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Updated: Jul 13, 2026
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Determinants of mortality and treatment outcome following surgical interventions for acute mesenteric ischemia
Panagiotis Kougias1, Donald Lau, Hosam F El Sayed
1Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA.
Background:
Acute mesenteric ischemia (AMI) is associated with high morbidity and mortality due in part to its diagnostic difficulty and operative challenges. The purpose of this study was to review our experience of surgical management in patients with this condition and to identify variables associated with adverse outcomes following surgical interventions.
Methods:
Hospital records and clinical data of all patients undergoing surgical interventions for AMI were reviewed during a recent 12-year period. Clinical outcomes as well as factors influencing mortality were analyzed.
Results:
A total of 72 patients (41 females, overall mean age 65 years, range 34 to 83 years) were included in the study. Thrombosis and embolism were the cause of AMI in 48 patients (67%) and 24 patients (33%), respectively. Abdominal pain was the most common presenting symptom (96%), followed by nausea (56%). Preoperative angiogram was performed in 61 patients (85%). All patients underwent operative interventions, which included thromboembolectomy (n = 22, 31%), mesenteric bypass grafting (n = 33, 46%), patch angioplasty (n = 9, 12%), reimplantation (n = 5, 7%), and endarterectomy (n = 3, 4%). Bowel resection was necessary in 22 patients (31%) during the initial operation, and second-look operation was performed in 38 patients (53%). Perioperative morbidity and 30-day mortality rates were 39% and 31%, respectively. Univariate analysis showed renal insufficiency (P < .02), age >70 (P < .001), metabolic acidosis (P < .02), and symptom duration (P < .005), and bowel resection in second-look operations (P < .01) were associated with mortality. Logistic regression analysis showed age >70 (P = .03) and prolonged symptom duration (P = .02) were independent predictors of mortality.
Conclusions:
Elderly patients and those with a prolonged duration of symptoms had worse outcomes following surgical intervention for AMI. A high index of suspicion with prompt diagnostic evaluation may reduce time delay prior to surgical intervention, which may lead to improved patient survival. Aggressive surgical intervention should be performed as promptly as possible in patients once the diagnosis of AMI is made.
Insights
Elderly patients and those with prolonged symptoms face worse outcomes after acute mesenteric ischemia (AMI) surgery. Prompt diagnosis and aggressive surgical intervention are crucial for improving patient survival in AMI cases.
Area of Science:
- Vascular Surgery
- Gastrointestinal Surgery
- Surgical Outcomes Research
Background:
- Acute mesenteric ischemia (AMI) presents significant challenges due to diagnostic difficulty and high morbidity/mortality.
- Surgical management of AMI requires careful consideration of patient factors and intervention strategies.
Purpose of the Study:
- To review surgical management experiences in AMI patients.
- To identify factors associated with adverse outcomes after surgical interventions for AMI.
Main Methods:
- Retrospective review of hospital records and clinical data for 72 AMI patients over 12 years.
- Analysis of clinical outcomes and factors influencing mortality following surgical interventions.
Main Results:
- Thrombosis (67%) and embolism (33%) were primary causes of AMI.
- Common symptoms included abdominal pain (96%) and nausea (56%).
- Age >70, renal insufficiency, metabolic acidosis, prolonged symptom duration, and need for bowel resection were associated with mortality; age >70 and prolonged symptom duration were independent predictors.
Conclusions:
- Elderly patients and those with prolonged symptoms experienced worse outcomes.
- Prompt diagnosis and aggressive surgical intervention are vital for improving AMI patient survival.
- Minimizing delay between diagnosis and surgery is critical for better outcomes.
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