title: Acute mesenteric ischemia: Utility of endovascular techniques.
abstract: BACKGROUND
  Acute mesenteric ischemia (AMI) has a high mortality. Early diagnosis and treatment are very important. In our institution there is a therapeutic protocol that includes endovascular techniques (ET) in patients with AMI without peritoneal irritation at diagnosis. The aim of this study was to evaluate the use of ET in conjunction with conventional surgery in the management of potentially reversible IMA diagnosed by computed tomography (CT-angiography).
  
  
  METHODS
  Observational, descriptive and retrospective study that evaluated the use of ET in patients with AMI (arterial origin) in 2 periods (before and after the application of a protocol that includes ET), between 2009-2013. All patients were diagnosed by a CT-angiography, as the diagnostic technique of choice, because of the clinical and analytical suspicion.
  
  
  RESULTS
  Our series included 73 patients with IMA diagnosed by CT-angiography (45: 2009-2011; 28: 2012-2013). Leukocytosis was common (82%), high lactate levels are less frequent (47% vs. 53%). There were 49 patients with IMA without peritoneal irritation. In 51% bowel resection surgery was performed (44% survival); 18%: revascularization by ET (survival 67%); 31%: palliative treatment (0% survival). 33% of patients undergoing first-line RVI needed a surgical rescue (bowel resection). The overall mortality was 67% (2009-2011) vs. 62% (2012-2013).
  
  
  CONCLUSIONS
  Since the protocol application, there is a higher indication of ET in patients with AMI without peritoneal irritation, showing a decreased mortality. With ET application, there is a higher survival in these patients. In our experience, the use of ET in cases of AMI without peritoneal irritation at diagnosis, may increase survival.
authors: Servicio Cirugía General y del Aparato Digestivo, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí-Universitat Autònoma de Barcelona. Electronic address: annserracant@gmail.com.
authors: Anna
authors: A
authors: Serracant Barrera
authors: Servicio Cirugía General y del Aparato Digestivo, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí-Universitat Autònoma de Barcelona.
authors: Alexis
authors: A
authors: Luna Aufroy
authors: Servicio Cirugía General y del Aparato Digestivo, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí-Universitat Autònoma de Barcelona.
authors: José Manuel
authors: JM
authors: Hidalgo Rosas
authors: Servicio Cirugía General y del Aparato Digestivo, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí-Universitat Autònoma de Barcelona.
authors: Gabriel
authors: G
authors: Cánovas Moreno
authors: Unidad Radiología Vascular Intervencionista, UDIAT-Centre Diagnòstic, Corporació Parc Taulí, Sabadell, Institut Universitari Parc Taulí-Universitat Autònoma de Barcelona, Barcelona, España.
authors: José Ramón
authors: JR
authors: Fortuño Andres
authors: Unidad Radiología Vascular Intervencionista, UDIAT-Centre Diagnòstic, Corporació Parc Taulí, Sabadell, Institut Universitari Parc Taulí-Universitat Autònoma de Barcelona, Barcelona, España.
authors: Joan
authors: J
authors: Falcó Fages
authors: Servicio Cirugía General y del Aparato Digestivo, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Institut Universitari Parc Taulí-Universitat Autònoma de Barcelona.
authors: Salvador
authors: S
authors: Navarro Soto
mesh_terms: D057510:Endovascular Procedures / Q000009:adverse effects; D006801:Humans; D007511:Ischemia / Q000175:diagnosis; D065666:Mesenteric Ischemia; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000009:adverse effects
keywords: Acute mesenteric ischemia; Endovascular revascularization; Endovascular techniques; Isquemia mesentérica aguda; Radiología vascular intervencionista; Revascularización endovascular