[Acute mesenteric ischemia: changes in 1985-1995. Surgical Research Associations]

Acute mesenteric ischaemia (AMI) resulting in intestinal ischaemia and/or infarction is associated with an extremely serious prognosis and a mortality rate ranging from 40% to 100%. The aim of the study is to appreciate the epidemiological, therapeutic and prognostic changing aspects of the AMI over a decade.

Two retrospective and multicentric series (492 and 305 patients, respectively) identically collected between 1980-1985 and 1990-1995 by the French Associations of Surgical Research were compared. Comparisons concerned the patients' clinical features, the aetiology of AMI and the surgical management. The mortality was analysed taking into account the former items.

The overall mortality rate decreased from 77% to 59% (P < 0.0001). The patients' preoperative clinical features improved but collapse remained the main serious factor. The rate of venous origin AMI increased significantly (P < 0.02) with a mortality decrease (51% to 19%, P < 0.0001). The mortality rate of thrombotic origin AMI decreased (83% to 63%, P < 0.0001). The results of surgical management improved, even though the frequency of angiographies, vascular and second-look procedures did not increase.

Even though the prognosis of AMI remains extremely serious, a significant decrease of the overall mortality rate is observed. Two ways of progress can be recommended: the first, successfully initiated involving better management of the patients with a greater number of classical surgical procedures; the second, more aggressive treatment advocated by more specialised surgical teams.