Effect of Timing on Endovascular Therapy and Exploratory Laparotomy Outcome in Acute Mesenteric Ischemia

Ann Gastroenterol. Nov-Dec 2019;32(6):600-604. doi: 10.20524/aog.2019.0419. Epub 2019 Sep 26.

Abstract

Background: Abdominal exploration followed by vascular bypass has been the standard of care for acute mesenteric ischemia (AMI), but there is increasing use of endovascular treatment with selective exploratory laparotomy.

Methods: We performed a retrospective review of patients diagnosed with AMI who underwent mesenteric artery angioplasty or stenting at a single institution from 2010-2017. Patients were divided into 3 groups: those who did not undergo exploratory laparotomy; those who received endovascular treatment before laparotomy (post-reperfusion laparotomy group); and those who had endovascular treatment after laparotomy (pre-reperfusion laparotomy group).

Results: Patients who did not undergo exploratory laparotomy showed 85.7% (12/14) survival, compared with 63.6% (7/11) in the post-reperfusion group and 25.0% (2/8) in the pre-reperfusion group, P=0.077). Time to reperfusion was significant (P=0.009) in predicting survival for patients who underwent exploratory laparotomy.

Conclusion: Emergent endovascular treatment prior to laparotomy seems to be associated with a higher survival.

Keywords: Acute mesenteric ischemia; endovascular therapy; stenting.