Interdisciplinary approach in emergency revascularization and treatment for acute mesenteric ischemia
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Abstract
BACKGROUND: Mesenteric ischemia is associated with poor outcome and high overall mortality. The aim was to analyze an interdisciplinary treatment approach of vascular and visceral specialists focusing on the in-hospital outcome and follow-up in patients with acute and acute-on-chronic mesenteric ischemia. METHODS: From 2010 until 2017, 26 consecutive patients with acute or acute on chronic mesenteric ischemia were treated by an interdisciplinary team. Data were prospectively collected and retrospectively evaluated. Throughout the initial examination, the extent of bowel resection was determined by the visceral surgeon and the appropriate mode of revascularization by the vascular surgeon. The routine follow-up included clinical examination and ultrasound- or CT-imaging for patency assessment and overall survival as primary endpoint of the study. RESULTS: Out of 26 patients, 18 (69.2%) were rendered for open repair. Ten patients (38.5%) received reconstruction of the superior mesenteric artery with an iliac-mesenteric bypass. Seven patients (26.9%) underwent thrombembolectomy of the mesenteric artery. One patient received an infra-diaphragmatic aorto-celiac-mesenteric bypass. Out of the 8 patients, who were not suitable for open revascularization, 2 patients (7.7%) were treated endovascularly and 6 (23.1%) underwent explorative laparotomy. The in-hospital mortality was 23% (n = 6). The mean survival of the revascularized group (n = 20) was 51.8 months (95% CI 39.1-64.5) compared to 15.7 months in the non-revascularized group (n = 6) (95% CI - 4.8-36.1; p = 0.08). The median follow-up was 64.6 months. Primary patency in the 16 patients after open and 2 after interventional revascularization was 100% and 89.9% in the follow-up. CONCLUSION: The interdisciplinary treatment of mesenteric ischemia improves survival if carried out in time. Hereby open revascularization measures are advantageous as they allow bowel assessment, resection, and revascularization in a one-stop fashion especially in advanced cases.
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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 [1]
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References 23 · Cited by 18
- Authors
- Zientara, A., Domenghino, A.-R., Schwegler, I., Bruijnen, H., Schnider, A., Weber, M., Gutknecht, S., & Attigah, N.
- Affiliations
- Royal Brompton & Harefield NHS Foundation Trust (GB)
- Triemli Hospital (CH)
- University Hospital Augsburg (DE)
- Corresponding author
- Attigah, Nicolas
- Venue
- BMC Surgery
- Published
- 2021-02-18
- Volume
- 21
- Issue
- 1
- Pages
- 89-89
- ISSN
- 1471-2482 (ISSN-L)
- PMC
- PMC7890998
- OpenAlex
- W3113237076
- Cited by
- 18
- References
- 23
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 4 · 2023: 3 · 2022: 3 · 2021: 2
- FWCI
- 2.82
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Surgery (publishedVersion, cc-by)
- Research Square (acceptedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Emergency Medicine › Appendicitis Diagnosis and Management
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic Thrombus and Embolism
- Keywords
- acute mesenteric ischemia, interdisciplinary treatment, urgent revascularization, open surgical revascularization, thrombectomy, endovascular revascularization, bowel resection, in-hospital mortality, survival
- MeSH terms
- Acute Disease, Emergency Medical Services, Humans, Patient Care Team, Retrospective Studies, Vascular Surgical Procedures, Treatment Outcome, Mesenteric Artery, Superior, Mesenteric Ischemia
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