Acute mesenteric ischemia: still high mortality rate in the era of 24-hour availability of angiography.
BACKGROUND
Acute mesenteric ischemia (AMI) is a serious condition with high mortality rate due to difficult and late diagnosis. Early and aggressive evaluation in high risk patients by mesenteric angiography is the key to the reduction in mortality rate. However; many physicians hesitated to perform it because of its availability, the risk of complications and high negative results. This study reviewed outcome of AMI in term of mortality rate, factors associated with mortality and the rate of angiography in high risk patients.


METHODS
The clinical data of the patients who were diagnosed as AMI were retrospectively reviewed. The clinical outcome was recorded and the factors associated with mortality were analysed.


RESULTS
Thirty-five patients were enrolled into this study during 5 years. The mortality rate was 74.3%. There were 22 high risk patients for AMI. The rate of angiography performed in this group was 4.5% (1/22). The factors associated with mortality were age more than 60 years, patients with peritonitis, hypotension, arterial cause, time interval between admission and operation or treatment more than 24 hours, bowel gangrene >100 cms. However all these factors were not statistically significant.


CONCLUSIONS
The mortality rate of AMI is still high even at the tertiary hospital where the angiography is available 24 hours. To decrease the mortality rate, the physicians must have the high index of suspicion in high risk patients and do not hesitate to perform early mesenteric angiography.
Nonthasoot
Bunthoon
B
Department of Surgery, Faculty of Medicine, Chulalongkorn University, Thailand, Bangkok, Thailand.
Tullavardhana
Thawatchai
T
Sirichindakul
Boonchoo
B
Suphapol
Jade
J
Nivatvongs
Supanit
S
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D005260:Female; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000401:mortality* / Q000517:prevention & control; D008297:Male; D008638:Mesenteric Arteries / Q000000981:diagnostic imaging*; D008641:Mesenteric Vascular Occlusion / Q000000981:diagnostic imaging / Q000401:mortality* / Q000517:prevention & control; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome