Retrograde open mesenteric stenting and outcomes for acute mesenteric ischemia

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Gastroenterology

Background:

• Limited data exists on retrograde open mesenteric stenting (ROMS) for acute mesenteric ischemia.
• Existing studies are small, single-center, and lack defined outcomes.
• Patient populations and utilization of ROMS vary widely.

Purpose of the Study:

• To evaluate the characteristics and outcomes of patients with acute mesenteric ischemia requiring urgent surgical intervention.
• To compare ROMS with traditional open bypass and open superior mesenteric artery (SMA) embolectomy.
• To identify factors associated with mortality in acute mesenteric ischemia.

Main Methods:

• Retrospective cohort study using the National Inpatient Sample (NIS) database (2018-2020).
• Included 898 patients undergoing urgent surgical intervention for mesenteric ischemia.
• Groups: open bypass (BYPASS), open SMA embolectomy (OPEN), and ROMS. Statistical analysis included t-tests, chi-squares, and multivariate regression.

Main Results:

• ROMS patients were older and had higher comorbidity scores but experienced the lowest mortality (15.9%) compared to BYPASS (19.7%) and OPEN (34.5%).
• ROMS was associated with a 50% decreased incidence of mortality (OR 0.45).
• Open SMA embolectomy (OR 2.0) and previous myocardial infarction (OR 1.9) increased mortality, while peripheral vascular disease (PVD) showed a protective effect (OR 0.56).

Conclusions:

• ROMS demonstrated a significant mortality benefit over traditional open procedures for acute mesenteric ischemia.
• Advanced age, history of MI, and open SMA embolectomy are associated with increased mortality.
• ROMS may be a superior alternative for restoring mesenteric flow in acute settings, warranting further prospective studies.