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Garzelli L, Dufay R, Tual A, Corcos O, Cazals-Hatem D, Vilgrain V, Nuzzo A, Ben Abdallah I, Ronot M. Predictors of Survival Without Intestinal Resection after First-Line Endovascular Revascularization in Patients with Acute Arterial Mesenteric Ischemia. Radiology 2024; 311:e230830. [PMID: 38860892 DOI: 10.1148/radiol.230830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
Background Acute arterial mesenteric ischemia requires emergency treatment and is associated with high mortality rate and poor quality of life. Identifying factors associated with survival without intestinal resection (hereafter, intestinal resection-free [IRF] survival) could help in treatment decision-making after first-line endovascular revascularization. Purpose To identify factors associated with 30-day IRF survival in patients with acute arterial mesenteric ischemia whose first-line treatment was endovascular revascularization. Materials and Methods Patients with acute arterial mesenteric ischemia whose first-line treatment was endovascular revascularization because of a low probability of bowel necrosis were included in this single-center retrospective cohort (May 2014 to August 2022). Patient demographics, laboratory values, clinical characteristics at admission, CT scans, angiograms, and endovascular revascularization-related variables were included. The primary end point was 30-day IRF survival, and secondary end points were 3-month, 1-year, and 3-year overall survival. Factors independently associated with 30-day IRF survival were identified with binary logistic regression. Results A total of 117 patients (median age, 70 years [IQR, 60-77]; 53 female, 64 male) were included. Within 30 days after revascularization, 73 of 117 patients (62%) survived without resection, 28 of 117 (24%) survived after resection, 14 of 117 (12%) died without resection, and two of 117 (2%) underwent resection but died. The 30-day IRF survival was 63% (74 of 117). The 3-month, 1-year, and 3-year mortality rate was 18% (21 of 117), 21% (25 of 117), and 27% (32 of 117), respectively. Independent predictors of 30-day IRF survival were persistent bowel enhancement at initial CT (odds ratio [OR], 0.3; 95% CI: 0.2, 0.8; P = .013) and C-reactive protein (CRP) level less than 100 mg/L (OR, 0.3; 95% CI: 0.1, 0.8; P = .002). The 30-day IRF survival was 86%, 61%, 47%, and 23% in patients with both favorable features, persistent bowel enhancement but CRP level greater than 100 mg/L, no bowel enhancement but CRP level less than 100 mg/L, and both unfavorable features, respectively. Conclusion Independent predictors associated with 30-day IRF survival in patients with acute arterial mesenteric ischemia whose first-line treatment was endovascular revascularization were persistent bowel wall enhancement at initial CT and CRP level less than 100 mg/L. © RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Lorenzo Garzelli
- From the Departments of Radiology (L.G., R.D., A.T., V.V., M.R.), Pathology (D.C.H.), and Gastroenterology, IBD, and Intestinal Insufficiency (O.C., A.N.), Hôpital Beaujon, AP-HP Nord, 100 Blvd du Général Leclerc, 92110 Clichy, France; Department of Vascular Surgery, Hôpital Bichat, AP-HP Nord, Paris, France (I.B.A.); Université Paris-Cité, Paris, UMR 1149 CRI, Paris, France (V.V., M.R.); Université des Antilles, Cayenne, French West Indies (L.G.)
| | - Raphael Dufay
- From the Departments of Radiology (L.G., R.D., A.T., V.V., M.R.), Pathology (D.C.H.), and Gastroenterology, IBD, and Intestinal Insufficiency (O.C., A.N.), Hôpital Beaujon, AP-HP Nord, 100 Blvd du Général Leclerc, 92110 Clichy, France; Department of Vascular Surgery, Hôpital Bichat, AP-HP Nord, Paris, France (I.B.A.); Université Paris-Cité, Paris, UMR 1149 CRI, Paris, France (V.V., M.R.); Université des Antilles, Cayenne, French West Indies (L.G.)
| | - Arnaud Tual
- From the Departments of Radiology (L.G., R.D., A.T., V.V., M.R.), Pathology (D.C.H.), and Gastroenterology, IBD, and Intestinal Insufficiency (O.C., A.N.), Hôpital Beaujon, AP-HP Nord, 100 Blvd du Général Leclerc, 92110 Clichy, France; Department of Vascular Surgery, Hôpital Bichat, AP-HP Nord, Paris, France (I.B.A.); Université Paris-Cité, Paris, UMR 1149 CRI, Paris, France (V.V., M.R.); Université des Antilles, Cayenne, French West Indies (L.G.)
| | - Olivier Corcos
- From the Departments of Radiology (L.G., R.D., A.T., V.V., M.R.), Pathology (D.C.H.), and Gastroenterology, IBD, and Intestinal Insufficiency (O.C., A.N.), Hôpital Beaujon, AP-HP Nord, 100 Blvd du Général Leclerc, 92110 Clichy, France; Department of Vascular Surgery, Hôpital Bichat, AP-HP Nord, Paris, France (I.B.A.); Université Paris-Cité, Paris, UMR 1149 CRI, Paris, France (V.V., M.R.); Université des Antilles, Cayenne, French West Indies (L.G.)
| | - Dominique Cazals-Hatem
- From the Departments of Radiology (L.G., R.D., A.T., V.V., M.R.), Pathology (D.C.H.), and Gastroenterology, IBD, and Intestinal Insufficiency (O.C., A.N.), Hôpital Beaujon, AP-HP Nord, 100 Blvd du Général Leclerc, 92110 Clichy, France; Department of Vascular Surgery, Hôpital Bichat, AP-HP Nord, Paris, France (I.B.A.); Université Paris-Cité, Paris, UMR 1149 CRI, Paris, France (V.V., M.R.); Université des Antilles, Cayenne, French West Indies (L.G.)
| | - Valérie Vilgrain
- From the Departments of Radiology (L.G., R.D., A.T., V.V., M.R.), Pathology (D.C.H.), and Gastroenterology, IBD, and Intestinal Insufficiency (O.C., A.N.), Hôpital Beaujon, AP-HP Nord, 100 Blvd du Général Leclerc, 92110 Clichy, France; Department of Vascular Surgery, Hôpital Bichat, AP-HP Nord, Paris, France (I.B.A.); Université Paris-Cité, Paris, UMR 1149 CRI, Paris, France (V.V., M.R.); Université des Antilles, Cayenne, French West Indies (L.G.)
| | - Alexandre Nuzzo
- From the Departments of Radiology (L.G., R.D., A.T., V.V., M.R.), Pathology (D.C.H.), and Gastroenterology, IBD, and Intestinal Insufficiency (O.C., A.N.), Hôpital Beaujon, AP-HP Nord, 100 Blvd du Général Leclerc, 92110 Clichy, France; Department of Vascular Surgery, Hôpital Bichat, AP-HP Nord, Paris, France (I.B.A.); Université Paris-Cité, Paris, UMR 1149 CRI, Paris, France (V.V., M.R.); Université des Antilles, Cayenne, French West Indies (L.G.)
| | - Iannis Ben Abdallah
- From the Departments of Radiology (L.G., R.D., A.T., V.V., M.R.), Pathology (D.C.H.), and Gastroenterology, IBD, and Intestinal Insufficiency (O.C., A.N.), Hôpital Beaujon, AP-HP Nord, 100 Blvd du Général Leclerc, 92110 Clichy, France; Department of Vascular Surgery, Hôpital Bichat, AP-HP Nord, Paris, France (I.B.A.); Université Paris-Cité, Paris, UMR 1149 CRI, Paris, France (V.V., M.R.); Université des Antilles, Cayenne, French West Indies (L.G.)
| | - Maxime Ronot
- From the Departments of Radiology (L.G., R.D., A.T., V.V., M.R.), Pathology (D.C.H.), and Gastroenterology, IBD, and Intestinal Insufficiency (O.C., A.N.), Hôpital Beaujon, AP-HP Nord, 100 Blvd du Général Leclerc, 92110 Clichy, France; Department of Vascular Surgery, Hôpital Bichat, AP-HP Nord, Paris, France (I.B.A.); Université Paris-Cité, Paris, UMR 1149 CRI, Paris, France (V.V., M.R.); Université des Antilles, Cayenne, French West Indies (L.G.)
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Xu R, Tang L, Qin S, Zhang S, Wang M. Percutaneous Mechanical Thrombectomy Using the AcoStream Thrombus Aspiration System for Acute Superior Mesenteric Artery Embolism. Ann Vasc Surg 2024; 106:264-272. [PMID: 38815920 DOI: 10.1016/j.avsg.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/09/2024] [Accepted: 03/06/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND This study was performed to summarize our experience in treating acute superior mesenteric artery embolism (SMAE) by percutaneous mechanical thrombectomy (PMT). METHODS Between January 2023 and October 2023, 18 patients presenting with acute mesenteric ischemia were admitted to our center, including 11 cases of SMAE, 3 cases of superior mesenteric artery thrombosis, and 4 cases of superior mesenteric vein thrombosis. We retrospectively reviewed 8 patients (4 males and 4 females; range, 51-79 years; mean, 62.50 ± 9.67 years) who underwent treatment of acute SMAE using the AcoStream system. The patients had no obvious evidence of intestinal necrosis as shown by peritoneal puncture or computed tomography. Thrombectomy was performed on the superior mesenteric artery (SMA) using an 8F AcoStream thrombus aspiration system (Acotec, China). The demographics, risk factors, therapeutic effect, complications, mortality, and follow-up of the study population were assessed. RESULTS The technical success rate was 100%. After 1-3 passes (2.38 ± 0.92) and aspiration thrombectomy, complete thrombus removal was achieved in 7 (87.50%) patients. One patient received an adjunctive catheter-directed thrombolysis due to partial thrombus removal. Thrombolysis was conducted for 2 days, resulting in complete resolution of the thrombus. The other 7 patients did not receive adjunctive endovascular intervention due to complete thrombus removal and no residual stenosis. No distal embolization or device-related complications were noted during the procedure. After the procedure, sufficient clinical improvement was seen in 6 patients within 1-2 days. Two patients showed no significant improvement of their symptoms. Laparotomy was performed on day 1 and day 2 after thrombectomy in patients 3 and 7, respectively. Intestinal necrosis was diagnosed operatively and intestinal resection was performed. All patients were discharged 6-15 days (9.50 ± 3.07) after admission without perioperative complication or death. The mean follow-up period was 5.00 ± 3.30 months (range, 1-10 months), and the follow-up rate was 100%. During the follow-up, all patients remained symptom-free. Computed tomography angiography images showed good flow in the trunk and branches of the SMA in all patients. CONCLUSIONS PMT using the AcoStream system is a minimally invasive, safe, and effective technique for acute SMAE. Early application of PMT can achieve immediate revascularization of the SMA and have the potential advantage of avoiding laparotomy or reducing the extension of enterectomy, as it could theoretically restore intestinal perfusion in less time than open revascularization. If the symptoms do not improve after PMT, exploratory laparotomy should be scheduled as soon as possible. Further studies are necessary on this field to confirm these findings.
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Affiliation(s)
- Rongwei Xu
- Department of General Surgery, The First Affiliated Hospital to Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Linna Tang
- Department of Hospital Infection Control, The First Affiliated Hospital to Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Shiyong Qin
- Department of General Surgery, The First Affiliated Hospital to Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Shuguang Zhang
- Department of General Surgery, The First Affiliated Hospital to Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Minghai Wang
- Department of General Surgery, The First Affiliated Hospital to Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China.
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Thurner A, Kickuth R. [Indications and techniques for endovascular revascularization of visceral arteries in mesenteric ischemia]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:353-358. [PMID: 38060014 DOI: 10.1007/s00104-023-02013-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/08/2023]
Abstract
Endovascular revascularization of visceral arteries is an important cornerstone of an interdisciplinary treatment concept for both acute and chronic forms of mesenteric ischemia. The advantages lie in the minimally invasive procedure and the speed of restoration of perfusion. This article provides an overview of the indications, techniques and current state of the clinical literature with respect to endovascular revascularization.
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Affiliation(s)
- Annette Thurner
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
| | - Ralph Kickuth
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
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Gries JJ, Virk HUH, Chen B, Sakamoto T, Alam M, Krittanawong C. Advancements in Revascularization Strategies for Acute Mesenteric Ischemia: A Comprehensive Review. J Clin Med 2024; 13:570. [PMID: 38276076 PMCID: PMC10816895 DOI: 10.3390/jcm13020570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
Even with modern advancements in the management of acute mesenteric ischemia over the past decade, morbidity and mortality remain high, and the best primary treatment modality is still debated amongst interventionalists. Traditionally, interventionalists have favored an open surgical approach but are now trending for endovascular interventions due to apparent reduced mortality and complications. Newer studies suggest hybrid approaches, and intestinal stroke centers may be superior to either strategy alone. This narrative review will explore the natural history of acute mesenteric ischemia with the aim of increasing interventionalist awareness of modern advancements in revascularization strategies for this devastating disease.
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Affiliation(s)
- Jacob J. Gries
- Department of Internal Medicine, Geisinger Medical Center, Danville, PA 17822, USA;
| | - Hafeez Ul Hassan Virk
- Harrington Heart & Vascular Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Bing Chen
- Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA 17822, USA
| | - Takashi Sakamoto
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo 113-0033, Japan
- Department of Clinical Epidemiology & Health Economics, School of Public Health, The University of Tokyo, Tokyo 113-0033, Japan
| | - Mahboob Alam
- Section of Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Chayakrit Krittanawong
- Cardiology Division, NYU Langone Health and NYU School of Medicine, New York, NY 10016, USA
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Tual A, Garzelli L, Nuzzo A, Corcos O, Castier Y, Ben Abdallah I, Ronot M. Strengthening the Description of Superior Mesenteric Artery Occlusions in Acute Mesenteric Ischaemia: Proposition for an Anatomical Classification. Eur J Vasc Endovasc Surg 2023; 65:802-808. [PMID: 36736617 DOI: 10.1016/j.ejvs.2023.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 01/14/2023] [Accepted: 01/25/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The aim of this study was to propose computed tomography angiography (CTA) based anatomical segmentation of the superior mesenteric artery (SMA), in order to standardise the reporting of occlusive lesions in acute mesenteric ischaemia (AMI). METHODS A retrospective CTA evaluation of patients with occlusive AMI admitted between 2016 and 2021. After the screening of 468 patients, 95 were included. The SMA was segmented into proximal (S1, ostium to the inferior pancreaticoduodenal artery), middle (S2, from the inferior pancreaticoduodenal to the ileocolic artery), and distal (S3, downstream the ileocolic artery) sections. The jejunal arteries were labelled J1 to J6, and the middle, right, and ileocolic arteries C1, C2, and C3. Two radiologists independently applied the proposed segmentation to a cohort of patients with occlusive AMI to describe occlusive lesions. Intra- and inter-rater agreement was assessed with kappa statistics. RESULTS Occlusions involved one segment in 50 (53%) patients (S1, n = 27 [28%]; S2, n = 12 [13%]; S3, n = 11 [12%]); two segments in 37 (39%) patients (S2/S3, n = 31 [33%]; S1/S2, n = 3 [3%]; S1/S3, n = 3 [3%]); and all three segments in eight patients (S1/S2/S3, 8%). The median number of jejunal arteries was four (interquartile range 3, 4.5). C1 and C2 were present in 93 (98%) and 23 patients (24%), respectively. Almost perfect intra-rater agreement was obtained for S1 (91% agreement, κ = 0.82, 95% confidence interval [CI] 0.72 - 0.92); substantial agreement was obtained for S2 (90% agreement, κ = 0.80, 95% CI 0.68 - 0.92) and S3 (86% agreement, κ = 0.72, 95% CI 0.58 - 0.86). Almost perfect inter-rater agreement (with the second junior reading) was obtained for S1 (97% agreement, κ = 0.95, 95% CI 0.89 - 1.0), S2 (91% agreement, κ = 0.82, 95% CI 0.72 - 0.92), and S3 (agreement 96%, κ = 0.91, 95% CI 0.83 - 0.99). CONCLUSION A standardised CTA based anatomical segmental description of SMA occlusive lesions in AMI is proposed; it provided substantial to almost perfect intra- and inter-rater agreement for most anatomical segments.
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Affiliation(s)
- Arnaud Tual
- Université Paris Cité, France & Service de Radiologie, Hôpital Beaujon, APHP Nord, Clichy, France
| | - Lorenzo Garzelli
- Université Paris Cité, France & Service de Radiologie, Hôpital Beaujon, APHP Nord, Clichy, France
| | - Alexandre Nuzzo
- Intestinal Stroke Centre, Service de Gastroenterologie, MICI et Insuffisance Intestinale, Hôpital Beaujon, APHP Nord, Clichy, France
| | - Olivier Corcos
- Intestinal Stroke Centre, Service de Gastroenterologie, MICI et Insuffisance Intestinale, Hôpital Beaujon, APHP Nord, Clichy, France
| | - Yves Castier
- Université Paris Cité, France & Service de Chirurgie Vasculaire, Hôpital Bichat, APHP Nord, Paris, France
| | - Iannis Ben Abdallah
- Université Paris Cité, France & Service de Chirurgie Vasculaire, Hôpital Bichat, APHP Nord, Paris, France
| | - Maxime Ronot
- Université Paris Cité, France & Service de Radiologie, Hôpital Beaujon, APHP Nord, Clichy, France.
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Bongiovanni S, Bozzolo M, Amabile S, Peano E, Balderi A. Case report: ultrasound assisted catheter directed thrombolysis of an embolic partial occlusion of the superior mesenteric artery. FRONTIERS IN RADIOLOGY 2023; 3:1167901. [PMID: 37492380 PMCID: PMC10365118 DOI: 10.3389/fradi.2023.1167901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/25/2023] [Indexed: 07/27/2023]
Abstract
Acute mesenteric ischemia (AMI) is a severe medical condition defined by insufficient vascular supply to the small bowel through mesenteric vessels, resulting in necrosis and eventual gangrene of bowel walls. We present the case of a 64-year-old man with recrudescence of prolonged epigastric pain at rest of few hours duration, cold sweating and episodes of vomiting. A computed tomography scan of his abdomen revealed multiple filling defects in the mid-distal part of the superior mesenteric artery (SMA) and the proximal part of jejunal branches, associated with small intestine walls thickening, suggesting SMA thromboembolism and initial intestinal ischemia. Considering the absence of signs of peritonitis at the abdominal examination and the presence of multiple arterial emboli was decided to perform an endovascular treatment with ultrasound assisted catheter-directed thrombolysis with EkoSonic Endovascular System-EKOS, which resulted in complete dissolution of the multiple emboli and improved blood flow into the intestine wall. The day after the procedure the patient's pain improved significantly and 5 days after he was discharged home asymptomatic on warfarin anticoagulation. After 1 year of follow-up the patient is fine with no further episodes of mesenteric ischemia or other embolisms.
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Affiliation(s)
- Simone Bongiovanni
- Interventional Radiology Unit, Department of Radiology, A.O. S. Croce e Carle - Cuneo, Cuneo, Italy
| | - Marco Bozzolo
- Postgraduate School in Radiology, University of Turin, Turin, Italy
| | - Simone Amabile
- Postgraduate School in Radiology, University of Turin, Turin, Italy
| | - Enrico Peano
- Interventional Radiology Unit, Department of Radiology, A.O. S. Croce e Carle - Cuneo, Cuneo, Italy
| | - Alberto Balderi
- Interventional Radiology Unit, Department of Radiology, A.O. S. Croce e Carle - Cuneo, Cuneo, Italy
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Acute Superior Mesenteric Artery Embolism Treated with Percutaneous Mechanical Thrombectomy: a Single-Center Preliminary Application and Experience. Indian J Surg 2023. [DOI: 10.1007/s12262-023-03676-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Garzelli L, Nuzzo A, Hamon A, Ben Abdallah I, Gregory J, Raynaud L, Paulatto L, Dioguardi Burgio M, Castier Y, Panis Y, Vilgrain V, Corcos O, Ronot M. Reperfusion injury on computed tomography following endovascular revascularization of acute mesenteric ischemia: prevalence, risk factors, and patient outcome. Insights Imaging 2022; 13:194. [PMID: 36512135 PMCID: PMC9748024 DOI: 10.1186/s13244-022-01339-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Data about reperfusion injury (RI) following acute arterial mesenteric ischemia (AAMI) in humans are scarce. We aimed to assess the prevalence and risk factors of RI following endovascular revascularization of AMI and evaluate its impact on patient outcomes. METHODS Patients with AAMI who underwent endovascular revascularization (2016-2021) were included in this retrospective cohort. CT performed < 7 days after treatment was reviewed to identify features of RI (bowel wall hypoattenuation, mucosal hyperenhancement). Clinical, laboratory, imaging, and treatments were compared between RI and non-RI patients to identify factors associated with RI. Resection rate and survival were also compared. RESULTS Fifty patients (23 men, median 72-yrs [IQR 60-77]) were included, and 22 were diagnosed with RI (44%) after a median 28 h (22-48). Bowel wall hypoattenuation and mucosal hyperenhancement were found in 95% and 91% of patients with post-interventional RI, respectively. Patients with RI had a greater increase of CRP levels after endovascular treatment (p = 0.01). On multivariate analysis, a decreased bowel wall enhancement on baseline CT (HR = 8.2), an embolic cause (HR = 7.4), complete SMA occlusion (HR = 7.0), and higher serum lactate levels (HR = 1.4) were associated with RI. The three-month survival rate was 78%, with no difference between subgroups (p = 0.99). However, the resection rate was higher in patients with RI (32% versus 7%; p = 0.03). CONCLUSION RI is frequent after endovascular revascularization of AAMI, especially in patients who present with decreased bowel wall enhancement on pre-treatment CT, an embolic cause, and a complete occlusion of the SMA. However, its occurrence does not seem to negatively impact short-term survival.
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Affiliation(s)
- Lorenzo Garzelli
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411599.10000 0000 8595 4540Service de Radiologie, Hôpital Beaujon, APHP.Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France
| | - Alexandre Nuzzo
- grid.411599.10000 0000 8595 4540Intestinal Stroke Center, Service de Gastroenterology, MICI Et Insuffisance Intestinale, Hôpital Beaujon, APHP.Nord, Clichy, France
| | - Annick Hamon
- grid.411599.10000 0000 8595 4540Intestinal Stroke Center, Service de Gastroenterology, MICI Et Insuffisance Intestinale, Hôpital Beaujon, APHP.Nord, Clichy, France
| | - Iannis Ben Abdallah
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411119.d0000 0000 8588 831XService de Chirurgie Vasculaire, Hôpital Bichat, APHP.Nord, Paris, France
| | - Jules Gregory
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411599.10000 0000 8595 4540Service de Radiologie, Hôpital Beaujon, APHP.Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France
| | - Lucas Raynaud
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411599.10000 0000 8595 4540Service de Radiologie, Hôpital Beaujon, APHP.Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France
| | - Luisa Paulatto
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411599.10000 0000 8595 4540Service de Radiologie, Hôpital Beaujon, APHP.Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France
| | - Marco Dioguardi Burgio
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411599.10000 0000 8595 4540Service de Radiologie, Hôpital Beaujon, APHP.Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France
| | - Yves Castier
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411119.d0000 0000 8588 831XService de Chirurgie Vasculaire, Hôpital Bichat, APHP.Nord, Paris, France
| | - Yves Panis
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411119.d0000 0000 8588 831XService de Chirurgie Digestive, Hôpital Bichat, APHP.Nord, Paris, France
| | - Valérie Vilgrain
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411599.10000 0000 8595 4540Service de Radiologie, Hôpital Beaujon, APHP.Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France
| | - Olivier Corcos
- grid.411599.10000 0000 8595 4540Intestinal Stroke Center, Service de Gastroenterology, MICI Et Insuffisance Intestinale, Hôpital Beaujon, APHP.Nord, Clichy, France
| | - Maxime Ronot
- grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France ,grid.411599.10000 0000 8595 4540Service de Radiologie, Hôpital Beaujon, APHP.Nord, 100 Blvd du Général Leclerc, 92118 Clichy, France
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Fan W, Lu S, Tan J, Cui X, Liang K, Zhu L, He Q, Yu B, Shi W. Midterm Results of Drug-Coated Balloon Alone or Combined with Rotarex Thrombectomy Device for Treatment of Subacute Femoropopliteal Artery Thrombotic Occlusion. Ann Vasc Surg 2022; 92:240-248. [PMID: 36503024 DOI: 10.1016/j.avsg.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/23/2022] [Accepted: 11/15/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND This retrospective multicenter study aimed to compare the midterm results of the Rotarex rotational thrombectomy device combined with drug-coated balloon (DCB) and DCB-alone for the treatment of subacute femoropopliteal artery thrombotic occlusion. METHODS All patients (74, aged 70.1 ± 9.3 years) were nonrandomized and divided into 2 groups based on treatment strategy between 2018 and 2020. Intraoperative technical success (defined as <30% residual stenosis), dissection types and bailout-stenting rates were assessed. Ankle-brachial index (ABI), primary patency (PP, restenosis <50%) and freedom from clinically driven target lesion reintervention (CD-TLR) were documented at follow-up. RESULTS Among them, 35 patients were treated with the Rotarex catheter combined with DCB while 39 patients underwent DCB-alone. The-overall technical success rate was 100%. Patients in the Rotarex + DCB group showed lower rate of bailout stenting than those in the DCB alone group (22.9% vs. 59.0%; P = 0.01). ABI at discharge was significantly higher in both groups. Mean follow-up time was 18.5 ± 3.4 months; 62 patients completed Doppler ultrasound investigation while 12 patients were censored. According to Kaplan-Meier analysis, the estimated PP was 82.0 ± 6.7% in the Rotarex + DCB group, whereas a significantly lower rate in the DCB alone group (60.9 ± 8.3%, P = 0.04). In addition, the freedom from CD-TLR rate was 82.9 ± 6.4% in the Rotarex + DCB group and 61.5 ± 7.8% in the DCB-alone group (P = 0.04). CONCLUSIONS These initial data indicate that the Rotarex thrombectomy device combined with DCB is an effective choice for the treatment of subacute femoropopliteal artery thrombotic occlusion compared to DCB-alone. The combined procedure had superior midterm results.
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Affiliation(s)
- Weijian Fan
- Department of Vascular Surgery, Huashan Hospital of Fudan University, Shanghai, PR China; Department of Vascular Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, PR China
| | - Shuangshuang Lu
- Department of Radiology, Huashan Hospital of Fudan University, Shanghai, PR China
| | - Jinyun Tan
- Department of Vascular Surgery, Huashan Hospital of Fudan University, Shanghai, PR China; Fudan Zhangjiang Institute, Shanghai, PR China
| | | | - Kun Liang
- Department of Vascular Surgery, Huashan Hospital of Fudan University, Shanghai, PR China
| | - Lei Zhu
- Department of Vascular Surgery, Huashan Hospital of Fudan University, Shanghai, PR China
| | - Qing He
- Department of Vascular Surgery, Huashan Hospital of Fudan University, Shanghai, PR China
| | - Bo Yu
- Department of Vascular Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, PR China; Fudan Zhangjiang Institute, Shanghai, PR China.
| | - Weihao Shi
- Department of Vascular Surgery, Huashan Hospital of Fudan University, Shanghai, PR China.
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10
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Lam A, Kim YJ, Fidelman N, Higgins M, Cash BD, Charalel RA, Guimaraes MS, Kwan SW, Patel PJ, Plett S, Scali ST, Stadtlander KS, Stoner M, Tong R, Kapoor BS. ACR Appropriateness Criteria® Radiologic Management of Mesenteric Ischemia: 2022 Update. J Am Coll Radiol 2022; 19:S433-S444. [PMID: 36436968 DOI: 10.1016/j.jacr.2022.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
Mesenteric ischemia is a serious medical condition characterized by insufficient vascular supply to the small bowel. In the acute setting, endovascular interventions, including embolectomy, transcatheter thrombolysis, and angioplasty with or without stent placement, are recommended as initial therapeutic options. For nonocclusive mesenteric ischemia, transarterial infusion of vasodilators, such as papaverine or prostaglandin E1, is the recommended initial treatment. In the chronic setting, endovascular means of revascularization, including angioplasty and stent placement, are generally recommend, with surgical options, such as bypass or endarterectomy, considered alternative options. Although the diagnosis of median arcuate ligament syndrome remains controversial, diagnostic angiography can be helpful in rendering a diagnosis, with the preferred treatment option being a surgical release. Systemic anticoagulation is recommended as initial therapy for venous mesenteric ischemia with acceptable rates of recanalization. If anticoagulation fails, transcatheter thrombolytic infusion can be considered with possible adjunctive placement of a transjugular intrahepatic portosystemic shunt to augment antegrade flow. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Alexander Lam
- University of California, San Francisco, San Francisco, California.
| | - Yoon-Jin Kim
- Research Author, University of California, San Francisco, San Francisco, California
| | - Nicholas Fidelman
- Panel Chair, University of California, San Francisco, San Francisco, California
| | - Mikhail Higgins
- Panel Vice-Chair, Boston University School of Medicine, Boston, Massachusetts
| | - Brooks D Cash
- Chief of Gastroenterology, Hepatology, and Nutrition Division, University of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association
| | | | - Marcelo S Guimaraes
- Division Chief Pediatric Radiology, Medical University of South Carolina, Charleston, South Carolina
| | | | - Parag J Patel
- Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sara Plett
- Department of Radiology Chair, Sonoran Crossing Medical Center, Southwest Medical Imaging, Scottsdale, Arizona
| | - Salvatore T Scali
- University of Florida, Gainesville, Florida; Society for Vascular Surgery; SVS PSO VQI EVAR Registry Chair
| | | | - Michael Stoner
- Chief, Division of Vascular Surgery, Vice-Chair, Clinical Operations, University of Rochester Medical Center, Rochester, New York; Society for Vascular Surgery
| | - Ricky Tong
- Main Line Health, Bryn Mawr, Pennsylvania; Peer Review Committee
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11
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Tamme K, Reintam Blaser A, Laisaar KT, Mändul M, Kals J, Forbes A, Kiss O, Acosta S, Bjørck M, Starkopf J. Incidence and outcomes of acute mesenteric ischaemia: a systematic review and meta-analysis. BMJ Open 2022; 12:e062846. [PMID: 36283747 PMCID: PMC9608543 DOI: 10.1136/bmjopen-2022-062846] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To estimate the incidence of acute mesenteric ischaemia (AMI), proportions of its different forms and short-term and long-term mortality. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE (Ovid), Web of Science, Scopus and Cochrane Library were searched until 26 July 2022. ELIGIBILITY CRITERIA Studies reporting data on the incidence and outcomes of AMI in adult populations. DATA EXTRACTION AND SYNTHESIS Data extraction and quality assessment with modified Newcastle-Ottawa scale were performed using predeveloped standard forms. The outcomes were the incidence of AMI and its different forms in the general population and in patients admitted to hospital, and the mortality of AMI in its different forms. RESULTS From 3064 records, 335 full texts were reviewed and 163 included in the quantitative analysis. The mean incidence of AMI was 6.2 (95% CI 1.9 to 12.9) per 100 000 person years. On average 5.0 (95% CI 3.3 to 7.1) of 10 000 hospital admissions were due to AMI. Occlusive arterial AMI was the most common form constituting 68.6% (95% CI 63.7 to 73.2) of all AMI cases, with similar proportions of embolism and thrombosis.Overall short-term mortality (in-hospital or within 30 days) of AMI was 59.6% (95% CI 55.5 to 63.6), being 68.7% (95% CI 60.8 to 74.9) in patients treated before the year 2000 and 55.0% (95% CI 45.5 to 64.1) in patients treated from 2000 onwards (p<0.05). The mid/long-term mortality of AMI was 68.2% (95% CI 60.7 to 74.9). Mortality due to mesenteric venous thrombosis was 24.6% (95% CI 17.0 to 32.9) and of non-occlusive mesenteric ischaemia 58.4% (95% CI 48.6 to 67.7). The short-term mortality of revascularised occlusive arterial AMI was 33.9% (95% CI 30.7 to 37.4). CONCLUSIONS In adult patients, AMI is a rarely diagnosed condition with high mortality, although with improvement of treatment results over the last decades. Two thirds of AMI cases are of occlusive arterial origin with potential for better survival if revascularised. PROSPERO REGISTRATION NUMBER CRD42021247148.
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Affiliation(s)
- Kadri Tamme
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Anaesthesiology and Intensive Care Clinic, Tartu University Hospital, Tartu, Estonia
| | - Annika Reintam Blaser
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Department of Intensive Care Medicine, Luzerner Kantonsspital, Luzern, Luzern, Switzerland
| | - Kaja-Triin Laisaar
- Department of Epidemiology and Biostatistics, Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Merli Mändul
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Department of Statistics, Institute of Mathematics and Statistics, University of Tartu, Tartu, Estonia
| | - Jaak Kals
- Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Surgery Clinic, Tartu University Hospital, Tartu, Estonia
| | - Alastair Forbes
- Department of Internal Medicine, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Internal Medicine Clinic, Tartu University Hospital, Tartu, Estonia
| | - Olga Kiss
- Anaesthesiology and Intensive Care Clinic, Tartu University Hospital, Tartu, Estonia
| | - Stefan Acosta
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Martin Bjørck
- Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Joel Starkopf
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Anaesthesiology and Intensive Care Clinic, Tartu University Hospital, Tartu, Estonia
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12
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Yu Z, Wang S, Lang D, Yin X, Lin Z, Hu S, Wang D, Xu Q, Hu J. Percutaneous mechanical thrombectomy in the management of early acute superior mesenteric artery embolism. Vascular 2022:17085381221085150. [PMID: 35420466 DOI: 10.1177/17085381221085150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE This study was performed to summarize our experience in the management of early-stage acute superior mesenteric artery embolism (ASMAE) by percutaneous mechanical thrombectomy (PMT). METHODS The clinical data of 12 patients with early-stage ASMAE treated by PMT in our institution from November 2019 to September 2021 were retrospectively analyzed. The patients had no obvious evidence of bowel infarction as shown by peritoneal puncture and computed tomography angiography. Thrombectomy of the superior mesenteric artery was performed using a 6F AngioJet catheter. RESULTS The emboli were completely removed in 10 (83.3%) patients. Six patients were treated only by the AngioJet device. The other six patients underwent combined treatment with a 6F multipurpose drainage catheter after PMT, including one patient who underwent simultaneous stent implantation. Two patients showed no significant improvement in their symptoms after the operation; one was found to have intestinal necrosis and underwent resection by exploratory laparotomy, and the other died of septic shock 3 days after PMT (further intervention had been discontinued because of complications with multiple underlying diseases). No other PMT-related complications occurred. Only one patient was found to have a pseudoaneurysm of the superior mesenteric artery 1 week after PMT and underwent resection by exploratory laparotomy. The 11 surviving patients were smoothly discharged from the hospital after their symptoms were relieved. At a mean follow-up of 13.2 months, computed tomography angiography showed smooth patency of the superior mesenteric artery. No patients developed serious symptoms during follow-up. CONCLUSIONS PMT by the AngioJet device is a minimally invasive, safe, and effective technique to remove ASMAE. Early application of PMT can avoid acute intestinal necrosis. Combining the AngioJet device with a 6F multipurpose drainage catheter might be more helpful to remove residual emboli.
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Affiliation(s)
- Zuanbiao Yu
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Shuyuan Wang
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Dehai Lang
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Xiaoliang Yin
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Zuodong Lin
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Songjie Hu
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Di Wang
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Qiyang Xu
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Jiangnan Hu
- Department of Pharmaceutical Sciences, 538800University of North Texas Health Science Center, Fort Worth, TX, USA
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13
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Yadong S, Haobo S, Liang C, Hao H, Zhaoxuan L, Jianping G. Endovascular Revascularization as Primary Treatment for Acute Embolic Mesenteric Ischemia: Stent Thrombectomy plus Aspiration versus Aspiration Alone. J Vasc Interv Radiol 2021; 33:295-303. [PMID: 34915163 DOI: 10.1016/j.jvir.2021.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/05/2021] [Accepted: 12/04/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the outcomes of stent thrombectomy combined with aspiration versus aspiration alone in acute mesenteric ischemia (AMI). METHODS This was a single-center, retrospective cohort study. Between 1 May 2012 and 1 January 2021, 41 patients (mean age, 73.8±7.9 years) with AMI who underwent stent thrombectomy plus aspiration (Group 1, n=14) or aspiration alone (Group 2, n=27) were included. Patients' treatment regimens, clinical and follow-up outcomes were reviewed and analyzed. The group differences were compared using a Chi square test, Fisher's exact test, independent t test, or Mann-Whitney U test. The cumulative survival rate was calculated using a Kaplan-Meier curve. RESULTS The overall clinical success rate was 78.0% (32/41), and no significant difference was found between Group 1 and Group 2 (78.6% vs. 77.8%, p = 1.00). Whereas Group 1 was associated with a higher complete clearance rate (78.6% vs. 44.4%, p = 0.04), less adjunctive local thrombolysis (14.3% vs. 48.1%, p = 0.03), and shorter length of hospital stay (5.7±4.7 vs. 10.7±9.0 days, p = 0.03). The estimated survival rate at 1 month, 3 months, 6 months, 1 year, and 2 years was 73.2%, 72.5%, 71.4%, 65.3%, and 59.8%, respectively. No significant difference was found in survival rate between the groups (log-rank, p = 0.96). The recurrence rate for Group 1 and Group 2 were 8.3% (1/12) and 4.0% (1/25), respectively. CONCLUSIONS Compared with aspiration alone, additional stent thrombectomy showed superiorities in higher complete clearance rate, reduced adjunctive thrombolysis, and shorter length of hospital stay.
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Affiliation(s)
- Shi Yadong
- The Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, China
| | - Su Haobo
- The Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, China
| | - Chen Liang
- The Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, China
| | - Huang Hao
- The Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, China
| | - Lu Zhaoxuan
- The Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, China
| | - Gu Jianping
- The Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, China.
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14
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Yu Z, Hu J, Lang D. Pseudoaneurysm as a rare complication in the treatment of superior mesenteric artery embolism via percutaneous mechanical thrombectomy: a case report. J Int Med Res 2021; 49:3000605211022941. [PMID: 34162263 PMCID: PMC8236792 DOI: 10.1177/03000605211022941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Percutaneous mechanical thrombectomy is a safe and effective treatment for addressing thrombosis in various embolic diseases. In recent years, this approach has also been actively applied in the management of acute embolic occlusion of the superior mesenteric artery. A pseudoaneurysm as a complication of this operation is remarkably rare. This is the first case report of the diagnosis and treatment of a pseudoaneurysm that developed as a complication after the application of percutaneous mechanical thrombectomy via an AngioJet device for thrombolysis in the superior mesenteric artery.
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Affiliation(s)
- Zuanbiao Yu
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences; Ningbo Institute of Life and Health Industry, Ningbo, Zhejiang, China
| | - Jiangnan Hu
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Dehai Lang
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences; Ningbo Institute of Life and Health Industry, Ningbo, Zhejiang, China
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15
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Hou L, Wang T, Wang J, Zhao J, Yuan D. Outcomes of different acute mesenteric ischemia therapies in the last 20 years: A meta-analysis and systematic review. Vascular 2021; 30:669-680. [PMID: 34154466 DOI: 10.1177/17085381211024503] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Acute mesenteric ischemia is a disease with high morbidity and mortality, and it is traditionally treated with open surgery. Endovascular therapy and hybrid techniques are alternative treatments that are also currently available. We performed a meta-analysis to evaluate the outcomes of the different treatment approaches in the last 20 years. METHODS Studies on acute mesenteric ischemia that were indexed in PubMed, Embase, and MEDLINE databases (from January 1, 2000, to April 1, 2021) were reviewed. All related retrospective observational studies and case series were included. A random-effects model was used to calculate pooled estimates, and the results were reported as proportions and 95% confidence intervals (CIs). RESULTS In our study, a total of 2369 patients (in 39 studies) underwent endovascular, open surgery, or retrograde open mesenteric stenting. The pooled mortality estimates for open surgery, endovascular therapy, and retrograde open mesenteric stenting were 40% (95% CI, 0.33-0.47; I2 = 84%), 26% (95% CI, 0.19-0.33; I2 = 33%), and 32% (95% CI, 0.21-0.44; I2 = 26%), respectively. CONCLUSIONS The mortality associated with open surgical treatment, endovascular therapy, and retrograde open mesenteric stenting tend to be similar in the last 20 years.
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Affiliation(s)
- Li Hou
- West China School of Medicine, West China Hospital, 12530Sichuan University, Chengdu, China.,Department of Vascular Surgery, West China Hospital, 12530Sichuan University, Chengdu, China
| | - Tiehao Wang
- Department of Vascular Surgery, West China Hospital, 12530Sichuan University, Chengdu, China
| | - Jiarong Wang
- Department of Vascular Surgery, West China Hospital, 12530Sichuan University, Chengdu, China
| | - Jichun Zhao
- Department of Vascular Surgery, West China Hospital, 12530Sichuan University, Chengdu, China
| | - Ding Yuan
- Department of Vascular Surgery, West China Hospital, 12530Sichuan University, Chengdu, China
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16
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Acute Pancreatitis: A Rare Complication After Percutaneous Mechanical Thrombectomy of Portal Vein Thrombosis. Ann Vasc Surg 2020; 72:663.e5-663.e8. [PMID: 33227464 DOI: 10.1016/j.avsg.2020.09.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/15/2020] [Accepted: 09/28/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Acute pancreatitis caused by Percutaneous Mechanical Thrombectomy treatment is extremely rare, and so far, no clinical report involving portal veins has been reported. In the article, we summarize this unusual case and share our experience. METHODS Percutaneous mechanical thrombectomy was performed for the patient who was diagnosed with portal vein thrombosis. Postoperatively, the patient was complicated by acute pancreatitis and received a series of medical treatments. RESULTS During the first month of follow-up, the patient was free of any clinical symptoms or signs. CONCLUSIONS When performing percutaneous mechanical thrombectomy therapy, it is crucial to grasp the time limit strictly, strengthen perioperative rehydration and urine alkalinization to prevent massive hemolysis and subsequent complications. Early detection and the early administration of therapy for this potentially severe complication are essential for obtaining a good prognosis.
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17
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Loffroy R, Edriss N, Goyault G, Chabanier A, Pernes JM, Sauguet A, Touil M, Woerly B, Pongas D, Chevallier O, Falvo N, Galland C, Midulla M, Garnier N, Guenfoudi MP, Boulin M, Aho-Gléglé S, Bost S. Percutaneous mechanical atherothrombectomy using the Rotarex ®S device in peripheral artery in-stent restenosis or occlusion: a French retrospective multicenter study on 128 patients. Quant Imaging Med Surg 2020; 10:283-293. [PMID: 31956549 DOI: 10.21037/qims.2019.11.15] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background To ascertain the safety and mid-term outcomes of Rotarex®S rotational atherectomy plus thrombectomy device (Straub Medical AG, Wangs, Switzerland) with or without adjunctive treatment (e.g., percutaneous transluminal angioplasty, PTA/drug-coated balloon, DCB/stenting) in patients with in-stent restenosis (ISR) or occlusion in the iliac and/or infrainguinal arteries. Methods French multicenter retrospective study of all patients treated by in-stent percutaneous mechanical debulking (PMD) of the lower limbs with Rotarex®S device between January 2013 and November 2018. Results The cohort consisted of 128 patients (88 men and 40 women), aged 39-94 years (mean, 66.7±12 years). All patients presented with cardio-vascular risk factors. Overall, 51.5% of patients had critical limb ischemia. The study demonstrated a technical success of 96.9% in the population with PMD and adjunctive PTA (95/128, 74.2%) or adjunctive DCB (16/128, 12.5%) or both (13/128, 10.2%). At 12-months follow-up, the primary clinical success/patency rate was 92.3% and the secondary clinical success/patency rate was 91.4%. Rate of limb salvage was 93.7%. Overall 32 (25%) reinterventions were reported with mean time from Rotarex®S treatment to reintervention of 7.1±8.2 months. Target lesion revascularization (TLR) was 19.5% (25/128). Seven (5.5%) patients developed distal embolism that responded to endovascular treatment. At mean follow-up, major adverse events (MAE) observed were death (18/128, 14.1%), myocardial infarction (MI) (9/128, 7.0%), stroke (2/128, 1.6%) and renal failure (3/128, 2.3%). Conclusions Recanalization with Rotarex®S rotational atherectomy plus thrombectomy device is a practical choice for arterial ISR/occlusions of the iliac and/or infrainguinal arteries, regardless of the age of the thrombus, with satisfying TLR. Only adjunctive PTA is often necessary to further improve the recanalization.
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Affiliation(s)
- Romaric Loffroy
- Department of Vascular and Interventional Radiology, Centre Hospitalier Universitaire François-Mitterrand, Dijon, France
| | - Nizam Edriss
- Department of Vascular Surgery, Centre Hospitalier Artois-Ternois, Arras, France
| | - Gilles Goyault
- Department of Vascular and Interventional Radiology, Clinique de l'Orangerie, Strasbourg, France
| | - Alain Chabanier
- Department of Interventional Cardiology, Centre Hospitalier de la Côte Basque, Bayonne, France
| | - Jean-Marc Pernes
- Department of Interventional Radiology and Cardiology, Hôpital Privé d'Antony, Paris, France
| | - Antoine Sauguet
- Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France
| | - Mehdi Touil
- Department of Vascular Surgery, Centre Hospitalier Artois-Ternois, Arras, France
| | - Bernard Woerly
- Department of Vascular and Interventional Radiology, Clinique de l'Orangerie, Strasbourg, France
| | - Dionyssios Pongas
- Department of Interventional Radiology and Cardiology, Hôpital Privé d'Antony, Paris, France
| | - Olivier Chevallier
- Department of Vascular and Interventional Radiology, Centre Hospitalier Universitaire François-Mitterrand, Dijon, France
| | - Nicolas Falvo
- Department of Vascular and Interventional Radiology, Centre Hospitalier Universitaire François-Mitterrand, Dijon, France
| | - Christophe Galland
- Department of Vascular and Interventional Radiology, Centre Hospitalier Universitaire François-Mitterrand, Dijon, France
| | - Marco Midulla
- Department of Vascular and Interventional Radiology, Centre Hospitalier Universitaire François-Mitterrand, Dijon, France
| | - Nathalie Garnier
- Department of Pharmacy, Statistics and Clinical Research, Centre Hospitalier Universitaire François-Mitterrand, Dijon, France
| | - Marie-Pierre Guenfoudi
- Department of Pharmacy, Statistics and Clinical Research, Centre Hospitalier Universitaire François-Mitterrand, Dijon, France
| | - Mathieu Boulin
- Department of Pharmacy, Statistics and Clinical Research, Centre Hospitalier Universitaire François-Mitterrand, Dijon, France
| | - Serge Aho-Gléglé
- Department of Epidemiology, Statistics and Clinical Research, Centre Hospitalier Universitaire François-Mitterrand, Dijon, France
| | - Stéphanie Bost
- Department of Pharmacy, Statistics and Clinical Research, Centre Hospitalier Universitaire François-Mitterrand, Dijon, France
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18
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Zhang Z, Chen X, Li C, Feng H, Yu H, Zhu R. Percutaneous Mechanical Thrombectomy for Acute Superior Mesenteric Artery Embolism: Preliminary Experience in Five Cases. Ann Vasc Surg 2019; 63:186-192. [PMID: 31629130 DOI: 10.1016/j.avsg.2019.08.096] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/08/2019] [Accepted: 08/20/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND This study was performed to summarize our experience in treating acute superior mesenteric artery embolism (SMAE) by percutaneous mechanical thrombectomy (PMT). METHODS The clinical data of five patients with acute SMAE treated by PMT in our center from October 2015 to May 2018 were retrospectively analyzed. PMT was performed under local anesthesia. Access was established via the femoral artery or brachial artery. Thrombectomy was performed on the superior mesenteric artery using a 6F Rotarex catheter (Straub Medical, Wangs, Switzerland). RESULTS Technical success of PMT was achieved in all five patients; emboli were completely removed in three patients and partially removed in two patients. No PMT-related complications were noted after surgery. Four patients were smoothly discharged from the hospital after their symptoms were relieved. One patient still had symptoms of intestinal ischemia after the operation, and massive small intestinal necrosis was found by exploratory laparotomy. Intestinal resection was performed, and the patient died 4 months later. CONCLUSIONS PMT by the Rotarex system is a minimally invasive, safe, and effective technique in removing SMAE. Early application of PMT can avoid intestinal necrosis.
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Affiliation(s)
- Zhe Zhang
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Xueming Chen
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Chenyu Li
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hai Feng
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hongzhi Yu
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Renming Zhu
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Prakash VS, Marin M, Faries PL. Acute and Chronic Ischemic Disorders of the Small Bowel. Curr Gastroenterol Rep 2019; 21:27. [PMID: 31065817 DOI: 10.1007/s11894-019-0694-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Ischemic disorders of the small bowel represent a rare but highly morbid disease process which is often difficult to diagnose and has a complex management course involving multidisciplinary care. Given recent advances in radiologic modalities and surgical/endovascular techniques, this review seeks to provide a disease overview as well as a summary of emerging management strategies. RECENT FINDINGS In cases of acute mesenteric ischemia without evidence of frank bowel necrosis, an endovascular-first strategy employing thrombolysis, pharmacomechanical thrombectomy, and/or adjunctive angioplasty/stenting has been shown to have positive outcomes. In cases requiring open laparotomy, retrograde open mesenteric stenting may facilitate less dissection and more straightforward revascularization. While endovascular intervention for chronic mesenteric ischemia was historically limited by high rates of restenosis, use of covered stents in these vascular beds has been shown to have excellent patency rates. Ischemia of the small bowel can be acute or chronic in nature-endovascular treatment modalities have been shown to have excellent results given appropriate patient selection and should be an important tool in the armamentarium of management options for this complex disease process.
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Affiliation(s)
- Vivek S Prakash
- Division of Vascular Surgery, Department of Surgery, The Mount Sinai Hospital, New York, NY, USA
| | - Michael Marin
- Division of Vascular Surgery, Department of Surgery, The Mount Sinai Hospital, New York, NY, USA
| | - Peter L Faries
- Division of Vascular Surgery, Department of Surgery, The Mount Sinai Hospital, New York, NY, USA.
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Liu YR, Tong Z, Hou CB, Cui SJ, Guo LR, Qi YX, Qi LX, Guo JM, Gu YQ. Aspiration therapy for acute embolic occlusion of the superior mesenteric artery. World J Gastroenterol 2019; 25:848-858. [PMID: 30809084 PMCID: PMC6385017 DOI: 10.3748/wjg.v25.i7.848] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 01/20/2019] [Accepted: 01/26/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Embolic superior mesenteric artery (SMA) occlusion is associated with high mortality rates. Delayed treatment often leads to serious consequences, including intestinal necrosis, resection, and even patient death. Endovascular repair is being introduced, which can improve clinical symptoms and prognosis and decrease the incidence of exploratory laparotomy. Many reports have described successful endovascular revascularization of embolic SMA occlusion. However, most of those reports are case reports, and there are few reports on Chinese patients. In this paper, we describe the technical and clinical outcomes of aspiration therapy using a guiding catheter and long sheath technique which facilitates the endovascular repair procedure.
AIM To evaluate the complications, feasibility, effectiveness, and safety of endovascular treatment for the acute embolic occlusion of the SMA.
METHODS This retrospective study reviewed eight patients (six males and two females) from August 2013 to October 2018 at Xuanwu Hospital, Capital Medical University. The patients presented with acute embolic occlusion of the SMA on admission and were initially diagnosed by computed tomography angiography (CTA). The patients who underwent endovascular treatment with a guiding catheter had no obvious evidence of bowel infarct. No intestinal necrosis was identified by gastrointestinal surgeons through peritoneal puncture or CTA. The complications, feasibility, effectiveness, safety, and mortality were assessed.
RESULTS Six (75%) patients were male, and the mean patient age was 70.00 ± 8.43 years (range, 60-84 years). The acute embolic occlusion of the SMA was initially diagnosed by CTA. All patients had undertaken anticoagulation primarily, and percutaneous aspiration using a guiding catheter was then undertaken because the emboli had large amounts of thrombus residue. No death occurred among the patients. Complete patency of the suffering artery trunk was achieved in six patients, and defect filling was accomplished in two patients. The in-hospital mortality was 0%. The overall 12-mo survival rate was 100%. All patients survived, and two of the eight patients had complications (the clot broke off during aspiration).
CONCLUSION Aspiration therapy is feasible, safe, and beneficial for acute embolic SMA occlusion. Aspiration therapy has many benefits for reducing patients’ death, resolving thrombi, and improving symptoms.
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Affiliation(s)
- Yi-Ren Liu
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Zhu Tong
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Cheng-Bei Hou
- Center of Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Shi-Jun Cui
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Lian-Rui Guo
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yi-Xia Qi
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Li-Xing Qi
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Jian-Ming Guo
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yong-Quan Gu
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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Mechanical Thrombectomy Using the Solitaire AB Device for Acute Embolic Mesenteric Ischemia. J Vasc Interv Radiol 2019; 30:43-48. [DOI: 10.1016/j.jvir.2018.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/07/2018] [Accepted: 08/05/2018] [Indexed: 12/24/2022] Open
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