title: Effects of a multimodal management strategy for acute mesenteric ischemia on survival and intestinal failure.
abstract: OBJECTIVE
  Acute mesenteric ischemia (AMI) is an emergency with a high mortality rate; survivors have high rates of intestinal failure. We performed a prospective study to assess a multidisciplinary and multimodal management approach, focused on intestinal viability.
  
  
  METHODS
  In an Intestinal Stroke Center, we developed a multimodal management strategy involving gastroenterologists, vascular and abdominal surgeons, radiologists, and intensive care specialists; it was tested in a pilot study on 18 consecutive patients with occlusive AMI, admitted to a tertiary center from July 2009 to November 2011. Patients with left ischemic colitis, nonocclusive AMI, chronic mesenteric ischemia, and other emergencies were excluded. Patients received specific medical management: revascularization of viable small bowel and/or resection of nonviable small bowel; 12 patients received arterial revascularization. We evaluated the percentages of patients who survived for 30 days or 2 years, the number with permanent intestinal failure, and morbidity. Lengths and rates of intestinal resection were compared with or without revascularization, and in patients with early or late-stage disease.
  
  
  RESULTS
  Patients were followed up for a mean of 497 days (range, 7-2085 d); 95% survived for 30 days, 89% survived for 2 years, and 28% had morbidities within 30 days. Intestinal resection was necessary for 7 cases (39%), with mean lengths of intestinal resection of 30 cm and 207 cm, with or without revascularization, respectively (P = .03). Among patients with early or late-stage AMI, rates of resection were 18% and 71%, respectively (P = .049). Patients with early stage disease had shorter lengths of intestinal resection than those with late-stage disease (7 vs 94 cm; P = .02), and spent less time in intensive care (2.5 vs 49.8; P = .02).
  
  
  CONCLUSIONS
  A multidisciplinary and multimodal management approach might increase survival of patients with AMI and prevent intestinal failure.
authors.affiliation: Department of Gastroenterology, Inflammatory Bowel Diseases, Nutritional Support and Intestinal Transplantation, Beaujon Hospital Clichy, Paris VII University, Clichy, France. olivier.corcos@bjn.aphp.fr
authors.forename: Olivier
authors.initials: O
authors.lastname: Corcos
authors.forename: Yves
authors.initials: Y
authors.lastname: Castier
authors.forename: Annie
authors.initials: A
authors.lastname: Sibert
authors.forename: Sebastien
authors.initials: S
authors.lastname: Gaujoux
authors.forename: Maxime
authors.initials: M
authors.lastname: Ronot
authors.forename: Francisca
authors.initials: F
authors.lastname: Joly
authors.forename: Catherine
authors.initials: C
authors.lastname: Paugam
authors.forename: Frederic
authors.initials: F
authors.lastname: Bretagnol
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdel-Rehim
authors.forename: Fadi
authors.initials: F
authors.lastname: Francis
authors.forename: Vanessa
authors.initials: V
authors.lastname: Bondjemah
authors.forename: Marianne
authors.initials: M
authors.lastname: Ferron
authors.forename: Magaly
authors.initials: M
authors.lastname: Zappa
authors.forename: Aurelien
authors.initials: A
authors.lastname: Amiot
authors.forename: Carmen
authors.initials: C
authors.lastname: Stefanescu
authors.forename: Guy
authors.initials: G
authors.lastname: Leseche
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Marmuse
authors.forename: Jacques
authors.initials: J
authors.lastname: Belghiti
authors.forename: Philippe
authors.initials: P
authors.lastname: Ruszniewski
authors.forename: Valerie
authors.initials: V
authors.lastname: Vilgrain
authors.forename: Yves
authors.initials: Y
authors.lastname: Panis
authors.forename: Jean
authors.initials: J
authors.lastname: Mantz
authors.forename: Yoram
authors.initials: Y
authors.lastname: Bouhnik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D003422:Critical Care / Q000379:methods; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D007511:Ischemia / Q000401:mortality* / Q000628:therapy*; D008297:Male; D065666:Mesenteric Ischemia; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000401:mortality* / Q000628:therapy*