title: A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia.
abstract: OBJECTIVE
  Few centers have adopted endovascular therapy for the treatment of acute mesenteric ischemia (AMI). We sought to evaluate the effect of endovascular therapy on outcomes for the treatment of AMI.
  
  
  METHODS
  A single-center, retrospective cohort review was performed on all consecutive patients with thrombotic or embolic AMI presenting between 1999 and 2008. Patients with mesenteric venous thrombosis, nonocclusive mesenteric ischemia, and ischemia associated with aortic dissection were excluded. Demographic factors, preoperative metabolic status, and etiology were compared. Primary clinical outcomes included endovascular technical success, operative complications, and in-hospital mortality.
  
  
  RESULTS
  Seventy consecutive patients were identified with AMI (mean age, 64 ± 13 years). Etiology of mesenteric ischemia was 65% thrombotic and 35% embolic occlusions. Endovascular revascularization was the preferred treatment (81%) vs operative therapy (19%). Successful endovascular treatment was achieved in 87%. Endovascular therapy required laparotomy in 69% vs traditional therapy in 100% (P < .05), with a median 52-cm necrotic bowel resected (interquartile range [IQR], 11-140 cm) vs 160 cm (IQR, 90-250 cm; P < .05), respectively. Acute renal failure and pulmonary failure occurred less frequently with endovascular therapy (27% vs 50%; P < .05 and 27% vs 64%; P < .05). Successful endovascular treatment resulted in a mortality rate of 36% compared with 50% (P < .05) with traditional therapy, whereas the mortality rate for endovascular failures was 50%. Endovascular therapy was associated with improved mortality in thrombotic AMI (odds ratio, 0.10; 95% confidence interval, 0.10-0.76; P < .05).
  
  
  CONCLUSIONS
  Endovascular therapy has altered the management of AMI, and there are measurable advantages to this approach. Using endovascular therapy as the primary modality for AMI reduces complications and improves outcomes.
authors.affiliation: Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA. arthursz@mac.com
authors.forename: Zachary M
authors.initials: ZM
authors.lastname: Arthurs
authors.forename: Jessica
authors.initials: J
authors.lastname: Titus
authors.forename: Mohsen
authors.initials: M
authors.lastname: Bannazadeh
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Eagleton
authors.forename: Sunita
authors.initials: S
authors.lastname: Srivastava
authors.forename: Timur P
authors.initials: TP
authors.lastname: Sarac
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Clair
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D000368:Aged; D000800:Angioplasty, Balloon; D016009:Chi-Square Distribution; D017128:Embolectomy; D004617:Embolism / Q000150:complications / Q000628:therapy; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000401:mortality / Q000628:therapy; D008297:Male; D065666:Mesenteric Ischemia; D008641:Mesenteric Vascular Occlusion / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D016017:Odds Ratio; D009820:Ohio; D012131:Respiratory Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000150:complications / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000209:etiology / Q000401:mortality / Q000628:therapy; D058017:Vascular Grafting; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality