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Endovascular First Approach for Acute Embolic Mesenteric Ischaemia: A 15 Year Single Centre Retrospective Study.

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Endovascular treatment is a suitable first-line approach for acute mesenteric ischemia (AMI) from embolic occlusion, achieving high technical success. While mortality is considerable, this method may reduce the need for laparotomy compared to open surgery.

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Area of Science:

  • Vascular Surgery
  • Interventional Radiology
  • Gastroenterology

Background:

  • Acute mesenteric ischemia (AMI) is a critical condition with high mortality.
  • Embolic occlusion of mesenteric arteries is a common cause of AMI.
  • Traditional treatment often involves open surgery, which carries significant risks.

Purpose of the Study:

  • To evaluate the outcomes of endovascular treatment as a primary approach for embolic AMI.
  • To assess technical success, complications, mortality, and need for laparotomy after endovascular intervention.

Main Methods:

  • Retrospective, single-center study of patients with occlusive AMI (2009-2024).
  • Included patients with acute embolic mesenteric artery occlusion; excluded thrombotic cases.
  • Assessed outcomes including technical success, procedure-related complications, 30-day mortality, laparotomy, and bowel resection rates.

Main Results:

  • 48 patients (76%) underwent endovascular revascularization with 98% technical success.
  • 15% experienced procedure-related complications (e.g., SMA dissection).
  • 30-day mortality was 44%, associated with older age, peritonitis, and metabolic derangements.

Conclusions:

  • Endovascular treatment is a viable first-line option for embolic AMI, offering good technical success.
  • Mortality rates are acceptable given the patient population's high average age and severity of AMI.
  • This approach potentially reduces the need for laparotomy compared to open embolectomy.