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Ohira G, Hayano K, Tochigi T, Maruyama T, Toyozumi T, Kurata Y, Maruyama M, Arai S, Nakada TA, Matsubara H. Treatment outcomes in non-occlusive mesenteric ischemia and post-treatment return to social activities. Surg Today 2024:10.1007/s00595-024-02909-8. [PMID: 39088065 DOI: 10.1007/s00595-024-02909-8] [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: 04/18/2024] [Accepted: 07/15/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE To investigate the treatment outcomes of patients with non-occlusive mesenteric ischemia (NOMI) at our institution, we focused on their post-treatment return to social activities. METHODS This study included patients with suspected NOMI who were referred to our department between 2011 and 2023. In-hospital mortality was also investigated as a prognostic factor. The Glasgow-Pittsburgh Outcome Categories (GPOC) score was used to evaluate the return to social activities. The relationship between in-hospital mortality and GPOC scores and patient background and treatment factors was examined. RESULTS Eighty-two patients were included in the study. Among them, 54 (65.9%) died during hospitalization. Only 9 patients (11%) returned to their social activities. In the multivariate analysis, non-surgical management was found to be the only independent factor for in-hospital mortality. Positive portal venous gas on computed tomography, no open abdomen, no pre-onset catecholamine administration, platelet count < 100,000/µL, lactate level < 5 mmol/L, APTT < 46 s, and Sequential Organ Failure Assessment score < 11 were factors significantly associated with an increased likelihood of return to social activities. CONCLUSION This is the first study to assess the post-treatment return to social activities among patients with NOMI. Our findings highlight the concerning reality that survivors may face prolonged dependence on medical care.
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Affiliation(s)
- Gaku Ohira
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuuou-Ku, Chiba, 260-8670, Japan.
| | - Koichi Hayano
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuuou-Ku, Chiba, 260-8670, Japan
| | - Toru Tochigi
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuuou-Ku, Chiba, 260-8670, Japan
| | - Tetsuro Maruyama
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuuou-Ku, Chiba, 260-8670, Japan
| | - Takeshi Toyozumi
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuuou-Ku, Chiba, 260-8670, Japan
| | - Yoshihiro Kurata
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuuou-Ku, Chiba, 260-8670, Japan
| | - Michihiro Maruyama
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuuou-Ku, Chiba, 260-8670, Japan
| | - Satoko Arai
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuuou-Ku, Chiba, 260-8670, Japan
| | - Taka-Aki Nakada
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuuou-Ku, Chiba, 260-8670, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuuou-Ku, Chiba, 260-8670, Japan
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Duivenvoorden AAM, Metz FM, Wijenbergh R, Verberght HCR, van Bijnen AAJHM, Olde Damink SWM, Geelkerken RH, Lenaerts K, Lubbers T. Intestinal Fatty Acid Binding Protein as a Predictor of Early Mesenteric Injury Preceding Clinical Presentation: A Case Report. EJVES Vasc Forum 2024; 61:136-140. [PMID: 38884076 PMCID: PMC11176664 DOI: 10.1016/j.ejvsvf.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 04/01/2024] [Accepted: 04/23/2024] [Indexed: 06/18/2024] Open
Abstract
Introduction Diagnosing non-occlusive mesenteric ischaemia (NOMI) in patients is complicated, due to poor signs and symptoms and non-specific laboratory tests, leading to a high mortality rate. This case study presents the rare case of a patient who developed mesenteric ischaemia after an emergency thoracic endovascular aneurysm repair (TEVAR) for a type B aortic dissection (TBAD) and peri-operative cardiogenic shock. Study outcomes revealed that intestinal fatty acid binding protein (I-FABP) identified early mucosal damage two days before the clinical presentation. Report A 43 year old male patient was admitted to the emergency department with an acute TBAD and a dissection of the superior mesenteric artery (SMA), for which TEVAR was performed with additional stent placement in the SMA. Peri-operatively, the patient went into cardiogenic shock with a sustained period of hypotension. Post-operatively, the plasma I-FABP levels were measured prospectively, revealing an initial increase on post-operative day five (551.1 pg/mL), which continued beyond day six (610.3 pg/mL). On post-operative day seven, the patient developed a fever and demonstrated signs of peritonitis and bowel perforation. He underwent an emergency laparotomy, followed by an ileocaecal resection (<100 cm) with a transverse ileostomy. Pathological analysis confirmed the diagnosis of mesenteric ischaemia. Discussion The diagnosis of NOMI in critically ill patients is often complicated, and the currently available diagnostic markers lack the specificity and sensitivity to detect early intestinal injury. This case report highlights that elevated I-FABP in plasma levels may indicate the presence of early mesenteric injury. Further research needs to be conducted before I-FABP can be applied in daily practice.
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Affiliation(s)
- Annet A M Duivenvoorden
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Flores M Metz
- Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands
- Dutch Expert Centre for Gastrointestinal Ischaemia, Enschede, the Netherlands
| | - Robin Wijenbergh
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Hanne C R Verberght
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Annemarie A J H M van Bijnen
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Steven W M Olde Damink
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Robert H Geelkerken
- Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands
- Dutch Expert Centre for Gastrointestinal Ischaemia, Enschede, the Netherlands
| | - Kaatje Lenaerts
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Tim Lubbers
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands
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3
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Schwarzova K, Damle S, Sellke FW, Robich MP. Gastrointestinal complications after cardiac surgery. Trauma Surg Acute Care Open 2024; 9:e001324. [PMID: 38616788 PMCID: PMC11015217 DOI: 10.1136/tsaco-2023-001324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/09/2024] [Indexed: 04/16/2024] Open
Abstract
Gastrointestinal complications after cardiac surgery are relatively rare entities but carry a high mortality. We identified over 70 articles written since 2010 using the PubMed database. We included 40 in our review. The most common complications include paralytic ileus, gastrointestinal bleeding, and bowel ischemia. Patients who undergo cardiac procedures are at risk for poor perfusion of the gastrointestinal tract and, thus, at risk for resulting complications. Risk factors for these complications include peri-operative use of vasopressors, prolonged operative time, and the time of cardiopulmonary bypass. Presentation of gastrointestinal complications tends to differ as patients after open heart surgery can remain intubated, and exams can be limited. Early recognition and aggressive therapy are paramount. We aim to provide a review that will help the reader get familiar with the most common gastrointestinal complications that can negatively affect outcomes after cardiac surgery.
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Affiliation(s)
- Klara Schwarzova
- Department of Surgery, Ascension Saint Agnes Hospital, Baltimore, Maryland, USA
| | - Sameer Damle
- Department of Surgery, Ascension Saint Agnes Hospital, Baltimore, Maryland, USA
| | - Frank William Sellke
- Department of Cardiac Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Michael Phillip Robich
- Department of Cardiac Surgery, Johns Hopkins Medical Institutions Campus, Baltimore, Maryland, USA
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Sun YT, Wu W, Yao YT. The association of vasoactive-inotropic score and surgical patients' outcomes: a systematic review and meta-analysis. Syst Rev 2024; 13:20. [PMID: 38184601 PMCID: PMC10770946 DOI: 10.1186/s13643-023-02403-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/30/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND The objective of this study is to conduct a systematic review and meta-analysis examining the relationship between the vasoactive-inotropic score (VIS) and patient outcomes in surgical settings. METHODS Two independent reviewers searched PubMed, Web of Science, EMBASE, Scopus, Cochrane Library, Google Scholar, and CNKI databases from November 2010, when the VIS was first published, to December 2022. Additional studies were identified through hand-searching the reference lists of included studies. Eligible studies were those published in English that evaluated the association between the VIS and short- or long-term patient outcomes in both pediatric and adult surgical patients. Meta-analysis was performed using RevMan Manager version 5.3, and quality assessment followed the Joanna Briggs Institute (JBI) Critical Appraisal Checklists. RESULTS A total of 58 studies comprising 29,920 patients were included in the systematic review, 34 of which were eligible for meta-analysis. Early postoperative VIS was found to be associated with prolonged mechanical ventilation (OR 5.20, 95% CI 3.78-7.16), mortality (OR 1.08, 95% CI 1.05-1.12), acute kidney injury (AKI) (OR 1.26, 95% CI 1.13-1.41), poor outcomes (OR 1.02, 95% CI 1.01-1.04), and length of stay (LOS) in the ICU (OR 3.50, 95% CI 2.25-5.44). The optimal cutoff value for the VIS as an outcome predictor varied between studies, ranging from 10 to 30. CONCLUSION Elevated early postoperative VIS is associated with various adverse outcomes, including acute kidney injury (AKI), mechanical ventilation duration, mortality, poor outcomes, and length of stay (LOS) in the ICU. Monitoring the VIS upon return to the Intensive Care Unit (ICU) could assist medical teams in risk stratification, targeted interventions, and parent counseling. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022359100.
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Affiliation(s)
- Yan-Ting Sun
- Department of Anesthesiology, Baoji High-Tech Hospital, Shaanxi, 721000, China
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100037, China
| | - Wei Wu
- Department of Anesthesiology, Baoji High-Tech Hospital, Shaanxi, 721000, China
| | - Yun-Tai Yao
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100037, China.
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Schaab F. Nichtokklusive mesenteriale Ischämie. COLOPROCTOLOGY 2023. [DOI: 10.1007/s00053-023-00692-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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Umemoto K, Kato K, Yamabuki T, Takada M, Ambo Y, Nakamura F, Hirano S. The preoperative SOFA score and remnant small intestine length are postoperative risk factors for mortality in patients with non-occlusive mesenteric ischemia: a case-control study. Acute Med Surg 2023; 10:e821. [PMID: 36844676 PMCID: PMC9949515 DOI: 10.1002/ams2.821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 01/18/2023] [Indexed: 02/25/2023] Open
Abstract
Aim Non-occlusive mesenteric ischemia (NOMI) is a fatal condition with a low survival rate in most cases. The risk factors for perioperative mortality in NOMI cases are unclear. The purpose of this study was to define the risk factors for mortality in patients with NOMI undergoing surgery. Methods Thirty-eight consecutive patients who underwent surgery for NOMI at Teine Keijinkai Hospital between 2012 and 2020 were included in the study. Patient information, including age, sex, physical findings, comorbidities, laboratory data, and computed tomography and surgical findings were retrospectively analyzed. Results Of the 38 patients, 18 (47%) died before discharge. Significant univariate predictors of mortality were a high Sequential Organ Failure Assessment (SOFA) score, high lactate level, low blood pH, and short intestinal length after surgery. In the multivariate analysis, a high SOFA score (odds ratio 1.33, P = 0.036) and short intestine length after surgery (odds ratio 34.7, P = 0.003) were identified as independent risk factors for perioperative mortality. Conclusion The preoperative SOFA score and postoperative residual intestinal length may be predictors of death in NOMI surgical patients, not age and the content of comorbidities.
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Affiliation(s)
- Kazufumi Umemoto
- Department of SurgeryTeine Keijinkai HospitalSapporoJapan
- Division of Surgery, Department of Gastroenterological Surgery IIHokkaido University Faculty of MedicineSapporoJapan
| | - Kentaro Kato
- Department of SurgeryTeine Keijinkai HospitalSapporoJapan
| | | | - Minoru Takada
- Department of SurgeryTeine Keijinkai HospitalSapporoJapan
| | - Yoshiyasu Ambo
- Department of SurgeryTeine Keijinkai HospitalSapporoJapan
| | | | - Satoshi Hirano
- Division of Surgery, Department of Gastroenterological Surgery IIHokkaido University Faculty of MedicineSapporoJapan
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Konan A, Piton G, Ronot M, Hassoun Y, Winiszewski H, Besch G, Doussot A, Delabrousse E, Calame P. Abdominal atherosclerosis is not a risk factor of nonocclusive mesenteric ischemia among critically ill patients: a propensity matching study. Ann Intensive Care 2022; 12:117. [PMID: 36565393 DOI: 10.1186/s13613-022-01096-4] [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: 09/09/2022] [Accepted: 12/13/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Although risk factors of occlusive acute mesenteric ischemia are well known, triggering factors of nonocclusive mesenteric ischemia (NOMI) remain unclear. Alongside to the known risk factors for NOMI, the role of atherosclerosis is not fully elucidated. The purpose of our study was to evaluate whether abdominal atherosclerosis is a risk factor for NOMI. METHODS From January 2018 to December 2021, all consecutive patients admitted to the intensive care unit who underwent contrast-enhanced CT for suspicion of NOMI were evaluated for inclusion. Clinical and biological data at the time of the CT scan were retrospectively extracted from medical charts and reviewed by a single radiologist. The cohorts were matched by a 1:1 propensity score based on the patient clinical, biological data, and abdominal CT features associated with NOMI. Noncontrast CT acquisitions were used to calculate calcium scores of the abdominal aorta, celiac trunk, superior mesenteric artery (SMA), and common iliac artery according to the Agatston method. Analyses were performed before and after propensity score matching. RESULTS Among the 165 critically ill patients included, 59 (36%) had NOMI. Before matching analysis, the SMA and total abdominal Agatston calcium scores were not different between patients without and with NOMI (52.00 [IQR = 0, 473] vs. 137.00 [IQR = 0, 259], P = 0.857, respectively, and 7253 [IQR = 1220, 21738] versus 5802 [IQR = 2075, 15,084]; P = 0.723). The results were similar after matching 38 patients with NOMI and 38 without: 153 [IQR = 0, 665] versus 85 [IQR = 0, 240] (P = 0.312) for the SMA calcium score, and 7915 [IQR = 1812, 21561] versus 4139 [IQR = 1440, 9858] (P = 0.170) for the total abdominal Agatston calcium score. CONCLUSION Our results suggest that atherosclerosis is not a risk factor for NOMI in critically ill patients.
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Affiliation(s)
- Anhum Konan
- Department of Radiology, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France.,Department of Radiology, Yopougon University Hospital, 21 BP 632, Abidjan, Côte d'Ivoire
| | - Gael Piton
- Medical Intensive Care Unit, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France
| | - Maxime Ronot
- Department of Radiology, University Hospitals Paris Nord Val-de-Seine, AP-HP, Beaujon, 92110, Clichy, France
| | - Youness Hassoun
- Department of Radiology, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France
| | - Hadrien Winiszewski
- Medical Intensive Care Unit, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France
| | - Guillaume Besch
- Surgical Intensive Care Unit, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France
| | - Alexandre Doussot
- Department of Digestive Surgery, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France
| | - Eric Delabrousse
- Department of Radiology, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France.,EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Franche-Comté, Besançon, France
| | - Paul Calame
- Department of Radiology, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France. .,EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Franche-Comté, Besançon, France. .,Service de Radiologie, CHRU Besançon, Hôpital Jean Minjoz, 3 Boulevard Fleming, 25030, Besançon, France.
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8
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Yu B, Ko RE, Yoo K, Gil E, Choi KJ, Park CM. Non-occlusive mesenteric ischemia in critically ill patients. PLoS One 2022; 17:e0279196. [PMID: 36534676 PMCID: PMC9762570 DOI: 10.1371/journal.pone.0279196] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Non-occlusive mesenteric ischemia (NOMI) is a life-threatening acute condition that has an overall in-hospital mortality rate of up to 75%. Critically ill patients are often admitted to intensive care units (ICUs) due to shock, and these patients are frequently at risk of developing NOMI. The objective of this study was to determine the clinical features of critically ill patients with NOMI and evaluate the risk factors for in-hospital mortality among these patients. METHODS We reviewed the electronic medical records of 7,346 patients who underwent abdominal contrast-enhanced computed tomography during their ICU stay at Samsung Medical Center (Seoul, Korea) between January 1, 2010 and December 31, 2019. After reviewing each patient's computed tomography (CT) scans, 60 patients were diagnosed with NOMI and included in this analysis. The patients were divided into survivor (n = 23) and non-survivor (n = 37) groups according to the in-hospital mortality. RESULTS The overall sequential organ failure assessment (SOFA) score for the included patients upon admission to the ICU was 8.6 ± 3.1, and medical ICU admissions were most common (66.7%) among the patients. The SOFA score upon admission to the ICU was higher for the non-survivors than for the survivors (9.4 vs. 7.4; p = 0.017). Non-survivors were more often observed in the medical ICU admissions (39.1% vs. 83.8%) than in the surgical ICU admissions (47.8% vs. 10.8%) or the cardiac ICU admissions (13.0% vs. 5.4%). Laboratory test results, abdominal CT findings, and the use of vasopressors and inotropes did not differ between the two groups. In a multivariable analysis, SOFA scores >8 upon admission to the ICU (odds ratio [OR] 4.51; 95% 1.12-18.13; p = 0.034), patients admitted to the ICU with medical problems (OR 7.99; 95% 1.73-36.94; p = 0.008), and abdominal pain (OR 4.26; 95% 1.05-17.35; p = 0.043) were significant prognostic predictors for in-hospital mortality. CONCLUSIONS The SOFA score >8 upon admission to the ICU, admission to the ICU for medical problems, and abdominal pain at diagnosis are associated with increased mortality among patients with NOMI.
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Affiliation(s)
- Byunghyuk Yu
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Intensive Care Unit, Kyungpook National University Chilgok Hospital, Daegu, Korea
- School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ryoung-Eun Ko
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keesang Yoo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eunmi Gil
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung-Jin Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail: (KJC); (CMP)
| | - Chi-Min Park
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail: (KJC); (CMP)
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Ishiyama Y, Harada T, Amiki M, Ito S. Safety and effectiveness of indocyanine green fluorescence imaging for evaluating non-occlusive mesenteric ischemia. Asian J Surg 2022; 45:2331-2333. [PMID: 35725794 DOI: 10.1016/j.asjsur.2022.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 05/06/2022] [Indexed: 11/26/2022] Open
Affiliation(s)
| | | | - Manabu Amiki
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Shingo Ito
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
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Kayali F, Sarodaya V, Shah HI, Hayat MY, Leung MST, Harky A. Predicting outcomes of mesenteric ischemia postcardiac surgery: A systematic review. J Card Surg 2022; 37:2025-2039. [PMID: 35488799 DOI: 10.1111/jocs.16516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 03/12/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This systematic review aims to identify predictors of outcomes of mesenteric ischemia in patients following cardiac surgery. METHODS A comprehensive literature search was done on EMBASE, PubMed, Ovid MEDLINE, and SCOPUS using keywords relating to bowel ischemia and cardiac surgery. Database search results were screened by at least two authors and 32 articles were selected for inclusion in this review. RESULTS Data on 1907 patients were analyzed. The mean age was 70.0 ± 2.99 years and the prevalence of bowel ischemia was 1.74%. Advanced age was a significant risk factor. 63.16% of patients reported were men, and 58.4% of patients died in hospital. There was heterogeneity in the reported significance of the following preoperative risk factors: hypertension, smoking status, type 2 diabetes mellitus, end-stage renal disease, preoperative left ventricular ejection fraction <35%. Cardiopulmonary bypass (CPB) time, preoperative/operative intra-aortic balloon pump (IABP) support, and inotrope usage were significantly associated with the development of mesenteric ischemia; however, other intraoperative factors including the type of cardiac surgery and duration of aortic cross-clamping had varying levels of reported significance. There were discrepancies in the reported significance of leukocytosis and metabolic acidosis (pH <7.3) as postoperative markers. Postoperative vasopressor use, prolonged ventilation time, and elevation in lactate, transaminases, creatinine, and intestinal fatty acid-binding protein (IFABP) levels were found to be strongly associated with bowel ischemia. CONCLUSION This systematic review found the strongest associations of mesenteric ischemia postcardiac surgery to be advanced age, CPB time, rise in lactate, transaminases, creatinine, and IFABP. IABP support, vasopressor, and inotrope use as well as prolonged ventilation were strongly linked too.
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Affiliation(s)
- Fatima Kayali
- UCLan Medical School, University of Central Lancashire, Preston, UK
| | - Varun Sarodaya
- Department of Critical Care Medicine, Barts Health NHS Trust, London, UK
| | - Hussain I Shah
- UCL Medical School, University College London, London, UK
| | - Muhammad Y Hayat
- Faculty of Medicine, St George's Hospital Medical School, London, UK
| | - Marco S T Leung
- Department of Surgery, Imperial Healthcare Trust, London, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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11
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Association of Serum Creatinine Level with Prognosis of Laparotomy for Acute Mesenteric Ischemia after Cardiovascular Surgery. Surg Res Pract 2022; 2022:1737161. [PMID: 35386950 PMCID: PMC8979745 DOI: 10.1155/2022/1737161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/14/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Acute mesenteric ischemia is a life-threatening complication after cardiovascular surgery with a mortality rate of 52.9–81.3%. However, few studies have evaluated the predictors of clinical outcome after treatment for acute mesenteric ischemia following cardiovascular surgery. Therefore, this study aimed to elucidate prognostic factors in patients who underwent laparotomy for acute mesenteric ischemia after cardiovascular surgery. Methods We retrospectively analyzed 29 patients (20 men and 9 women; median age, 71.0 years) who underwent laparotomy for acute mesenteric ischemia after cardiovascular surgery between January 2010 and August 2020. These patients were classified into the survivor group (comprising patients who were discharged or referred to another hospital, n = 16) and the nonsurvivor group (comprising those who experienced in-hospital mortality, n = 13). We compared clinical parameters between the groups to identify the predictors of outcomes. Results More patients in the nonsurvivor group underwent emergency cardiovascular surgery (62.5% vs. 100%, p = 0.017) and received hemodialysis (12.5% vs. 61.5%, p = 0.008) at the onset of acute mesenteric ischemia than those in the survivor group. The prelaparotomy serum creatinine level was higher in the nonsurvivor group than in the survivor group (1.27 vs. 2.33 mg/dL, p = 0.004). Logistic regression analysis revealed an association between preoperative serum creatinine level and in-hospital mortality (odds ratio 5.047, p = 0.046), and Cox regression analysis demonstrated a relationship between serum creatinine level and in-hospital mortality (hazard ratio 1.610, p = 0.009). The area under the curve (receiver operating characteristic analysis) for the serum creatinine level was 0.813. Furthermore, the optimal cutoff value of the serum creatinine level was 1.59 mg/dL with a sensitivity and specificity of 0.846 and 0.687, respectively, in predicting in-hospital mortality. Conclusions The elevated serum creatinine level was associated with a poor clinical outcome after surgery for acute mesenteric ischemia following cardiovascular surgery.
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12
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6535923. [DOI: 10.1093/ejcts/ezac096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/13/2022] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
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13
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Borioni R, Garofalo M, Turani F, Weltert LP, Paciotti C, Bellisario A, DE Paulis R. Kinetics of serum procalcitonin in patients with acute mesenteric ischemia and bowel infarction after cardiac surgery. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 63:202-207. [PMID: 34308615 DOI: 10.23736/s0021-9509.21.11924-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The present study reports perioperative changes in PCT levels occuring in cardiac patients with acute mesenteric ischemia (AMI) undergoing laparotomy. The aim of this study was to demonstrate that PCT kinetics may confirm the presence of AMI after cardiac surgery, distinguishing between bowel infarction and diffuse ischemia. METHODS PCT values from adult patients undergoing laparotomy for AMI after elective or urgent cardiac surgery (January 2010 - December 2019) were determinated at the ICU admission after cardiac surgery, 24 hours later and at the onset of clinical symptoms. Patients affected by diffuse intestinal ischemia with no need for bowel resection were allocated to Group A (n.8), patients presented with intestinal necrosis requiring small or large bowel resection were allocated to Group B (n.12). RESULTS At the beginning of the abdominal symptoms, PCT levels increased in both group, compared to those immediately after cardiac surgery. The PCT increasing resulted much more evident in patients presenting with intestinal necrosis - Group B (20.65 ng/ml [IQR8.47-34.5] vs. 4.31 ng/ml [IQR 8.47-34.5], p <0.05), rather than in those with diffuse ischemia - Group A (13.25 ng/ml [IQR 5.97-27.65] vs. 10.4 ng/ml [IQR 3.68-14.05], p 0.260). This trend was confirmed in the subgroup of patients undergoing CVVHD and in patients who experience AMI recurrence. CONCLUSIONS Increasing PCT values after cardiac surgery are proportional to the severity of wall ischemia and high levels of PCT are predictive of intestinal necrosis. Routine PCT monitoring after cardiac surgery should be considered extremely useful in suggesting the possibility of abdominal complications, alerting medical staff to the need of prompt treatment.
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Affiliation(s)
- Raoul Borioni
- Department of Cardiovascular Sciences, European Hospital, Rome, Italy -
| | - Mariano Garofalo
- Department of Cardiovascular Sciences, European Hospital, Rome, Italy
| | - Franco Turani
- Department of Anesthesiology, Aurelia Hospital, Rome, Italy
| | - Luca P Weltert
- Department of Cardiovascular Sciences, European Hospital, Rome, Italy
| | | | | | - Ruggero DE Paulis
- Department of Cardiovascular Sciences, European Hospital, Rome, Italy
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14
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Belov DV, Shivanov IV, Saevets GA, Danko NA, Shopova EN, Pleshakov OO. Endovascular therapy in acute mesenteric ischemia after coronary artery bypass grafting: a case report and literature review. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2021. [DOI: 10.15829/1728-8800-2021-2586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
In the pattern of abdominal complications after cardiac surgery, acute mesenteric ischemia is rare but high-mortality pathology. In the initial stages, the disease has no specific signs, which makes it difficult to perform early multislice computed tomography to diagnose it. Risk stratification and an individual approach to the choice of diagnostic and therapeutic measures aimed at early restoration of mesenteric blood flow will reduce the mortality in this complication.
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Affiliation(s)
- D. V. Belov
- South Ural State Medical University; Federal Center for Cardiovascular Surgery
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15
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Mothes H, Wickel J, Sponholz C, Lehmann T, Kaluza M, Zanow J, Doenst T. Monitoring of the Progression of the Perioperative Serum Lactate Concentration Improves the Accuracy of the Prediction of Acute Mesenteric Ischemia Development After Cardiovascular Surgery. J Cardiothorac Vasc Anesth 2021; 35:1792-1799. [PMID: 33663981 DOI: 10.1053/j.jvca.2021.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To examine the sensitivity and specificity of perioperative lactate gradients for the prediction of subsequent acute mesenteric ischemia development in patients undergoing cardiovascular surgery. DESIGN Retrospective, single-center, case-control study. SETTING University hospital. PARTICIPANTS The study comprised 108 (1.15%) patients with acute mesenteric ischemia who were selected from 9,385 patients who underwent cardiovascular surgery and were matched to 324 control patients by age and surgery type. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Univariate and logistic regression analyses were used to examine intraoperative and early postoperative lactate levels in patients with and without mesenteric ischemia after cardiac surgery. Late intraoperative lactate concentrations were significantly greater in patients who subsequently developed mesenteric ischemia (p < 0.001). Patients with lactate levels >3 mmol/L had a four-fold increased risk of mesenteric ischemia development (odds ratio [OR] 4.2, 95% confidence interval [CI] 2.4-7.5; area under the curve [AUC] 0.597; p < 0.002). Patients whose lactate levels remained >3 mmol/L on the first postoperative day had a nearly eight-fold increased risk (OR 7.8, 95% CI 4.6-13.3; AUC 0.68; p < 0.001), indicating that mesenteric ischemia developed at an early stage in almost every second patient (p < 0.001). For patients with normal or less elevated lactate levels, similar results were obtained for a >200% increase between the intraoperative and early postoperative periods (OR 4.1, 95% CI 2.4-6.8; AUC 0.62; p < 0.001). CONCLUSION Late intraoperative and early postoperative lactate levels >3 mmol/L and increases >200%, even when remaining within the normal range, should raise the suspicion of subsequent mesenteric ischemia development.
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Affiliation(s)
- Henning Mothes
- Department of General, Visceral and Vascular Surgery, Sophien- und Hufeland-Klinikum, Weimar, Germany.
| | - Jana Wickel
- Department of Obstetrics and Gynecology, University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Christoph Sponholz
- Department of Anesthesia and Intensive Care, University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Thomas Lehmann
- Institute of Medical Statistics, Informatics and Documentation, University Hospital, Jena, Germany
| | - Mirko Kaluza
- Department of Cardiovascular and Thoracic Surgery, University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Juergen Zanow
- Department of General, Visceral and Vascular Surgery, Sophien- und Hufeland-Klinikum, Weimar, Germany
| | - Torsten Doenst
- Department of Cardiovascular and Thoracic Surgery, University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
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16
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Miller AS, Boyce K, Box B, Clarke MD, Duff SE, Foley NM, Guy RJ, Massey LH, Ramsay G, Slade DAJ, Stephenson JA, Tozer PJ, Wright D. The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery. Colorectal Dis 2021; 23:476-547. [PMID: 33470518 PMCID: PMC9291558 DOI: 10.1111/codi.15503] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/08/2020] [Accepted: 12/12/2020] [Indexed: 12/15/2022]
Abstract
AIM There is a requirement for an expansive and up to date review of the management of emergency colorectal conditions seen in adults. The primary objective is to provide detailed evidence-based guidelines for the target audience of general and colorectal surgeons who are responsible for an adult population and who practise in Great Britain and Ireland. METHODS Surgeons who are elected members of the Association of Coloproctology of Great Britain and Ireland Emergency Surgery Subcommittee were invited to contribute various sections to the guidelines. They were directed to produce a pathology-based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. Each author was asked to provide a set of recommendations which were evidence-based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after two votes were included in the guidelines. RESULTS All aspects of care (excluding abdominal trauma) for emergency colorectal conditions have been included along with 122 recommendations for management. CONCLUSION These guidelines provide an up to date and evidence-based summary of the current surgical knowledge in the management of emergency colorectal conditions and should serve as practical text for clinicians managing colorectal conditions in the emergency setting.
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Affiliation(s)
- Andrew S. Miller
- Leicester Royal InfirmaryUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | | | - Benjamin Box
- Northumbria Healthcare Foundation NHS TrustNorth ShieldsUK
| | | | - Sarah E. Duff
- Manchester University NHS Foundation TrustManchesterUK
| | | | | | | | | | | | | | - Phil J. Tozer
- St Mark’s Hospital and Imperial College LondonHarrowUK
| | - Danette Wright
- Western Sydney Local Health DistrictSydneyNew South WalesAustralia
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17
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Xu J, Qin Z, Wang Y, Hu C, Wang G, Gu Z, Yuan S, Chen J, Huang D, Wang Z. The prognostic value of peak arterial lactate levels within 72 h of lung transplantation in identifying patient outcome. J Thorac Dis 2020; 12:7365-7373. [PMID: 33447426 PMCID: PMC7797848 DOI: 10.21037/jtd-20-3445] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Lactic acidosis is often seen in lung transplantation (LTx). Postoperative lactate is frequently associated with poor outcome in postoperative and critically ill patients. Our aim was to evaluate the predictive value of postoperative peak lactate levels within 72 h of LTx for 30-day and late mortality. Methods We evaluated patients who underwent LTx from January 2015 to September 2017. All admitted patients were classified according to the peak lactate level (PL) within 72 h of surgery: PL <5 mmol/L (Group 1); PL =5–10 mmol/L (Group 2), and PL >10 mmol/L (Group 3). We performed logistic regression analysis and used Cox regression models to identify the peak lactate level as a predictive factor for 30-day and late mortality, respectively. Results Of 255 eligible patients, mean age 55.61±12.16, mean lactate 4.99±2.93 and 80% male, and 40% had hyperlactatemia (PL >5 mmol/L) after LTx. The 30-day mortality rate was 17.9%, 28.9% and 68.8% in the three groups, respectively (P<0.05). Multivariate regression analyses revealed postoperative PL as a notable predictor of 30-day mortality [odds ratio =2.62 (1.42–4.84), P=0.002] as well as for late mortality [hazard ratio =2.70 (1.13–6.42), P=0.025]. Conclusions The postoperative peak lactate level within 72 h of surgery was an independent predictor for 30-day and late mortality in LTx patients.
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Affiliation(s)
- Jingjing Xu
- Department of Anesthesiology, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Zhong Qin
- Department of Anesthesiology, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Yanjuan Wang
- Department of Anesthesiology, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Chunxiao Hu
- Department of Anesthesiology, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Guilong Wang
- Department of Anesthesiology, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Zhengfeng Gu
- Department of Anesthesiology, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Shengjie Yuan
- Department of Anesthesiology, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Jingyu Chen
- Department of Lung Transplant Group, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China.,Jiangsu Key Laboratory of Organ Transplantation, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Dongxiao Huang
- Department of Anesthesiology, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Zhiping Wang
- Department of Anesthesiology, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China.,Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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18
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Elgharably H, Gamaleldin M, Ayyat KS, Zaki A, Hodges K, Kindzelski B, Sharma S, Hassab T, Yongue C, Serna SDL, Perez J, Spencer C, Bakaeen FG, Steele SR, Gillinov AM, Svensson LG, Pettersson GB. Serious Gastrointestinal Complications After Cardiac Surgery and Associated Mortality. Ann Thorac Surg 2020; 112:1266-1274. [PMID: 33217398 DOI: 10.1016/j.athoracsur.2020.09.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 08/26/2020] [Accepted: 09/11/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Severe gastrointestinal (GI) complications (GICs) after cardiac surgery are associated with poor outcomes. Herein, we characterize the severe forms of GICs and associated risk factors of mortality. METHODS We retrospectively analyzed the clinically significant postoperative GICs after cardiac surgical procedures performed at our institution from January 2010 to April 2017. Multivariable analysis was used to identify predictors for in-hospital mortality. RESULTS Of 29,909 cardiac surgical procedures, GICs occurred in 1037 patients (3.5% incidence), with overall in-hospital mortality of 14% compared with 1.6% in those without GICs. GICs were encountered in older patients with multiple comorbidities who underwent complex prolonged procedures. The most lethal GICs were mesenteric ischemia (n = 104), hepatopancreatobiliary (HPB) dysfunction (n = 139), and GI bleeding (n = 259), with mortality rates of 45%, 27%, and 17%, respectively. In the mesenteric ischemia subset, coronary artery disease (odds ratio [OR], 4.57; P = .002], coronary bypass grafting (OR, 6.50; P = .005), reoperation for bleeding/tamponade (OR, 12.07; P = .01), and vasopressin use (OR, 11.27; P < .001) were predictors of in-hospital mortality. In the HPB complications subset, hepatic complications occurred in 101 patients (73%), pancreatitis in 38 (27%), and biliary disease in 31 (22%). GI bleeding occurred in 20 patients (31%) with HPB dysfunction. In the GI bleeding subset, HPB disease (OR, 10.99; P < .001) and bivalirudin therapy (OR, 12.84; P = .01) were predictors for in-hospital mortality. CONCLUSIONS Although relatively uncommon, severe forms of GICs are associated with high mortality. Early recognition and aggressive treatment are mandatory to improve outcomes.
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Affiliation(s)
- Haytham Elgharably
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
| | | | - Kamal S Ayyat
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Anthony Zaki
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Kevin Hodges
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Bogdan Kindzelski
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Shashank Sharma
- Colorectal Surgery, and Quantitative Health Sciences, Cleveland, Ohio
| | - Tarek Hassab
- Colorectal Surgery, and Quantitative Health Sciences, Cleveland, Ohio
| | - Camille Yongue
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Solanus de la Serna
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Juan Perez
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Capri Spencer
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Faisal G Bakaeen
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Scott R Steele
- Colorectal Surgery, and Quantitative Health Sciences, Cleveland, Ohio
| | - A Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Gosta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
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19
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Chor CYT, Mahmood S, Khan IH, Shirke M, Harky A. Gastrointestinal complications following cardiac surgery. Asian Cardiovasc Thorac Ann 2020; 28:621-632. [DOI: 10.1177/0218492320949084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Gastrointestinal complications after cardiac surgery may be uncommon but they carry high mortality rates. Incidences range from 0.5% to 5.5%, while mortality rates of such complications vary from 0.3% to 87%. They range from small gastrointestinal bleeds, ileus, and pancreatitis to life-threatening complications such as liver failure and ischemic bowel. Due to the vague and often absence of specific signs and symptoms, diagnosis of a gastrointestinal complication is often late. This article aims to review and summarize the literature concerning gastrointestinal complications after cardiac surgery. We discuss the causes, risk factors, diagnosis, preventative measures, and management of these complications. In general, risk factor identification, preventive measures, early diagnosis, and swift management are the keys to reducing the occurrence of gastrointestinal complications and their associated morbidity and mortality.
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Affiliation(s)
| | - Saira Mahmood
- Department of Medicine, St George’s Hospital Medical School, London, UK
| | | | - Manasi Shirke
- Department of Medicine, Queen’s University Belfast, School of Medicine, Belfast, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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20
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Kühn F, Schiergens TS, Klar E. Acute Mesenteric Ischemia. Visc Med 2020; 36:256-262. [PMID: 33005650 DOI: 10.1159/000508739] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 05/16/2020] [Indexed: 12/15/2022] Open
Abstract
Background Despite constant improvements in diagnostic as well as interventional and surgical techniques, acute mesenteric ischemia (AMI) remains a life-threatening emergency with high mortality rates. The time to diagnosis of AMI is the most important predictor of patients' outcome; therefore, prompt diagnosis and intervention are essential to reduce mortality in patients with AMI. The present review was performed to analyze potential risk factors and to help find ways to improve the outcome of patients with AMI. Summary Whereas AMI only applies to approximately 1% of all patients with an "acute abdomen," its incidence is rising up to 10% in patients >70 years of age. The initial clinical stage of AMI is characterized by a sudden onset of strong abdominal pain followed by a painless interval. Depending on the extent of disease, the symptoms of nonocclusive mesenteric ischemia (NOMI) and patients with a venous thrombosis can be very different from those of acute occlusive ischemia. Biphasic contrast-enhanced CT represents the gold standard for the diagnosis of arterial and venous occlusion. In case of a central occlusion of the superior mesenteric artery or signs of peritonitis, immediate surgery should be performed. If major bowel resection becomes necessary, critical residual intestinal length limits must be kept in mind. Endovascular techniques for arterial occlusion have taken on a much greater importance today. For stable patients with NOMI, interventional catheter angiography is recommended because it enables diagnosis and treatment with selective application of vasodilators. Depending on its degree, interventional treatment with a transhepatic catheter lysis should be considered for acute and chronic portal vein thrombosis. Key Message The prompt and targeted use of the appropriate diagnostics and interventions appears to be the only way to reduce the persistently high mortality rates for AMI.
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Affiliation(s)
- Florian Kühn
- Department of General, Visceral, and Transplantation Surgery, Ludwig Maximilian University of Munich, Munich, Germany
| | - Tobias S Schiergens
- Department of General, Visceral, and Transplantation Surgery, Ludwig Maximilian University of Munich, Munich, Germany
| | - Ernst Klar
- Department of General, Visceral, Vascular and Transplantation Surgery, University Medical Center Rostock, Rostock, Germany
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21
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Senda A, Endo A, Tachimori H, Fushimi K, Otomo Y. Early administration of glucocorticoid for thyroid storm: analysis of a national administrative database. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:470. [PMID: 32727523 PMCID: PMC7391822 DOI: 10.1186/s13054-020-03188-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/20/2020] [Indexed: 12/29/2022]
Abstract
Background Thyroid storm is a life-threatening disease with a mortality rate of over 10%. Although glucocorticoids have been recommended as a treatment option for thyroid storm, supportive evidence based on a large-scale clinical research is lacking. The objective of the current study was to evaluate the beneficial effects of glucocorticoids in the treatment of patients with severe thyroid storm. Methods A retrospective nationwide cohort study was conducted using a Japanese national administrative claims database. Patients admitted to intensive care units due to severe thyroid storm between the financial years 2013 and 2017 were included in the study. The primary outcome was in-hospital mortality; secondary outcomes were mortality within 30 days and insulin administration during hospitalization. Generalized linear mixed model (GLMM) with maximum likelihood estimation (MLE) and Bayesian estimation using Markov chain Monte Carlo methods (MCMC), in addition to propensity score matching (PSM), were used for statistical analysis. Results A total of 811 patients were included in the study, of which 600 patients were treated with glucocorticoids, and 211 patients were treated without glucocorticoids. The early administration of glucocorticoids was not associated with a significant improvement in the in-hospital mortality of patients with thyroid storm [adjusted odds ratio (95% confidence interval) = 1.77 (0.95–3.34), 1.44 (1.14–1.93), and 1.46 (0.72–3.00) in the GLMM (MLE), GLMM (MCMC), and PSM, respectively]. The results of mortality within 30 days were almost identical to the results of in-hospital mortality. However, insulin use was significantly higher in the glucocorticoid group. Conclusions This analysis of a nationwide administrative database indicates that the administration of glucocorticoids does not improve the survival of patients with thyroid storm.
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Affiliation(s)
- Atsushi Senda
- Department of Acute Critical Care and Disaster Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Akira Endo
- Department of Acute Critical Care and Disaster Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Hisateru Tachimori
- Department of Mental Health Policy and Evaluation, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo, 187-0031, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Yasuhiro Otomo
- Department of Acute Critical Care and Disaster Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
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22
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Renaudier M, de Roux Q, Bougouin W, Boccara J, Dubost B, Attias A, Fiore A, de'Angelis N, Folliguet T, Mulé S, Amiot A, Langeron O, Mongardon N. Acute mesenteric ischaemia in refractory shock on veno-arterial extracorporeal membrane oxygenation. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 10:62–70. [PMID: 33609105 DOI: 10.1177/2048872620915655] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/08/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Acute mesenteric ischaemia is a severe complication in critically ill patients, but has never been evaluated in patients on veno-arterial extracorporeal membrane oxygenation (V-A ECMO). This study was designed to determine the prevalence of mesenteric ischaemia in patients supported by V-A ECMO and to evaluate its risk factors, as well as to appreciate therapeutic modalities and outcome. METHODS In a retrospective single centre study (January 2013 to January 2017), all consecutive adult patients who underwent V-A ECMO were included, with exclusion of those dying in the first 24 hours. Diagnosis of mesenteric ischaemia was performed using digestive endoscopy, computed tomography scan or first-line laparotomy. RESULTS One hundred and fifty V-A ECMOs were implanted (65 for post-cardiotomy shock, 85 for acute cardiogenic shock, including 39 patients after refractory cardiac arrest). Overall, median age was 58 (48-69) years and mortality 56%. Acute mesenteric ischaemia was suspected in 38 patients, with a delay of four (2-7) days after ECMO implantation, and confirmed in 14 patients, that is, a prevalence of 9%. Exploratory laparotomy was performed in six out of 14 patients, the others being too unstable to undergo surgery. All patients with mesenteric ischaemia died. Independent risk factors for developing mesenteric ischaemia were renal replacement therapy (odds ratio (OR) 4.5, 95% confidence interval (CI) 1.3-15.7, p=0.02) and onset of a second shock within the first five days (OR 7.8, 95% CI 1.5-41.3, p=0.02). Conversely, early initiation of enteral nutrition was negatively associated with mesenteric ischaemia (OR 0.15, 95% CI 0.03-0.69, p=0.02). CONCLUSIONS Acute mesenteric ischaemia is a relatively frequent but dramatic complication among patients on V-A ECMO.
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Affiliation(s)
- Marie Renaudier
- Service d'anesthésie-réanimation chirurgicale, réanimation chirurgicale polyvalente, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, France
| | - Quentin de Roux
- Service d'anesthésie-réanimation chirurgicale, réanimation chirurgicale polyvalente, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, France.,U955-IMRB, Equipe 03 'Pharmacologie et technologies pour les maladies cardiovasculaires (PROTECT)' Inserm, Univ Paris Est Creteil (UPEC), Ecole Nationale Vétérinaire d'Alfort (EnVA), France
| | - Wulfran Bougouin
- Réanimation polyvalente, Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, France.,Paris Sudden Death Expertise Centre, Paris Cardiovascular Research Centre (PARCC), France.,AfterROSC Research Group, France
| | - Johanna Boccara
- Service d'anesthésie-réanimation chirurgicale, réanimation chirurgicale polyvalente, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, France
| | - Baptiste Dubost
- Service d'anesthésie-réanimation chirurgicale, réanimation chirurgicale polyvalente, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, France
| | - Arié Attias
- Service d'anesthésie-réanimation chirurgicale, réanimation chirurgicale polyvalente, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, France
| | - Antonio Fiore
- Service de chirurgie cardiaque, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, France
| | - Nicola de'Angelis
- Service de chirurgie digestive, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, France.,Univ Paris Est Creteil, Faculté de Santé, France
| | - Thierry Folliguet
- Service de chirurgie cardiaque, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, France.,Univ Paris Est Creteil, Faculté de Santé, France
| | - Sébastien Mulé
- Univ Paris Est Creteil, Faculté de Santé, France.,Service d'imagerie médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, France
| | - Aurélien Amiot
- Univ Paris Est Creteil, Faculté de Santé, France.,Service de gastro-entérologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, France
| | - Olivier Langeron
- Service d'anesthésie-réanimation chirurgicale, réanimation chirurgicale polyvalente, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, France.,Univ Paris Est Creteil, Faculté de Santé, France.,Département infection et épidémiologie, Institut Pasteur, Unité d'histopathologie et des modèles animaux, France
| | - Nicolas Mongardon
- Service d'anesthésie-réanimation chirurgicale, réanimation chirurgicale polyvalente, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, France.,U955-IMRB, Equipe 03 'Pharmacologie et technologies pour les maladies cardiovasculaires (PROTECT)' Inserm, Univ Paris Est Creteil (UPEC), Ecole Nationale Vétérinaire d'Alfort (EnVA), France.,AfterROSC Research Group, France.,Univ Paris Est Creteil, Faculté de Santé, France
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What affects the prognosis of NOMI patients? Analysis of clinical data and CT findings. Surg Endosc 2019; 34:5327-5330. [PMID: 31832858 DOI: 10.1007/s00464-019-07321-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 12/06/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Non-occlusive mesenteric ischemia (NOMI) is a mesenteric ischemic disease with considerably high mortality rate, although little has been known about what factors affect the patients' prognosis. The purpose of this study was to investigate prognostic factors of clinical data and computed tomography (CT) findings in patients with NOMI. METHODS This was a single institutional, retrospective study, reviewing 21 consecutive patients diagnosed with NOMI on angiography. Patients were divided into either ''survivor'' group or ''non-survivor'' group based on their clinical courses 1 month after diagnosis. Clinical information such as laboratory data, Charlson Comorbidity Index, and time from CT to injecting vasodilator was obtained from patients' medical records. Contrast-enhanced CT images were assessed in following items: defect of mural enhancement, pneumatosis intestinalis, hepatic portal venous gas, paralytic bowel dilatation, bowel wall thinning, and diameters of the relevant vessels. RESULTS Eight patients belonged to ''survivor'' group, whereas eleven were allocated to ''non-survivor'' group. None of CT findings showed significant difference between survivor group and non-survivor group [defect of mural enhancement: 75% and 100% (p = 0.16), pneumatosis intestinalis: 50% and 45.5% (p = 1.00), hepatic portal venous gas: 37.5% and 45.5% (p = 1.00), paralytic bowel dilatation: 12.5% and 63.6% (p = 0.06), and bowel wall thinning: 50% and 45.5% (p = 1.00)]. The diameters of the relevant vessels did not have significant difference either. Time from CT to injecting vasodilator was revealed to be significantly shorter in survivor group [187.5 (122.5-294) min and 310 (187-925.5)] (p = 0.048). None of the other clinical information had significant difference between each group. CONCLUSION Prompt angiography may be a key to improve the prognosis of NOMI patients.
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Clinical features and outcomes of nonocclusive mesenteric ischemia after cardiac surgery: a retrospective cohort study. Heart Vessels 2019; 35:630-636. [PMID: 31679059 DOI: 10.1007/s00380-019-01531-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/23/2019] [Indexed: 12/27/2022]
Abstract
Nonocclusive mesenteric ischemia after cardiac surgery is a life-threatening complication requiring emergent intervention. However, because of its rarity, the clinical features and outcomes of nonocclusive mesenteric ischemia remain unknown. The present study aimed to clarify patients' backgrounds, clinical features and mortality of nonocclusive mesenteric ischemia after cardiac surgery, using a Japanese national inpatient database. We identified patients undergoing cardiac or thoracic aortic surgery between July 2010 and March 2017, using the Japanese Diagnosis Procedure Combination database. We calculated the incidence proportion of nonocclusive mesenteric ischemia and examined treatment options (bowel resection and interventional radiology) and patients' discharge status (in-hospital mortality and destination of discharge). We identified 221,900 eligible patients to find 568 (0.26%) patients with bowel ischemia in the same admission. Of these, 124 (0.06%) patients developed nonocclusive mesenteric ischemia, and in-hospital mortality after nonocclusive mesenteric ischemia was 77%. Treatment options for nonocclusive mesenteric ischemia included bowel resection alone (n = 34), interventional radiology (n = 15), or both (n = 15); 27, 10, and 8 patients died, respectively. Seven patients (5.6%) were discharged to home. Among 60 patients without bowel resection or interventional radiology, 50 patients died. In multivariable regression analysis, older age, preoperative hemodialysis, preoperative circulatory support, and hypothermic cardiopulmonary bypass were associated with NOMI. The present study showed that nonocclusive mesenteric ischemia after cardiac surgery was very rare. Mortality following nonocclusive mesenteric ischemia was very high even if patients underwent bowel resection or interventional radiology.
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Keschenau PR, Simons N, Klingel H, Reuter S, Foldenauer AC, Vieß J, Weidener D, Andruszkow J, Blümich B, Tolba R, Jacobs MJ, Kalder J. Perfusion-related changes in intestinal diffusion detected by NMR-MOUSE® monitoring in minipigs. Microvasc Res 2019; 125:103876. [DOI: 10.1016/j.mvr.2019.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/22/2019] [Accepted: 04/28/2019] [Indexed: 02/07/2023]
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Sato H, Nakamura M, Uzuka T, Kondo M. Detection of patients at high risk for nonocclusive mesenteric ischemia after cardiovascular surgery. J Cardiothorac Surg 2018; 13:115. [PMID: 30445964 PMCID: PMC6240249 DOI: 10.1186/s13019-018-0807-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 11/05/2018] [Indexed: 01/26/2023] Open
Abstract
Objectives Nonocclusive mesenteric ischemia (NOMI) is a rare but life-threatening complication after cardiovascular surgery. Early diagnosis and treatment is essential for a chance to cure. The aim of this study is to identify the independent risk factors for NOMI based on the evaluation of 12 cases of NOMI after cardiovascular surgery. Methods We retrospectively analyzed 12 patients with NOMI and 674 other patients without NOMI who underwent cardiovascular surgery in our hospital. We reviewed the clinical data on NOMI patients, including their characteristics and the clinical course. In addition, we performed a statistical comparison of each factor from both NOMI and non-NOMI groups to identify the independent risk factors for NOMI. Results The median duration between the cardiac surgery and the diagnosis of NOMI was 14.0 (10.3–20.3) days. The in-hospital mortality of NOMI patients was 75.0%. Age (p < 0.05), peripheral arterial disease (p < 0.001), postoperative hemodialysis (p < 0.001), intraaortic balloon pump (p < 0.05), norepinephrine (NOE) > 0.10γ (p < 0.0001), percutaneous cardiopulmonary support (p < 0.001), sepsis (p < 0.05), loss of sinus rhythm (p < 0.05), prolonged ventilation (p < 0.0001), and resternotomy for bleeding (p < 0.05) showed significant differences between NOMI and non-NOMI groups. In the multivariate logistic regression model, prolonged ventilation [odds ratio (OR) = 18.1, p < 0.001] and NOE > 0.10 μg/kg/min (OR = 130.0, p < 0.0001) were detected as independent risk factors for NOMI. Conclusions We have identified the risk factors for NOMI based on the evaluation of the 12 cases of NOMI after cardiovascular surgery. This result may be useful in predicting NOMI, which is considered difficult in clinical practice. For the patient with suspected of NOMI who has these risk factors, early CT scan and surgical exploration should be performed without delay.
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Affiliation(s)
- Hiroshi Sato
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, S1W16, Chuo-ku, Sapporo, 060-8543, Japan.
| | - Masanori Nakamura
- Department of Cardiovascular Surgery, Sapporo City General Hospital, N11W13, Chuo-ku, Sapporo, 060-8604, Japan
| | - Takeshi Uzuka
- Department of Cardiovascular Surgery, Sapporo City General Hospital, N11W13, Chuo-ku, Sapporo, 060-8604, Japan
| | - Mayo Kondo
- Department of Cardiovascular Surgery, Sapporo City General Hospital, N11W13, Chuo-ku, Sapporo, 060-8604, Japan
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Singer P, Rattanachaiwong S. Editorial on "enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2)". J Thorac Dis 2018; 10:S974-S977. [PMID: 29849188 DOI: 10.21037/jtd.2018.04.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Pierre Singer
- Department of General Intensive Care, Rabin Medical Center, Petah Tikva and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sornwichate Rattanachaiwong
- Division of Clinical Nutrition, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Kammerer S, Schuelke C, Berkemeyer S, Velasco A, Heindel W, Koehler M, Buerke B. The role of multislice computed tomography (MSCT) angiography in the diagnosis and therapy of non-occlusive mesenteric ischemia (NOMI): Could MSCT replace DSA in diagnosis? PLoS One 2018; 13:e0193698. [PMID: 29494649 PMCID: PMC5832260 DOI: 10.1371/journal.pone.0193698] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 02/18/2018] [Indexed: 12/24/2022] Open
Abstract
Objectives Evaluation of multislice-CT (MSCT) during diagnosis and therapeutic decision-making in patients with suspected non-occlusive mesenteric ischemia (NOMI). Methods Retrospective, institutional review board-approved study of 30 patients (20 men, 10 women, mean age 64.6±14.2 years, range 24–87 years) undergoing biphasic abdominal MSCT followed by digital subtraction angiography (DSA) due to suspected NOMI. MSCT and DSA were qualitatively and quantitatively evaluated independently by two radiologists with respect to the possible diagnosis of NOMI. MSCT analysis included quantitative measurements, qualitative evaluation of contrast enhancement and assessment of secondary findings (bowel wall thickening, hypo-enhancement, intestinal pneumatosis). MSCT diagnosis and secondary findings were compared against DSA diagnosis. Results NOMI was diagnosed in a total of n = 28 patients. No differences were found when comparing the R1-rated MSCT diagnosis (p = 0.09) to the “gold standard”, while MSCT diagnosis was slightly inferior with R2 (p = 0.02). With R1, vessel-associated parameters revealed the best correlation, i.e. qualitative vessel width (r = -0.39;p = 0.03) and vessel contrast (r = 0.45;p = 0.01). Moderate correlations were found for quantitative vessel diameters in the middle segments (r = -0.48,p = 0.01), increasing to almost high correlations in the distal (r = -0.66;p<0.00001) superior mesenteric artery (SMA) segments. No significant correlation was apparent from secondary findings. Conclusions MSCT is an appropriate non-invasive method for diagnosing NOMI and leads to adequate and immediate therapeutic stratification.
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Affiliation(s)
- Sara Kammerer
- Department of Clinical Radiology, University Hospital Muenster, Muenster, Germany
| | - Christoph Schuelke
- Department of Clinical Radiology, University Hospital Muenster, Muenster, Germany
| | - Shoma Berkemeyer
- Reference Center for Mammography, University Hospital Muenster, Muenster Germany
| | - Aglae Velasco
- Department of Clinical Radiology, University Hospital Muenster, Muenster, Germany
| | - Walter Heindel
- Department of Clinical Radiology, University Hospital Muenster, Muenster, Germany
| | - Michael Koehler
- Department of Clinical Radiology, University Hospital Muenster, Muenster, Germany
| | - Boris Buerke
- Department of Clinical Radiology, University Hospital Muenster, Muenster, Germany
- * E-mail:
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