival rates and lower morbidity.
“Still, some preliminary evidence suggests that a multidisciplinary approach implemented in a special unit can achieve high survival rates and lower morbidity [2,14,15].”
From Management of acute mesenteric ischaemia: Results of a worldwide survey (2023) · cites this paper as [14]
Early AMI is a fully reversible condition, as opposed to late AMI with irreversible transmural necrosis.
“Indeed, early AMI is a fully reversible condition, as opposed to late AMI, with irreversible transmural necrosis [1, 4, 9].”
From Improving clinical suspicion of acute mesenteric ischemia among patients with acute abdomen: A cross-sectional study from an intestinal stroke center (2023) · cites this paper as [4]
The pilot study showed an improvement in survival and lower resection rates.
“Following the results of a pilot study showing an improvement in survival and lower resection rates [4], we created an intestinal stroke center (ISC) that provides 24/7 standardized multimodal and multidisciplinary care to AMI patients referred from the Paris region.”
From Improving clinical suspicion of acute mesenteric ischemia among patients with acute abdomen: A cross-sectional study from an intestinal stroke center (2023) · cites this paper as [4]
Adequate treatment of AMI is associated with lower mortality.
“Adequate treatment of AMI is associated with lower mortality [2,14,15], but it is less clear what the effect on morbidity is and whether this depends on age or other parameters such as co-morbidities.”
From Management of acute mesenteric ischaemia: Results of a worldwide survey (2023) · cites this paper as [14]
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References 40 · Cited by 142
- Authors
- Corcos, O., Castier, Y., Sibert, A., Gaujoux, S., Ronot, M., Joly, F., Paugam, C., Bretagnol, F., Abdel–Rehim, M., Francis, F., Bondjemah, V., Ferron, M., Zappa, M., Amiot, A., Stefanescu, C., Leseche, G., Marmuse, J., Belghiti, J., Ruszniewski, P., Vilgrain, V., Panis, Y., Mantz, J., & Bouhnik, Y.
- Affiliations
- Hôpital Beaujon (FR)
- Hôpital Bichat-Claude-Bernard (FR)
- Corresponding author
- Corcos, Olivier
- Venue
- Clinical Gastroenterology and Hepatology
- Publisher
- Elsevier BV
- Published
- 2013-02
- Volume
- 11
- Issue
- 2
- Pages
- 158-165.e2
- ISSN
- 1542-3565 (ISSN-L)
- OpenAlex
- W2169974175
- Cited by
- 142
- References
- 40
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 18 · 2023: 12 · 2022: 11 · 2021: 12 · 2020: 14 · 2019: 15 · 2018: 16 · 2017: 7 · 2016: 9 · 2015: 9 · 2014: 2 · 2013: 2
- FWCI
- 4.23
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Gastroenterology and Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Surgery › Intestinal and Peritoneal Adhesions
- Health Sciences › Medicine › Emergency Medicine › Appendicitis Diagnosis and Management
- Keywords
- acute mesenteric ischemia, intestinal failure, multimodal management, multidisciplinary care, intestinal revascularization, bowel resection, survival, disease stage
- MeSH terms
- Adult, Aged, Aged, 80 and over, Combined Modality Therapy, Critical Care, Female, Humans, Ischemia, Male, Middle Aged, Pilot Projects, Prospective Studies, Digestive System Surgical Procedures, Vascular Diseases, Survival Analysis, Treatment Outcome, Mesenteric Ischemia
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