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Multimodality Diagnosis of Mesenteric Ischemia
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Endovascular interventions decrease length of hospitalization and are cost-effective in acute mesenteric ischemia.

Young Erben1, Clinton D Protack2, Raymond A Jean3

  • 1Section of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn.

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|February 21, 2018
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Summary
This summary is machine-generated.

Endovascular intervention for acute mesenteric ischemia (AMI) is associated with significantly lower mortality and hospitalization costs compared to open surgery. This approach also reduces the risk of acute kidney injury and improves discharge outcomes.

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Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Gastroenterology

Background:

  • Acute mesenteric ischemia (AMI) is a critical vascular emergency with high morbidity and mortality.
  • A national shift towards endovascular procedures offers potential benefits in patient outcomes.
  • Evaluating the impact of endovascular interventions on AMI treatment is crucial.

Purpose of the Study:

  • To assess trends in endovascular versus open surgical revascularization for AMI.
  • To determine the impact of these treatment modalities on hospitalization length and costs.
  • To analyze secondary outcomes including acute kidney injury, mortality, and discharge disposition.

Main Methods:

  • Retrospective analysis of the National Inpatient Sample (2004-2014).
  • Inclusion of patients with AMI treated with open surgical revascularization (OPEN) or endovascular intervention (ENDO).
  • Comparison of primary endpoints (length of stay, hospitalization cost) and secondary endpoints (AKI, mortality, discharge status).

Main Results:

  • Endovascular intervention (ENDO) was associated with significantly lower in-hospital mortality (12.3% vs. 33.1%) and lower mean hospitalization costs ($41,615 vs. $60,286) compared to open surgery (OPEN).
  • Propensity-adjusted analysis confirmed OPEN was linked to higher mortality (OR 3.0) and costs (mean difference $9196).
  • Patients undergoing OPEN had a higher risk of acute kidney injury and discharge to skilled nursing facilities.

Conclusions:

  • Despite increasing use, endovascular intervention has not yet surpassed open revascularization for AMI.
  • Endovascular treatment demonstrates a one-third lower mortality rate, improved survival to discharge, and significant cost savings.
  • Endovascular approaches reduce the likelihood of acute kidney injury and facilitate home discharge.