Revascularization of acute mesenteric ischemia after creation of a dedicated multidisciplinary center
Open accessAbstract
Objective Arterial acute mesenteric ischemia (AAMI) is a vascular and gastroenterologic emergency, most often surgical, still associated with a poor prognosis and frequent short bowel syndrome in survivors. We report the results of revascularization in AAMI patients after the creation of an intestinal stroke center.Methods Since July 2009, we developed a multimodal and multidisciplinary management for AMI, focusing on intestinal viability and involving gastroenterologists, vascular and abdominal surgeons, radiologists, and intensive care specialists. This management was the first step to the creation of an intestinal stroke center, based on the stroke unit model. All patients received: (1) a specific medical protocol; (2) endovascular and/or open surgical revascularization whenever possible; and/or (3) resection of non-viable small bowel. We aimed to study survival, morbidity, type of revascularization, and bowel resection in patients who benefited from arterial revascularization in our intestinal stroke center.Results Eighty-three patients with AMI were prospectively enrolled in the intestinal stroke center. Among them, 29 patients with AAMI underwent revascularization. The mean age was 50.2 ± 12 years, with 41% of male gender. The mean follow-up was 22.7 ± 19 months. Overall 2-year survival was 89.2%, and 30-day operative mortality was 6.9%. Surgical revascularization included bypass grafting (65%), endarterectomy with patch angioplasty (21%) ± retrograde open mesenteric stenting of the superior mesenteric artery (7%), and endovascular revascularization as first stage procedure (38%). The 2-year primary patency rate of open revascularization was 88%. The rate and the median length of bowel resected were 24% and 43 cm (range, 36-49 cm), respectively.Conclusions In our experience, revascularization of AAMI patients as part of a multidisciplinary and multimodal management leads to encouraging results. Vascular surgeons have a central role in a dedicated intestinal stroke center.
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Heterogeneous clinical manifestations and pathophysiological mechanisms of different subtypes of AMI usually result in multiple specialties being involved in the primary diagnosis and management of AMI.
“Heterogeneous clinical manifestations and pathophysiological mechanisms of different subtypes of AMI (occlusive arterial or venous, non-occlusive) usually result in multiple specialties being involved in the primary diagnosis and management of AMI [3–7], and key similarities and differences between subtypes of AMI are incompletely studied.”
From Incidence, diagnosis, management and outcome of acute mesenteric ischaemia: a prospective, multicentre observational study (AMESI Study) (2024) · cites this paper as [3]
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 [6]
Progress in management of specific forms of acute mesenteric ischaemia has been achieved, concerning mainly endovascular and hybrid therapy of occlusive arterial acute mesenteric ischaemia.
“progress in management of specific forms of AMI has been achieved, concerning mainly the endovascular and hybrid therapy of occlusive arterial AMI.6 123”
From Incidence and outcomes of acute mesenteric ischaemia: a systematic review and meta-analysis (2022) · cites this paper as [6]
Recent published evidence suggests that treatment of occlusive AMI in "intestine stroke centers" using a multidisciplinary approach improves outcomes.
“Recent published evidence suggests that treatment of occlusive AMI in “intestine stroke centers” using a multidisciplinary approach improves outcomes [142, 143].”
From Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery. (2022) · cites this paper as [142]
Preliminary evidence suggests that treatment of AMI in especially dedicated centers using a multidisciplinary approach improves outcomes.
“Preliminary evidence suggests that treatment of AMI in especially dedicated centers using a multidisciplinary approach improves outcomes.”
From Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery. (2022) · cites this paper as [142]
AMI is a multidisciplinary emergency, requiring involvement of several different medical specialties.
“Acute mesenteric ischaemia (AMI) is a multidisciplinary emergency, requiring involvement of several different medical specialties [1,2].”
From Management of acute mesenteric ischaemia: Results of a worldwide survey (2023) · cites this paper as [2]
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 [2]
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 [2]
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- Authors
- Roussel, A., Castier, Y., Nuzzo, A., Pellenc, Q., Sibert, A., Panis, Y., Bouhnik, Y., & Corcos, O.
- Affiliations
- Groupe Hospitalo-Universitaire Paris Nord (FR)
- Corresponding author
- Roussel, Arnaud
- ORCID
- Venue
- Journal of Vascular Surgery
- Publisher
- Elsevier BV
- Published
- 2015-11
- Volume
- 62
- Issue
- 5
- Pages
- 1251-1256
- ISSN
- 0741-5214 (ISSN-L)
- OpenAlex
- W2161142575
- Cited by
- 92
- References
- 21
- Citations by year
- 2026: 7 · 2025: 7 · 2024: 10 · 2023: 7 · 2022: 11 · 2021: 11 · 2020: 11 · 2019: 7 · 2018: 9 · 2017: 9 · 2016: 3
- FWCI
- 7.04
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Vascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Emergency Medicine › Appendicitis Diagnosis and Management
- Keywords
- acute mesenteric ischemia, arterial revascularization, multidisciplinary management, endovascular revascularization, endarterectomy, patch angioplasty, bowel resection, short bowel syndrome
- MeSH terms
- Acute Disease, Adult, Cooperative Behavior, Female, Hospitals, University, Humans, Male, Mesenteric Vascular Occlusion, Middle Aged, Patient Care Team, Prospective Studies, Risk Factors, Digestive System Surgical Procedures, Time Factors, Vascular Surgical Procedures, Treatment Outcome, Critical Pathways, Interdisciplinary Communication, Kaplan-Meier Estimate, Endovascular Procedures, Mesenteric Ischemia
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