Surgical management of thrombotic acute intestinal ischemia

Abstract

Objective: To evaluate the University of Kentucky experience in treating acute intestinal ischemia to elucidate factors that contribute to survival.

Summary background data: Acute intestinal ischemia is reported to have a poor prognosis, with survival rates ranging from 0% to 40%. This is based on several reports, most of which were published more than a decade ago. Remarkably, there is a paucity of recent studies that report on current outcome for acute mesenteric ischemia.

Methods: A comparative retrospective analysis was performed on patients who were diagnosed with acute intestinal ischemia between May 1993 and July 2000. Patients were divided into two cohorts: nonthrombotic and thrombotic causes. The latter cohort was subdivided into three etiologic subsets: arterial embolism, arterial thrombosis, and venous thrombosis. Patient demographics, clinical characteristics, risk factors, surgical procedures, and survival were analyzed. Survival was compared with a collated historical series.

Results: Acute intestinal ischemia was diagnosed in 170 patients. The etiologies were nonthrombotic (102/170, 60%), thrombotic (58/170, 34%), or indeterminate (10/170, 6%). In the thrombotic cohort, arterial embolism accounted for 38% (22/58) of the cases, arterial thrombosis for 36% (21/58), and venous thrombosis for 26% (15/58). Patients with venous thrombosis were younger. Venous thrombosis was observed more often in men; arterial thrombosis was more frequent in women. The survival rate was 87% in the venous thrombosis group versus 41% and 38% for arterial embolism and thrombosis, respectively. Compared with the collated historical series, the survival rate was 52% versus 25%.

Conclusions: These results indicate that the prognosis for patients with acute intestinal ischemia is substantially better than previously reported.

Figure 1. Abdominal computed tomography scan in a patient with mesenteric venous thrombosis. The arrow points to the superior mesenteric vein. The vein is distended with intraluminal thrombus. The venous wall is enhanced with contrast as a result of arterial filling of the venous vasa vasorum and gives a halo effect.

Figure 2. Selective arteriogram of the superior mesenteric artery that shows findings consistent with an embolus (arrow). The proximal branches are perfused; the distal artery is occluded.