Endovascular Therapy as a Primary Revascularization Modality in Acute Mesenteric Ischemia.
OBJECTIVE
To evaluate endovascular therapy (EVT) as the primary revascularization method for acute mesenteric ischemia (AMI).


METHODS
A retrospective review was performed on all consecutive patients treated for AMI during a 5-year period (January 2009 to December 2013). EVT was attempted in all patients referred for emergent revascularization. Surgical revascularization was performed selectively after failure of EVT. Patient characteristics, clinical presentation, and outcomes were studied. Failures and complications of EVT were recorded.


RESULTS
Fifty patients, aged 79 ± 9 years (mean ± SD), out of 66 consecutive patients with AMI secondary to embolic or thrombotic obstruction of the superior mesenteric artery were referred for revascularization. The etiology of AMI was embolism in 18 (36 %) and thrombosis in 32 (64 %) patients. EVT was technically successful in 44 (88 %) patients. Mortality after successful or failed EVT was 32 %. The rates of emergency laparotomy, bowel resection, and EVT-related complication were 40, 34, and 10 %, respectively. Three out of six patients with failure of EVT were treated with surgical bypass. EVT failure did not significantly affect survival.


CONCLUSIONS
EVT is feasible in most cases of AMI, with favorable patient outcome and acceptable complication rate.
Heart Center, Kuopio University Hospital, PL 100, 70029 KYS, Kuopio, Finland. jkarkkai@gmail.com.|Department of Gastrointestinal Surgery, Kuopio University Hospital, PL 100, 70029 KYS, Kuopio, Finland. jkarkkai@gmail.com.
Jussi M
JM
Kärkkäinen
Department of Clinical Radiology, Kuopio University Hospital, PL 100, 70029 KYS, Kuopio, Finland. tiina.lehtimaki@kuh.fi.
Tiina T
TT
Lehtimäki
Department of Clinical Radiology, Kuopio University Hospital, PL 100, 70029 KYS, Kuopio, Finland. petri.saari@kuh.fi.
Petri
P
Saari
Heart Center, Kuopio University Hospital, PL 100, 70029 KYS, Kuopio, Finland. juha.hartikainen@kuh.fi.|University of Eastern Finland, PL 1627, 70211, Kuopio, Finland. juha.hartikainen@kuh.fi.
Juha
J
Hartikainen
Department of Gastrointestinal Surgery, Kuopio University Hospital, PL 100, 70029 KYS, Kuopio, Finland. tuomo.rantanen@kuh.fi.
Tuomo
T
Rantanen
Department of Gastrointestinal Surgery, Kuopio University Hospital, PL 100, 70029 KYS, Kuopio, Finland. hannu.paajanen@kuh.fi.|University of Eastern Finland, PL 1627, 70211, Kuopio, Finland. hannu.paajanen@kuh.fi.
Hannu
H
Paajanen
Department of Clinical Radiology, Kuopio University Hospital, PL 100, 70029 KYS, Kuopio, Finland. hannu.manninen@kuh.fi.|University of Eastern Finland, PL 1627, 70211, Kuopio, Finland. hannu.manninen@kuh.fi.
Hannu
H
Manninen
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D057510:Endovascular Procedures / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D065666:Mesenteric Ischemia / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
Acute mesenteric ischemia; Angioplasty; Endovascular revascularization; Mechanical thrombectomy; Stenting; Superior mesenteric artery