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Xhepa G, Vanzulli A, Sciacqua LV, Inzerillo A, Faerber P, Ierardi AM, Carrafiello G, Del Grande F, Ricoeur A. Advancements in Treatment Strategies for Chronic Mesenteric Ischemia: A Comprehensive Review. J Clin Med 2023; 12:7112. [PMID: 38002726 PMCID: PMC10672107 DOI: 10.3390/jcm12227112] [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: 10/17/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
Chronic mesenteric ischemia (CMI) arises from the inability to achieve adequate intestinal blood flow after meals, leading to an imbalance between oxygen and metabolite supply and demand. The true incidence of CMI remains uncertain. However, the occurrence of mesenteric artery occlusive disease (MAOD) is relatively common among the elderly population. Delays in diagnosing CMI can often be attributed to several factors, including the variability in patient symptoms and the range of potential causes for chronic abdominal pain with weight loss. Mikkelson pioneered the introduction of a surgical treatment for occlusive lesions of the superior mesenteric artery (SMA) in 1957. The inaugural performance of endovascular revascularization (ER) for visceral vessels took place in 1980. The literature has documented two types of endovascular revascularization (ER) methods: percutaneous transluminal angioplasty (PTA) and primary stenting (PMAS). Despite the limited quality of available evidence, the consensus among experts is strongly in favor of PMAS over PTA alone for the treatment of atherosclerotic mesenteric artery stenosis. There are several key areas of focus for chronic mesenteric ischemia (CMI) treatment. Randomized controlled trials comparing different stent types, such as covered stents versus bare metal stents, are needed to evaluate efficacy, patency rates, and long-term outcomes in CMI patients.
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Affiliation(s)
- Genti Xhepa
- Istituto Di Imaging ella Svizzera Italiana (IIMSI), Clinica Di Radiologia, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland;
- Interventional Radiology Unit, University Hospital of Geneva (HUG), 1205 Geneva, Switzerland; (A.I.); (P.F.); (A.R.)
| | - Andrea Vanzulli
- Residency Program in Diagnostic and Interventional Radiology, Università degli Studi di Milano, 20126 Milan, Italy; (A.V.); (L.V.S.)
| | - Lucilla Violetta Sciacqua
- Residency Program in Diagnostic and Interventional Radiology, Università degli Studi di Milano, 20126 Milan, Italy; (A.V.); (L.V.S.)
| | - Agostino Inzerillo
- Interventional Radiology Unit, University Hospital of Geneva (HUG), 1205 Geneva, Switzerland; (A.I.); (P.F.); (A.R.)
| | - Pierre Faerber
- Interventional Radiology Unit, University Hospital of Geneva (HUG), 1205 Geneva, Switzerland; (A.I.); (P.F.); (A.R.)
| | - Anna Maria Ierardi
- Department of Radiology, Foundation IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, University of Milan, 20122 Milan, Italy;
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology Department, IRCCS Ca’ Granda Fondazione Ospedale Maggiore Policlinico, Università degli Studi di Milano, 20126 Milan, Italy;
| | - Filippo Del Grande
- Istituto Di Imaging ella Svizzera Italiana (IIMSI), Clinica Di Radiologia, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland;
- Facoltà Di Scienze Biomediche, Campus Est, Università Della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Alexis Ricoeur
- Interventional Radiology Unit, University Hospital of Geneva (HUG), 1205 Geneva, Switzerland; (A.I.); (P.F.); (A.R.)
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Sultan SA, Acharya Y, Mustafa M, Hynes N. Two Decades of Experience With Chronic Mesenteric Ischaemia and Median Arcuate Ligament Syndrome in a Tertiary Referral Centre: A Parallel Longitudinal Comparative Study. Cureus 2021; 13:e20726. [PMID: 35047313 PMCID: PMC8759710 DOI: 10.7759/cureus.20726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2021] [Indexed: 12/13/2022] Open
Abstract
Background Chronic mesenteric ischaemia (CMI) and median arcuate ligament syndrome (MALS) have similar clinical presentations with surgical intervention as the mainstay of treatment. However, surgical response varies and is unpredictable. Therefore, we aim to evaluate the technical and clinical success rates of selective revascularisation in older patients with CMI and younger patients with MALS undergoing arcuate ligament decompression with celiac sympathectomy. Methods We conducted a retrospective single-centre longitudinal comparative study of all the patients who underwent surgery for symptoms of CMI and MALS from December 2002 to 2020 at our tertiary referral vascular centre. Our primary outcome was symptom-free survival post-intervention. The secondary outcomes were perioperative mortality, technical success, and all-cause mortality at 17 years. Results We operated on 28 patients; 17 patients with CMI (revascularisations with bypass) and 11 with MALS (decompression and celiac sympathectomy). All (100%) patients had technical success. There was no perioperative mortality. All the MALS patients had symptom-free survival following the procedure throughout follow-up. In contrast, three patients with CMI complained of recurring abdominal pain even after one year of the surgery. However, there was no further weight loss and none of them required any intervention. Conclusion Stratified management of CMI with revascularisation and open surgical decompression with celiac sympathectomy in MALS are effective treatments with favourable long-term outcomes.
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Affiliation(s)
- Sherif A Sultan
- Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospital, National University of Ireland, Galway, IRL.,Vascular and Endovascular Surgery, CORRIB-CÚRAM-Vascular Group, National University of Ireland, Galway, IRL
| | - Yogesh Acharya
- Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospital, National University of Ireland, Galway, IRL
| | | | - Niamh Hynes
- Vascular and Endovascular Surgery, CORRIB-CÚRAM-Vascular Group, National University of Ireland, Galway, IRL
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Andraska EA, Tran LM, Haga LM, Mak AK, Madigan MC, Makaroun MS, Eslami MH, Chaer RA. Contemporary management of acute and chronic mesenteric ischemia: 10-year experience from a multihospital healthcare system. J Vasc Surg 2021; 75:1624-1633.e8. [PMID: 34788652 PMCID: PMC9038632 DOI: 10.1016/j.jvs.2021.11.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/05/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Endovascular and hybrid methods are being increasingly used to treat mesenteric ischemia. However, long-term outcomes and risk of symptom recurrence remain unknown. The objective of this study was to define predictors of post-operative morbidity, mortality, and patency loss in acute (AMI) or chronic mesenteric ischemia (CMI). METHODS Inpatient and follow-up records for all patients who underwent revascularization for AMI and CMI from 2010 to 2020 at a multicenter hospital system were reviewed. Patency and mortality were evaluated with Cox regression, visualized with Kaplan-Meier curves, and compared using log rank testing. Patency was further evaluated with Fine-Gray regression utilizing death as a competing risk. Post-operative major adverse events (MAE) and 30-day mortality were evaluated with logistic regression. RESULTS 407 patients were included; 148 AMI and 259 CMI. In AMI, 30-day mortality was 31%. Open surgery was associated with lower rates of bowel resection (OR 0.23, 95% CI 0.13, 0.61). Etiology of AMI also did not change outcomes (OR 1.30, 95% CI 0.77, 2.19). Adjusted analyses indicates that a history of diabetes (OR 2.77, 95% CI 1.37, 5.61) and sepsis on presentation (OR 2.32, 95% CI 1.18, 4.58) were independently associated with increased risk of 30-day MAE. In CMI, open surgery and CKD were associated with higher MAE (OR 3.03, 95% CI 1.14, 8.05; OR 2.37, 95% CI 1.31, 4.31) while CKD (OR 3.02, 95% CI 1.10, 8.37) and inpatient status prior to revascularization (OR 2.78, 95% CI 1.01, 7.61) were associated with increased 30-day mortality. In CMI, patients in the endovascular cohort had higher rates of symptom recurrence (29% vs. 13%) with faster onset (endovascular 64 days vs. bypass 338 days). CONCLUSIONS AMI remains a morbid disease despite evolving revascularization techniques. An open approach should remain the gold standard as it reduces likelihood of bowel resection. In CMI, endovascular interventions have improved post-operative morbidity but result in early symptom recurrence and re-interventions. An endovascular-first approach should be standard in CMI with close surveillance.
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Affiliation(s)
- Elizabeth A Andraska
- University of Pittsburgh Medical Center, Department of Surgery, Heart and Vascular Institute.
| | - Lillian M Tran
- University of Pittsburgh Medical Center, Department of Surgery
| | - Lindsey M Haga
- University of Pittsburgh Medical Center, Department of Surgery, Heart and Vascular Institute
| | | | - Michael C Madigan
- University of Pittsburgh Medical Center, Department of Surgery, Heart and Vascular Institute
| | - Michel S Makaroun
- University of Pittsburgh Medical Center, Department of Surgery, Heart and Vascular Institute
| | - Mohammad H Eslami
- University of Pittsburgh Medical Center, Department of Surgery, Heart and Vascular Institute
| | - Rabih A Chaer
- University of Pittsburgh Medical Center, Department of Surgery, Heart and Vascular Institute
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Mitchell EL. The Society for Vascular Surgery clinical practice guidelines define the optimal care of patients with chronic mesenteric ischemia. J Vasc Surg 2021; 73:84S-86S. [PMID: 33349350 DOI: 10.1016/j.jvs.2020.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Erica L Mitchell
- Department of Surgery, University of Tennessee, and the Division of Vascular and Endovascular Surgery, Regional One Health, Memphis, Tenn.
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Green J, Ryer E, Borden N, Ali B, Garvin R, Yang A, Hashmi A, Salzler G, Elmore J. Defining Duplex Ultrasound Criteria for In-Stent Restenosis of the Superior Mesenteric Artery. Ann Vasc Surg 2021; 74:294-300. [PMID: 33508454 DOI: 10.1016/j.avsg.2020.12.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/11/2020] [Accepted: 12/11/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study sought to define duplex ultrasound (DUS) velocity criteria predicting ≥70% stenosis in superior mesenteric artery (SMA) stents by correlating in-stent peak systolic velocity (PSV) with computed tomographic angiography (CTA) measurements of percent stenosis. METHODS A retrospective review of 109 patients undergoing SMA stenting between 2003 and 2018 was conducted at a single institution. Thirty-seven surveillance duplex ultrasound studies were found to have a CTA performed within 30 days of study completion. Bare metal (n = 20) and covered stents (n = 17) were included. Velocities were paired to in-stent restenosis (ISR) measured by mean vessel diameter reduction on SMA centerline reconstructions from CTA. Receiver operating characteristic (ROC) curves was generated and logistic regression models for ≥70% ISR probability were used to define velocity criteria in the stented SMA. RESULTS At a PSV of 300 cm/sec, the sensitivity is 100% and specificity 80% for a ≥70% in-stent SMA stenosis. At a PSV of 400 cm/sec, the sensitivity and positive predictive value (PPV) is 63% and the specificity and negative predictive value (NPV) is 90%. A PSV of 450 cm/sec was consistent with the highest specificity (100%) and PPV (100%) but lower sensitivity (50%) and NPV (87.9%). One patient with a PSV of 441 cm/sec on surveillance DUS died from complications of acute-on-chronic mesenteric ischemia. CONCLUSIONS A PSV of 400 cm/sec on mesenteric DUS can predict ≥70% ISR with high sensitivity and should be considered as a diagnostic threshold for SMA in-stent restenosis.
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Affiliation(s)
- Jessica Green
- Department of Endovascular & Vascular Surgery, Geisinger Medical Center, Danville, PA
| | - Evan Ryer
- Department of Endovascular & Vascular Surgery, Geisinger Medical Center, Danville, PA.
| | - Nicholas Borden
- Department of Endovascular & Vascular Surgery, Geisinger Medical Center, Danville, PA
| | - Bilal Ali
- Department of Endovascular & Vascular Surgery, Geisinger Medical Center, Danville, PA
| | - Robert Garvin
- Department of Endovascular & Vascular Surgery, Geisinger Medical Center, Danville, PA
| | - Andrew Yang
- Department of Endovascular & Vascular Surgery, Geisinger Medical Center, Danville, PA
| | - Ammar Hashmi
- Department of Endovascular & Vascular Surgery, Geisinger Medical Center, Danville, PA
| | - Gregory Salzler
- Department of Endovascular & Vascular Surgery, Geisinger Medical Center, Danville, PA
| | - James Elmore
- Department of Endovascular & Vascular Surgery, Geisinger Medical Center, Danville, PA
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Huber TS, Björck M, Chandra A, Clouse WD, Dalsing MC, Oderich GS, Smeds MR, Murad MH. Chronic mesenteric ischemia: Clinical practice guidelines from the Society for Vascular Surgery. J Vasc Surg 2020; 73:87S-115S. [PMID: 33171195 DOI: 10.1016/j.jvs.2020.10.029] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 10/15/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Chronic mesenteric ischemia (CMI) results from the inability to achieve adequate postprandial intestinal blood flow, usually from atherosclerotic occlusive disease at the origins of the mesenteric vessels. Patients typically present with postprandial pain, food fear, and weight loss, although they can present with acute mesenteric ischemia and bowel infarction. The diagnosis requires a combination of the appropriate clinical symptoms and significant mesenteric artery occlusive disease, although it is often delayed given the spectrum of gastrointestinal disorders associated with abdominal pain and weight loss. The treatment goals include relieving the presenting symptoms, preventing progression to acute mesenteric ischemia, and improving overall quality of life. These practice guidelines were developed to provide the best possible evidence for the diagnosis and treatment of patients with CMI from atherosclerosis. METHODS The Society for Vascular Surgery established a committee composed of vascular surgeons and individuals experienced with evidence-based reviews. The committee focused on six specific areas, including the diagnostic evaluation, indications for treatment, choice of treatment, perioperative evaluation, endovascular/open revascularization, and surveillance/remediation. A formal systematic review was performed by the evidence team to identify the optimal technique for revascularization. Specific practice recommendations were developed using the Grading of Recommendations Assessment, Development, and Evaluation system based on review of literature, the strength of the data, and consensus. RESULTS Patients with symptoms consistent with CMI should undergo an expedited workup, including a computed tomography arteriogram, to exclude other potential causes. The diagnosis is supported by significant arterial occlusive disease in the mesenteric vessels, particularly the superior mesenteric artery. Treatment requires revascularization with the primary target being the superior mesenteric artery. Endovascular revascularization with a balloon-expandable covered intraluminal stent is the recommended initial treatment with open repair reserved for select younger patients and those who are not endovascular candidates. Long-term follow-up and surveillance are recommended after revascularization and for asymptomatic patients with severe mesenteric occlusive disease. Patient with recurrent symptoms after revascularization owing to recurrent stenoses should be treated with an endovascular-first approach, similar to the de novo lesion. CONCLUSIONS These practice guidelines were developed based on the best available evidence. They should help to optimize the care of patients with CMI. Multiple areas for future research were identified.
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Affiliation(s)
- Thomas S Huber
- University of Florida College of Medicine, Gainesville, Fla.
| | - Martin Björck
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Ankur Chandra
- Scripps Clinic/Scripps Green Hospital, La Jolla, Calif
| | - W Darrin Clouse
- Division of Vascular and Endovascular Surgery, University of Virginia Health System, Charlottesville, Va
| | - Michael C Dalsing
- Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Gustavo S Oderich
- Division of Vascular and Endovascular Surgery, University of Texas Health Science Center at Houston - McGovern Medical School, Houston, Tex
| | - Matthew R Smeds
- Division of Vascular and Endovascular Surgery, Saint Louis University School of Medicine, St. Louis, Mo
| | - M Hassan Murad
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn
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Barnes JA, Columbo JA, Ponukumati AS, Zwolak RM, Olive FT, Goodney PP, Powell RJ, Zacharias N. Long-Term Outcomes of Mesenteric Stenting and Analysis of In-Stent Restenosis Duplex Velocity Criteria. Ann Vasc Surg 2020; 68:226-233. [DOI: 10.1016/j.avsg.2020.04.064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 12/01/2022]
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Alahdab F, Arwani R, Pasha AK, Razouki ZA, Prokop LJ, Huber TS, Murad MH. A systematic review and meta-analysis of endovascular versus open surgical revascularization for chronic mesenteric ischemia. J Vasc Surg 2018; 67:1598-1605. [DOI: 10.1016/j.jvs.2017.12.046] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 12/14/2017] [Indexed: 01/27/2023]
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The outcomes of prosthetic bypass grafting for chronic mesenteric ischemia. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:223-228. [PMID: 32082738 DOI: 10.5606/tgkdc.dergisi.2018.15361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 12/31/2017] [Indexed: 12/24/2022]
Abstract
Background This study aims to analyze early and late outcomes of the prosthetic bypass grafting procedure in the treatment of chronic mesenteric ischemia. Methods Twenty-two patients (15 males, 7 females; mean age 60±10 years; range, 32 to 78 years) who underwent prosthetic bypass grafting for chronic mesenteric ischemia due to atherosclerosis between March 2009 and March 2017 were included in this study. The demographic and operative data were analyzed retrospectively. Results The most common risk factors for atherosclerosis were hypertension, diabetes, and hyperlipidemia. A total of 72% of the patients were active tobacco users. The common symptoms were postprandial angina and weight loss. Six patients (27%) had a history of endovascular intervention for mesenteric revascularization. Celiac artery bypass grafting was performed in 17 patients, while superior mesenteric artery bypass grafting was performed in 21 patients. Retrograde bypass was done in all patients and polytetrafluoroethylene grafts were used in 20 patients (90%). The mean hospital stay was 10.5 days and the mean follow-up was 44.7 months. The most common postoperative complications were respiratory failure (9%) and infection (9%). In-hospital mortality was observed in one patient (%4.5)who had acute myocardial infarction-related low cardiac output. One patient had graft thrombosis resulting in early graft infection a month after discharge. Late graft thrombosis was observed in two patients at 44 and 85 months, respectively. Late mortality was observed in two patients due to malignancy and cerebral bleeding, respectively. Conclusion Prosthetic bypass grafting via open surgery for chronic mesenteric ischemia seems to be an effective treatment in long-term and can be implemented with low surgical risks.
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Erben Y, Jean RA, Protack CD, Chiu AS, Liu S, Sumpio BJ, Miller SM, Sumpio BE. Improved mortality in treatment of patients with endovascular interventions for chronic mesenteric ischemia. J Vasc Surg 2018; 67:1805-1812. [PMID: 29395425 DOI: 10.1016/j.jvs.2017.10.071] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Chronic mesenteric ischemia (CMI) continues to be a devastating diagnosis. There is a national trend toward increased use of endovascular procedures with improved survival for the treatment of these patients. Our aim was to evaluate whether this trend has changed CMI patients' length of hospitalization and health care cost. METHODS We identified all patients admitted for CMI from the National Inpatient Sample (NIS) from 2000 to 2014. Our primary end points included length of hospital stay (LOS) and cost of hospitalization (COH). Our secondary end points included mortality assessment of the CMI hospitalization. RESULTS There were 15,475 patients admitted for CMI. The mean age of patients was 71 years, and 4022 (26.0%) were male. There were 10,920 (70.6%) patients treated endovascularly (ENDO) and 4555 (29.4%) patients treated in an open fashion (OPEN). Although a higher proportion of patients in the ENDO (43.3%) group vs OPEN (33.1%) had a Charlson Comorbidity Index score of ≥2 (P < .0001), they had a lower mortality rate (2.4% vs 8.7%; P < .0001), lower mean LOS (6.3 vs 14.0 days; P < .0001), and lower COH ($21,686 vs $42,974; P < .0001). After adjusting for clinical and hospital factors, OPEN continued to demonstrate higher mortality than ENDO (odds ratio, 7.2; 95% confidence interval, 4.9-10.6; P < .0001), longer LOS (mean, +9.7 days; P < .0001), and higher COH (mean, +$25,834; P < .0001). CONCLUSIONS The rate of ENDO continues to rise nationally in the treatment of CMI patients. After adjusting for clinical and hospital factors, patients in the ENDO group tend to have lower in-hospital mortality of 2.4% and lower LOS by 10 days, and they incur a cost saving of >$25,000 compared with patients in the OPEN group. ENDO should be considered first line of therapy for patients with CMI.
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Affiliation(s)
- Young Erben
- Section of Vascular and Endovascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn.
| | - Raymond A Jean
- Department of Surgery, Yale School of Medicine, New Haven, Conn; National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | | | - Alex S Chiu
- Department of Surgery, Yale School of Medicine, New Haven, Conn
| | - Shirley Liu
- Department of Surgery, Yale School of Medicine, New Haven, Conn
| | | | - Samuel M Miller
- Warren Alpert Medical School, Brown University, Providence, RI
| | - Bauer E Sumpio
- Section of Vascular and Endovascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
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Björck M, Koelemay M, Acosta S, Bastos Goncalves F, Kölbel T, Kolkman JJ, Lees T, Lefevre JH, Menyhei G, Oderich G, Kolh P, de Borst GJ, Chakfe N, Debus S, Hinchliffe R, Kakkos S, Koncar I, Sanddal Lindholt J, Vega de Ceniga M, Vermassen F, Verzini F, Geelkerken B, Gloviczki P, Huber T, Naylor R. Editor's Choice - Management of the Diseases of Mesenteric Arteries and Veins: Clinical Practice Guidelines of the European Society of Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2018; 53:460-510. [PMID: 28359440 DOI: 10.1016/j.ejvs.2017.01.010] [Citation(s) in RCA: 337] [Impact Index Per Article: 56.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Blauw JTM, Bulut T, Oderich GS, Geelkerken BRH. Mesenteric vascular treatment 2016: from open surgical repair to endovascular revascularization. Best Pract Res Clin Gastroenterol 2017; 31:75-84. [PMID: 28395791 DOI: 10.1016/j.bpg.2017.01.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/03/2017] [Accepted: 01/30/2017] [Indexed: 01/31/2023]
Abstract
The rise of endovascular techniques has improved the outcome of mesenteric ischemia. Key principle in reduction of morbidity and mortality is "revascularization first, resection later". We believe that mesenteric ischemia is a clinical challenge demanding 24/7 multidisciplinary team availability. This article describes the current insights into treatment of mesenteric ischemia.
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Affiliation(s)
- Juliëtte T M Blauw
- Department of Vascular Surgery, Medical Spectrum Twente, Enschede, The Netherlands; Department of Surgery, Isala Clinics, Zwolle, The Netherlands.
| | - Tomas Bulut
- Department of Radiology, Medical Spectrum Twente, Enschede, The Netherlands.
| | - Gustavo S Oderich
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Bob R H Geelkerken
- Department of Vascular Surgery, Medical Spectrum Twente, Enschede, The Netherlands; Experimental Centre for Technical Medicine, University of Twente, Enschede, The Netherlands.
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Zanow J, Settmacher U. [Management of complications after reconstruction of mesenteric arteries]. Chirurg 2015; 86:650-4. [PMID: 26041150 DOI: 10.1007/s00104-015-0031-y] [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: 11/27/2022]
Abstract
Because of the low ischemia tolerance of abdominal organs and the comorbidities of patients with abdominal ischemic syndromes, complications after the reconstruction of visceral arteries are often severe and associated with a significant mortality rate. The possible complications after interventions on the visceral arteries and their treatment are presented. Endovascular procedures have gained an increasingly important role in many primary interventions as well as in the treatment of complications.
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Affiliation(s)
- Jürgen Zanow
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Erlanger Allee 101, 07740, Jena, Deutschland,
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Saedon M, Saratzis A, Karim A, Goodyear S. Endovascular Versus Surgical Revascularization for the Management of Chronic Mesenteric Ischemia. Vasc Endovascular Surg 2015; 49:37-44. [PMID: 25964291 DOI: 10.1177/1538574415585127] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: Chronic mesenteric ischemia (CMI) can be treated with surgical revascularization (SR) or endovascular revascularization (ER). Materials and Methods: Systematic review of 12 studies comparing ER and SR in CMI. Primary end point was perioperative (30 days) survival. A secondary composite end point consisted of perioperative mortality, nonfatal cardiac events, nonfatal stroke, and nonfatal bowel ischemia. Further end points included late survival, primary patency, and symptom improvement. Results: The cumulative odds ratio (OR) for perioperative mortality was 0.78 (95% confidence interval [CI]: 0.40-1.50, P = .45) and 0.56 (95% CI: 0.28-1.11, P = .10) for the composite end point. The cumulative OR for survival after the 30th day was 0.83 (95% CI: 0.47-1.46), P = .51. Late primary patency was reported in 8 studies, with a cumulative OR of 3.57 (95% CI: 1.83-6.97, P = .0002)—favoring SR. Conclusion: In the first meta-analysis to compare ER and SR in CMI, there were no differences in mortality and morbidity. Patency rates were better following SR.
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Affiliation(s)
- Mahmud Saedon
- Division of Metabolic and Vascular Health, University of Warwick, Coventry, United Kingdom
- West Midlands Vascular Society, West Midlands, United Kingdom
| | - Athanasios Saratzis
- West Midlands Vascular Society, West Midlands, United Kingdom
- Warwickshire Vascular and Endovascular Unit, University Hospital Coventry & Warwickshire, Coventry, United Kingdom
| | - Ahmed Karim
- West Midlands Vascular Society, West Midlands, United Kingdom
- Warwickshire Vascular and Endovascular Unit, University Hospital Coventry & Warwickshire, Coventry, United Kingdom
| | - Steve Goodyear
- West Midlands Vascular Society, West Midlands, United Kingdom
- Warwickshire Vascular and Endovascular Unit, University Hospital Coventry & Warwickshire, Coventry, United Kingdom
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Radiology and mesenteric ischaemia. Clin Radiol 2015; 70:698-705. [PMID: 25812475 DOI: 10.1016/j.crad.2015.02.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 10/29/2014] [Accepted: 02/17/2015] [Indexed: 02/07/2023]
Abstract
This review focuses on the radiology of mesenteric ischaemia. Covering the acute and chronic presentations, both of which result from impaired vascularisation of the gastrointestinal tract, we evaluate the role of radiographs, ultrasound, CT, MRI, and catheter angiography in the diagnosis of these conditions. Looking to the future, we also assess some of the emerging imaging techniques. Across medicine and surgery there has been a significant shift towards minimally invasive interventions. Although percutaneous revascularisation of chronic mesenteric ischaemia has been performed for some time, there has been a developing trend for the use of such techniques in acute mesenteric ischaemia. We evaluate the available evidence for the use of these percutaneous interventions and assess how they compare with or in some instances compliment traditional surgical alternatives.
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Kanamori KS, Oderich GS, Fatima J, Sarac T, Cha S, Kalra M, De Martino R, Bower TC. Outcomes of reoperative open or endovascular interventions to treat patients with failing open mesenteric reconstructions for mesenteric ischemia. J Vasc Surg 2014; 60:1612-9.e1-2. [DOI: 10.1016/j.jvs.2014.08.093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 08/21/2014] [Indexed: 12/19/2022]
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A comparison of open and endovascular revascularization for chronic mesenteric ischemia in a clinical decision model. J Vasc Surg 2014; 60:715-25.e2. [DOI: 10.1016/j.jvs.2014.03.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 03/07/2014] [Indexed: 11/22/2022]
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AbuRahma AF, Campbell JE, Stone PA, Hass SM, Mousa AY, Srivastava M, Nanjundappa A, Dean LS, Keiffer T. Perioperative and late clinical outcomes of percutaneous transluminal stentings of the celiac and superior mesenteric arteries over the past decade. J Vasc Surg 2013; 57:1052-61. [DOI: 10.1016/j.jvs.2012.10.082] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 10/08/2012] [Accepted: 10/10/2012] [Indexed: 11/15/2022]
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Pecoraro F, Rancic Z, Lachat M, Mayer D, Amann-Vesti B, Pfammatter T, Bajardi G, Veith FJ. Chronic mesenteric ischemia: critical review and guidelines for management. Ann Vasc Surg 2012; 27:113-22. [PMID: 23088809 DOI: 10.1016/j.avsg.2012.05.012] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2011] [Revised: 07/06/2011] [Accepted: 05/06/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND CMI is caused by chronic occlusive disease of mesenteric arteries. In such an uncommon disease, clear recommendations are strongly needed. Unfortunately, treatment options for symptomatic CMI are still controversial and no guidelines exist. METHODS A systematic literature review of the last 25-years was conducted through MEDLINE, Embase, and Cochrane Review/Trials register to identify studies reporting on CMI treatment with more than 10 patients. Primary outcomes were perioperative mortality and morbidity rates. Secondary outcomes were survival rates, primary and secondary patency rates, vessels treated, CMI recurrence, follow-up (FU), technical success (TS), and in-hospital length of stay (InH-LOS). Patients were divided into endovascular treatment (ET) or open treatment (OT) groups. Subsequently, primary and secondary outcomes were analyzed by study publication year for the interval periods 1986-2000 ("A") and 2001-2010 ("B"). Differences were assessed using the t-test and the χ(2) test. RESULTS Forty-three articles with 1,795 patients were included. Perioperative mortality and morbidity rates were lower in the ET group. No difference in survival rate was observed. Primary and secondary patencies were superior in the OT group. A greater number of vessels were revascularized in the OT group. CMI recurrence was more frequent in the ET group. FU was longer in the OT group. TS was superior in the OT group and InH-LOS was shorter in the ET group. A higher number of patients were treated by ET in the period "A." No differences in mortality and morbidity were observed between period "A" and "B" in ET and OT groups. CONCLUSIONS Considering the lower periprocedural mortality and morbidity after ET, this approach should be considered as the first treatment option in most CMI patients, especially in those with severe malnutrition. Primary OT should be restricted to cases that do not qualify for ET or good surgical risk patients with long life expectancy. Considering better long-term results of OT, ET treatment should be considered as a bridge therapy to OT in some patients requiring retreatment if ET does not preclude subsequent OT.
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Affiliation(s)
- Felice Pecoraro
- Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland; Vascluar Surgery Unit, University Hospital P. Giaccone, Via L.Giuffrè 5, Palermo, Italy.
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Turba UC, Saad WE, Arslan B, Sabri SS, Trotter S, Angle JF, Hagspiel KD, Kern JA, Cherry KJ, Matsumoto AH. Chronic mesenteric ischaemia: 28-year experience of endovascular treatment. Eur Radiol 2012; 22:1372-84. [PMID: 22302502 DOI: 10.1007/s00330-011-2376-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 12/12/2011] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To report the outcomes associated with endovascular therapy for patients with chronic mesenteric ischemia (CMI). METHODS A retrospective review of patients who underwent endovascular therapy for CMI between April 1981 and September 2009 at a single institution was performed. Procedural details, mesenteric arteries treated, technical and clinical success rates, outcomes per patient and per vessel were assessed. RESULTS In 166 patients treatment was attempted using a variety of balloon and stent platforms during the 28-year period. The technical success rate was 97% per patient and 94% per vessel. The technical success rate of stenting (99.4%) was higher than for percutaneous transluminal angioplasty (PTA; 86%; P = 0.0001). Immediate clinical improvement was seen in 146 out of 166 (88.2%). The type of guidewire or device platform, brachial vs. femoral artery access, balloon and/or stent diameters used, and stenosis vs. occlusion had no statistical impact on mortality or the primary patency of any mesenteric artery outcomes. The outcome of the superior mesenteric artery (SMA) with PTA appears to be superior to that of stenting (P = 0.014). CONCLUSION Technical success rates are improved with the use of stents; however, PTA use in the SMA seems to offer better primary patency rates. KEY POINTS • Superior mesenteric artery (SMA) stenosis is often responsible for ischaemic symptoms. • Treatment with percutaneous transluminal angioplasty (PTA) seems superior to stenting • Although technical success rates are improved with the use of stents. • Higher mortality in the elderly and those presenting with nausea/vomiting/bloody stools.
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Affiliation(s)
- Ulku Cenk Turba
- Interventional Radiology, University of Virginia, Charlottesville, VA, USA.
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Ryer EJ, Oderich GS, Bower TC, Macedo TA, Vrtiska TJ, Duncan AA, Kalra M, Gloviczki P. Differences in anatomy and outcomes in patients treated with open mesenteric revascularization before and after the endovascular era. J Vasc Surg 2011; 53:1611-8.e2. [DOI: 10.1016/j.jvs.2011.01.054] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 01/15/2011] [Accepted: 01/22/2011] [Indexed: 11/25/2022]
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