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Updated: Jul 19, 2025
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Results after intraoperative open and endovascular revascularization of acute mesenteric ischemia requiring a
Marvin Kapalla1, Rahul Choubey2, Jürgen Weitz2
1Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Dresden, TU, Germany. Marvin.Kapalla@uniklinikum-dresden.de.
Background:
Acute mesenteric ischemia (AMI) is a dreaded condition with a difficult diagnosis and high mortality. Due to different baseline situations, the frequently performed comparison between endovascular and open surgical treatment is interfered with selection bias. The purpose of this study was to review outcomes in AMI treatment with an open or endovascular approach in association with laparotomy and to evaluate the endovascular-first strategy in similar clinical situations.
Methods:
The clinical data of 74 patients treated for AMI from 2007 to 2021 were retrospectively reviewed and compared. In-hospital mortality was appointed as the primary study endpoint. Risk factors for mortality were identified by using univariate and multivariate analysis.
Results:
In total, 61 patients (82%) were treated open surgically (OT) and, 13 patients (18%) with an endovascular approach (ET) in combination with laparatomy. The etiology of AMI was 49% arteriosclerotic and 51% thromboembolic occlusions. The total in-hospital mortality manifested at 43% (n =32) (OT 41% vs. ET 53.8%; P=0.54). As independent risk factors for in-hospital mortality, pneumatosis intestinalis (P=0.01), increased lactate concentration (P=0.04), and ischemic intestinal sections (P=0.01) were identified. Additionally, on univariate analysis patient age, congestive heart failure (> NYHA II) and atrial fibrillation were related with higher mortality.
Conclusions:
Morbidity and mortality of AMI remains at a high level. Conventional open or intraoperative endovascular therapy achieved similar results in patients with indication for laparotomy. Advanced disease stage with ischemic intestinal sections at presentation and cardiovascular comorbidities were associated with adverse outcome.
Insights
Acute mesenteric ischemia (AMI) treatment outcomes were similar for open surgery and endovascular approaches. Advanced disease and comorbidities increased mortality risk in AMI patients.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Interventional Radiology
Background:
- Acute mesenteric ischemia (AMI) presents diagnostic challenges and high mortality.
- Selection bias complicates comparisons between endovascular and open surgical treatments for AMI.
- Evaluating treatment outcomes for AMI requires careful consideration of patient baseline status.
Purpose of the Study:
- To compare outcomes of open surgical versus endovascular treatment for AMI in patients requiring laparotomy.
- To assess the efficacy of an endovascular-first strategy in specific clinical scenarios of AMI.
- To identify risk factors associated with mortality in AMI patients.
Main Methods:
- Retrospective review of clinical data from 74 AMI patients (2007-2021).
- Comparison of in-hospital mortality between open surgical (OT) and endovascular (ET) approaches.
- Univariate and multivariate analyses to identify mortality risk factors.
Main Results:
- In-hospital mortality was 43% overall (41% OT vs. 53.8% ET; P=0.54).
- Independent risk factors for mortality included pneumatosis intestinalis, elevated lactate, and ischemic bowel sections.
- Patient age, severe congestive heart failure, and atrial fibrillation were associated with increased mortality on univariate analysis.
Conclusions:
- Morbidity and mortality rates for AMI remain high.
- Open and endovascular therapies yielded similar outcomes in patients undergoing laparotomy.
- Advanced disease stage and cardiovascular comorbidities predict adverse outcomes in AMI.
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