Multidisciplinary Stepwise Management Strategy for Acute Superior Mesenteric Venous Thrombosis: An Intestinal Stroke Center Experience
Abstract
Backgroud Acute superior mesenteric venous thrombosis (ASMVT) is an uncommon but catastrophic abdominal vascular emergency with high rate of intestinal failure and mortality. The retrospective pilot study was performed to assess the effect of a multidisciplinary stepwise management strategy on survival and mesenteric recanalization in an integrated intestinal stroke center (ISC). Materials and methods A modern management strategy performed by multidisciplinary specialists in ISC was evaluated among 43 ASMVT patients that were classified into central vs peripheral type, operative vs nonoperative, early vs late treated group from March 2009 to April 2013. Patients received specific medical therapy, endovascular treatment, damage-control surgery, selective second-look laparotomy, critical care management, and clinical nutrition support in a stepwise way. The demographics, etiology, imaging characteristics, treatment procedures, complications, clinical outcome, and 1-year follow-up data were analyzed and compared. Confounding factors of mortality were identified by univariate and ROC-curve analysis. A single-center experience of over 5years for this modern strategy was also reported. Results The protocol of multidisciplinary stepwise management strategy was followed in all ASMVT patients successfully. The 30-day mortality and recanalization rate were 11.63% and 90.70%. Initial damage-control surgery was carried out in 46.51% patients, with selective second-look laparotomy in 23.26% patients. Endovascular thrombolysis was performed in 83.72% patients initially or postoperatively. Bowel resection was necessary in 18 patients with the length of 100.00 (47.50, 222.50) cm. The incidence of short-bowel syndrome was 13.95%. The rate and length of bowel resection, short-bowel syndrome rate were significantly lower in nonoperative and early-treated groups (P<0.05). During the follow-up survey, 1-year survival was 83.72%, with no additional death or re-thrombosis. Conclusion A multidisciplinary stepwise management strategy involving modern surgical and endovascular treatments that focus on early mesenteric recanalization and bowel viability salvage in a specialized ISC could significantly improve the clinical outcome of ASMVT patients.
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The concept of "intestinal stroke centers" has been promulgated in France and in China.
“The concept of “intestinal stroke centers” has been promulgated in France and in China [144, 145].”
From Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery. (2022) · cites this paper as [145]
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- Authors
- Yang, S., Fan, X., Ding, W., Liu, B., Meng, J., Xu, D., He, C., Yu, W., Wu, X., & Li, J.
- Affiliations
- Nanjing General Hospital of Nanjing Military Command (CN)
- Corresponding author
- Yang, Shuofei
- Fan, Xinxin
- Ding, Weiwei
- Liu, Baochen
- Meng, Jiaxiang
- Xu, Dandan
- He, Changsheng
- Yu, Wenkui
- Wu, Xingjiang
- Li, Jieshou
- Venue
- Thrombosis Research
- Publisher
- Elsevier BV
- Published
- 2015-01
- Volume
- 135
- Issue
- 1
- Pages
- 36-45
- ISSN
- 0049-3848 (ISSN-L)
- OpenAlex
- W1983548182
- Cited by
- 58
- References
- 6
- Citations by year
- 2025: 6 · 2024: 3 · 2023: 10 · 2022: 6 · 2021: 6 · 2020: 5 · 2019: 3 · 2018: 3 · 2017: 10 · 2016: 4 · 2015: 1 · 2014: 1
- FWCI
- 5.26
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Thrombosis Research (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Health Sciences › Medicine › Surgery › Vascular anomalies and interventions
- Keywords
- multidisciplinary management, damage control surgery, endovascular thrombolysis, second-look laparotomy, bowel resection, short bowel syndrome, intestinal failure, mortality, early treatment
- MeSH terms
- Adult, Anticoagulants, Female, Humans, Intestines, Male, Middle Aged, Laparoscopy, Pilot Projects, Retrospective Studies, Risk Factors, Ultrasonography, Reproducibility of Results, Treatment Outcome, Venous Thrombosis, Stroke, Mesenteric Ischemia
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