title: Surgical management of thrombotic acute intestinal ischemia.
abstract: OBJECTIVE
  To evaluate the University of Kentucky experience in treating acute intestinal ischemia to elucidate factors that contribute to survival.
  
  
  BACKGROUND
  Acute intestinal ischemia is reported to have a poor prognosis, with survival rates ranging from 0% to 40%. This is based on several reports, most of which were published more than a decade ago. Remarkably, there is a paucity of recent studies that report on current outcome for acute mesenteric ischemia.
  
  
  METHODS
  A comparative retrospective analysis was performed on patients who were diagnosed with acute intestinal ischemia between May 1993 and July 2000. Patients were divided into two cohorts: nonthrombotic and thrombotic causes. The latter cohort was subdivided into three etiologic subsets: arterial embolism, arterial thrombosis, and venous thrombosis. Patient demographics, clinical characteristics, risk factors, surgical procedures, and survival were analyzed. Survival was compared with a collated historical series.
  
  
  RESULTS
  Acute intestinal ischemia was diagnosed in 170 patients. The etiologies were nonthrombotic (102/170, 60%), thrombotic (58/170, 34%), or indeterminate (10/170, 6%). In the thrombotic cohort, arterial embolism accounted for 38% (22/58) of the cases, arterial thrombosis for 36% (21/58), and venous thrombosis for 26% (15/58). Patients with venous thrombosis were younger. Venous thrombosis was observed more often in men; arterial thrombosis was more frequent in women. The survival rate was 87% in the venous thrombosis group versus 41% and 38% for arterial embolism and thrombosis, respectively. Compared with the collated historical series, the survival rate was 52% versus 25%.
  
  
  CONCLUSIONS
  These results indicate that the prognosis for patients with acute intestinal ischemia is substantially better than previously reported.
authors.affiliation: University of Kentucky College of Medicine, Department of Surgery, Lexington, Kentucky 40536, USA. edende0@pop.uky.edu
authors.forename: E D
authors.initials: ED
authors.lastname: Endean
authors.forename: S L
authors.initials: SL
authors.lastname: Barnes
authors.forename: C J
authors.initials: CJ
authors.lastname: Kwolek
authors.forename: D J
authors.initials: DJ
authors.lastname: Minion
authors.forename: T H
authors.initials: TH
authors.lastname: Schwarcz
authors.forename: R M
authors.initials: RM
authors.lastname: Mentzer
mesh_terms: D000367:Age Factors; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D007511:Ischemia / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008641:Mesenteric Vascular Occlusion / Q000000981:diagnostic imaging / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed