title: Multidisciplinary stepwise management strategy for acute superior mesenteric venous thrombosis: an intestinal stroke center experience.
abstract: BACKGROUND
  Acute superior mesenteric venous thrombosis (ASMVT) is an uncommon but catastrophic abdominal vascular emergency with high rate of intestinal failure and mortality. The retrospective pilot study was performed to assess the effect of a multidisciplinary stepwise management strategy on survival and mesenteric recanalization in an integrated intestinal stroke center (ISC).
  
  
  METHODS
  A modern management strategy performed by multidisciplinary specialists in ISC was evaluated among 43 ASMVT patients that were classified into central vs peripheral type, operative vs nonoperative, early vs late treated group from March 2009 to April 2013. Patients received specific medical therapy, endovascular treatment, damage-control surgery, selective second-look laparotomy, critical care management, and clinical nutrition support in a stepwise way. The demographics, etiology, imaging characteristics, treatment procedures, complications, clinical outcome, and 1-year follow-up data were analyzed and compared. Confounding factors of mortality were identified by univariate and ROC-curve analysis. A single-center experience of over 5years for this modern strategy was also reported.
  
  
  RESULTS
  The protocol of multidisciplinary stepwise management strategy was followed in all ASMVT patients successfully. The 30-day mortality and recanalization rate were 11.63% and 90.70%. Initial damage-control surgery was carried out in 46.51% patients, with selective second-look laparotomy in 23.26% patients. Endovascular thrombolysis was performed in 83.72% patients initially or postoperatively. Bowel resection was necessary in 18 patients with the length of 100.00 (47.50, 222.50) cm. The incidence of short-bowel syndrome was 13.95%. The rate and length of bowel resection, short-bowel syndrome rate were significantly lower in nonoperative and early-treated groups (P<0.05). During the follow-up survey, 1-year survival was 83.72%, with no additional death or re-thrombosis.
  
  
  CONCLUSIONS
  A multidisciplinary stepwise management strategy involving modern surgical and endovascular treatments that focus on early mesenteric recanalization and bowel viability salvage in a specialized ISC could significantly improve the clinical outcome of ASMVT patients.
authors.affiliation: Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Department of Vascular Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Integrated Intestinal Stroke Center, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China. Electronic address: yangshuofei@gmail.com.
authors.forename: Shuofei
authors.initials: S
authors.lastname: Yang
authors.affiliation: Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Department of Vascular Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Integrated Intestinal Stroke Center, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China. Electronic address: fanxinxin2014@sohu.com.
authors.forename: Xinxin
authors.initials: X
authors.lastname: Fan
authors.affiliation: Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Department of Vascular Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Department of Gastroenterology, Inflammatory Bowel Diseases, Nutritional Support and Intestinal Transplantation, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Integrated Intestinal Stroke Center, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China. Electronic address: dingwei_nju@hotmail.com.
authors.forename: Weiwei
authors.initials: W
authors.lastname: Ding
authors.affiliation: Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Department of Vascular Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Integrated Intestinal Stroke Center, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China. Electronic address: 306446264@qq.com.
authors.forename: Baochen
authors.initials: B
authors.lastname: Liu
authors.affiliation: Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Department of Vascular Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Integrated Intestinal Stroke Center, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China. Electronic address: 774994964@qq.com.
authors.forename: Jiaxiang
authors.initials: J
authors.lastname: Meng
authors.affiliation: Department of Gastroenterology Nursing and ostomy care, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Integrated Intestinal Stroke Center, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China. Electronic address: xudandan2014@sohu.com.
authors.forename: Dandan
authors.initials: D
authors.lastname: Xu
authors.affiliation: Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Department of Vascular Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Department of Radiology and Intervention Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Integrated Intestinal Stroke Center, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China. Electronic address: hechsh@163.com.
authors.forename: Changsheng
authors.initials: C
authors.lastname: He
authors.affiliation: Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Surgical Intensive Care Unit, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Integrated Intestinal Stroke Center, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China. Electronic address: yudrnj@163.com.
authors.forename: Wenkui
authors.initials: W
authors.lastname: Yu
authors.affiliation: Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Department of Vascular Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Department of Radiology and Intervention Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Integrated Intestinal Stroke Center, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China. Electronic address: xingjiangwu@gmail.com.
authors.forename: Xingjiang
authors.initials: X
authors.lastname: Wu
authors.affiliation: Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Department of Gastroenterology, Inflammatory Bowel Diseases, Nutritional Support and Intestinal Transplantation, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Surgical Intensive Care Unit, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China; Integrated Intestinal Stroke Center, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, P. R. China. Electronic address: lijieshou2013@sohu.com.
authors.forename: Jieshou
authors.initials: J
authors.lastname: Li
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007422:Intestines / Q000473:pathology; D010535:Laparoscopy; D008297:Male; D065666:Mesenteric Ischemia / Q000628:therapy; D008875:Middle Aged; D010865:Pilot Projects; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000503:physiopathology*; D016896:Treatment Outcome; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000628:therapy*
chemical_list: D000925:Anticoagulants
keywords: endovascular recanalization; intestinal failure; mesenteric venous thrombosis; multidisciplinary management; superior mesenteric vein