Acute Mesenteric Ischemia: Epidemiology, Risk Ractors and Determinants of Mortality

Acute mesenteric ischemia (AMI) is a condition with a difficult diagnosis and a high mortality rate. Despite the fact that AMI is a rather common condition in the elderly, review of the literature evidences lack of data concerning perioperative assessment of risk of death. The purpose of this study was to evaluate clinical, laboratory and imagiologic findings at admission and identify variables associated with adverse outcome with the final purpose of supporting treatment decision.

The clinical data of all patients admitted to Centro Hospitalar de Vila Nova de Gaia e Espinho with the diagnosis of AMI from January 2010 to December 2014 were retrospectively reviewed.

A total of 64 patients (40 females and 24 males) with a mean age of 78±9.7 years were included. The most common aetiology was arterial embolization (36% of cases) followed by arterial thrombosis (34%), non-occlusive mesenteric ischemia in 22% and venous thrombosis in 8%. Global mortality rate reached 62.3%, with higher rates amongst patients submitted to revascularization and bowel resection (80%). Several clinical and laboratory findings were evaluated. Univariate analysis showed that leucocytosis, lactate level >2 mmol/L, age >80 years and colon involvement were associated with higher mortality (p<0.05).

Contemporary management of AMI requires a high index of suspicion and rapid surgical intervention, if the time frame for intervention has not already elapsed. A better definition of determinants of mortality seems vital for treatment decision. More studies are needed to support clinical decision making in AMI.