Causes and consequences of mesenteric embolization after endovascular aorto-iliac intervention - a nested case...

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Gastrointestinal Medicine

Background:

• Mesenteric embolization following endovascular aorto-iliac procedures is an understudied complication.
• Understanding its causes and consequences is crucial for patient outcomes.

Purpose of the Study:

• To investigate the risk factors and clinical characteristics of mesenteric embolization after endovascular aorto-iliac interventions.
• To identify potential diagnostic markers and effective management strategies.

Main Methods:

• A case-control study comparing 9 patients with mesenteric embolization to 36 matched controls.
• Data collected included patient demographics, comorbidities, procedural details, and biochemical markers.

Main Results:

• Current smokers and patients with renal insufficiency were more prevalent in the case group.
• Severe aortic irregularity (shagginess) and larger visceral thrombus were associated with embolization in aorto-iliac occlusive disease.
• Elevated myoglobin, lactate, AST, ALT, and amylase were observed in patients with mesenteric embolization.
• In-hospital mortality was 33% for cases, with open abdomen therapy and stomas used in some survivors.

Conclusions:

• Smoking cessation and careful patient selection, particularly identifying severe aortic shagginess, may prevent mesenteric embolization.
• Elevated myoglobin and lactate can indicate mesenteric embolization; AST, ALT, and amylase help assess organ ischemia.
• Damage control with open abdomen therapy and stomas may be beneficial for survival in complex cases.