Surgical and endovascular treatment for mesenteric ischemia

Abstract

Aim: Mesenteric ischemia is a rare, highly fatal, surgical emergency. In addition to open surgical (OS) intervention, endovascular treatment (ET) was also recommended for treatment in last years. Surgical resection becomes inevitable in the cases of intestinal ischemia. We aimed to assess patient-related factors and compare treatment outcomes in mesenteric ischemia treated by OS and ET. Material and Methods: Patients treated for mesenteric vascular occlusion at our hospital between 2013 and 2018 were retrospectively evaluated. Duration of symptoms, time from symptom onset to treatment, treatment used and surgery used, re-laparotomy need, duration of intensive care unit stay, duration of hospital stay, and 30-day and 1-year mortality rates were evaluated. Results: Twenty patients with mesenteric ischemia were evaluated. The OS group had a significantly higher CCI score than the ET group (p<0.05). The most common comorbidities in the OS and ET groups were coronary artery disease and hypertension, respectively. The duration of symptoms and time from symptom onset to treatment were significantly shorter in the OS group than the ET group (p<0.05). The OS group most commonly had SMA emboli while the ET group most common had chronic SMA occlusion (p<0.05). Thirty-day and 1-year mortality rates were significantly greater in the OS group than the ET group (p<0.05). Conclusion: Mesenteric ischemia is a highly morbid and fatal condition. ET significantly reduces morbidity and mortality in the face of signs of intestinal ischemia. On the other hand, OS would be inevitable for patients with signs of diffuse peritoneal irritation or those with suspected intestinal necrosis.