Etiology is a Factor when Choosing Endovascular or Open Treatment for Acute Mesenteric Ischemia

Abstract

Background

The role of endovascular therapy for patients presenting with AMI continues to be debated. This study was undertaken to compare open and endovascular treatment of AMI.

Methods

All patients who presented with AMI between 2010 and 2022 were identified. Patient demographics, baseline laboratory studies, length of stay (LOS), and outcomes were recorded. Student’s t-test was used for quantitative data and Fisher’s exact test for qualitative data.

Results

Sixty-five patients were treated for AMI: 47 with an open procedure; 18 with endovascular techniques. Of the 18 patients in the endovascular group, 8 (45%) underwent laparotomy/laparoscopy; four (22%) requiring bowel resection. Patients treated with an endovascular approach were more likely to be male (87% vs 45%, P = .025), be caused by thrombosis (78% vs 55%, P = .005), have lower incidence of other vascular disease (56% vs 87%, P = .015) and have a lower initial WBC (11.9 ± 3.9 vs 18.5 ± 8.4, P = .0017). There was shorter ICU LOS in the endovascular group (5.5 ± 5.7 vs 13.5 ± 13.8, P = .025). A trend for decreased bowel resection was seen in the endovascular group compared the open group [4 (22%) vs 19 (40%), P = .25]. A trend for lower mortality was seen in the endovascular group compared to the open group (22% vs 40%, P = .25). In the 23 patients that died, the cause of death was directly related to bowel ischemia in 16 (70%), cardiac in 5 (22%) and stroke in 2 (9%).

Conclusion

Endovascular treatment of AMI has potentially lower mortality and lengths of stay. When choosing endovascular vs open treatment, the status of the bowel should be an important initial determinate. We recommend that the underlying etiology (thrombosis vs embolic) also be a consideration with a low threshold for conversion to an open procedure if endovascular treatment does not rapidly restore mesenteric flow in patients with embolic disease.