Acute mesenteric ischemia is a disease with high morbidity and mortality, and it is traditionally treated with open surgery. Endovascular therapy and hybrid techniques are alternative treatments that are also currently available. We performed a meta-analysis to evaluate the outcomes of the different treatment approaches in the last 20 years.
Methods
Studies on acute mesenteric ischemia that were indexed in PubMed, Embase, and MEDLINE databases (from January 1, 2000, to April 1, 2021) were reviewed. All related retrospective observational studies and case series were included. A random-effects model was used to calculate pooled estimates, and the results were reported as proportions and 95% confidence intervals (CIs).
Results
In our study, a total of 2369 patients (in 39 studies) underwent endovascular, open surgery, or retrograde open mesenteric stenting. The pooled mortality estimates for open surgery, endovascular therapy, and retrograde open mesenteric stenting were 40% (95% CI, 0.33–0.47; I2 = 84%), 26% (95% CI, 0.19–0.33; I2 = 33%), and 32% (95% CI, 0.21–0.44; I2 = 26%), respectively.
Conclusions
The mortality associated with open surgical treatment, endovascular therapy, and retrograde open mesenteric stenting tend to be similar in the last 20 years.
JamiesonACThomasRJCadeJF. Lysis of a superior mesenteric artery embolus following local infusion of streptokinase and heparin. Aust N Z J Surg1979; 49(3): 355–356.
3.
MilnerRWooEYCarpenterJP. Superior mesenteric artery angioplasty and stenting via a retrograde approach in a patient with bowel ischemia. Vasc Endovascular Surg2004; 38(1): 89–91.
4.
PisimisisGTOderichGS. Technique of hybrid retrograde superior mesenteric artery stent placement for acute-on-chronic mesenteric ischemia. Ann Vasc Surg2011; 25(1): 5.
5.
NyagaVNArbynMAertsM. Metaprop: a Stata command to perform meta-analysis of binomial data. Arch Public Health2014; 72(1): 39.
6.
HigginsJPTThompsonSGDeeksJJ, et al.Measuring inconsistency in meta-analyses. BMJ2003; 327(7414): 557–560.
7.
MogaCGuoBSchopflocherD, et al.Development of a quality appraisal tool for case series studies using a modified Delphi technique. Edmonton, Canada: IHE, 2012.
8.
PuippeGDSuesstrunkJNocitoA, et al.Outcome of endovascular revascularisation in patients with acute obstructive mesenteric ischaemia - a single-centre experience. Vasa2015; 44(5): 363–370.
9.
SchermerhornMLGilesKAHamdanAD, et al.Mesenteric revascularization: management and outcomes in the United States, 1988-2006. J Vasc Surg2009; 50(2): 341–348.
10.
GagnièreJFavroltGAlfidjaA, et al.Acute thrombotic mesenteric ischemia: primary endovascular treatment in eight patients. Cardiovasc Intervent Radiol2011; 34(5): 942–948.
11.
AndraskaEHagaLLiX, et al.Retrograde open mesenteric stenting should be considered as the initial approach to acute mesenteric ischemia. J Vasc Surg2020; 72(4): 1260–1268.
12.
MenkeJ. Diagnostic accuracy of multidetector CT in acute mesenteric ischemia: systematic review and meta-analysis. Radiology2010; 256(1): 93–101.
13.
DuranMPohlEGrabitzK, et al.The importance of open emergency surgery in the treatment of acute mesenteric ischemia. World J Emerg Surg2015; 10: 45.
14.
YunWSLeeKKChoJ, et al.Treatment outcome in patients with acute superior mesenteric artery embolism. Ann Vasc Surg2013; 27(5): 613–620.
15.
FreitasBBausbackYSchusterJ, et al.Thrombectomy devices in the treatment of acute mesenteric ischemia: initial single-center experience. Ann Vasc Surg2018; 51: 124–131.
16.
KawasakiRMiyamotoNOkiH, et al.Aspiration therapy for acute superior mesenteric artery embolism with an angled guiding sheath and guiding catheter. J Vasc Interv Radiol2014; 25(4): 635–639.
17.
BjörnssonSBjörckMBlockT, et al.Thrombolysis for acute occlusion of the superior mesenteric artery. J Vasc Surg2011; 54(6): 1734–1742.
18.
SwerdlowNJVarkevisserRRBSodenPA, et al.Thirty-day outcomes after open revascularization for acute mesenteric ischemia from the American college of surgeons national surgical quality improvement program. Ann Vasc Surg2019; 61: 148–155.
19.
ScaliSTAyoDGilesKA, et al.Outcomes of antegrade and retrograde open mesenteric bypass for acute mesenteric ischemia. J Vasc Surg2019; 69(1): 129–140.
20.
OzturkGAydinliBAtamanalpSS, et al.Acute mesenteric ischemia in young adults. Wien Med Wochenschr2012; 162(15–16): 349–353.
21.
AlhanEUstaAÇekiçA, et al.A study on 107 patients with acute mesenteric ischemia over 30 years. Int J Surg2012; 10(9): 510–513.
22.
NewtonWB3rdSagranskyMJAndrewsJS, et al.Outcomes of revascularized acute mesenteric ischemia in the American College of Surgeons National Surgical Quality Improvement Program database. The Am surgeon2011; 77(7): 832–838.
23.
KassahunWTSchulzTRichterO, et al.Unchanged high mortality rates from acute occlusive intestinal ischemia: six year review. Langenbecks Arch Surg2008; 393(2): 163–171.
24.
KougiasPLauDEl SayedHF, et al.Determinants of mortality and treatment outcome following surgical interventions for acute mesenteric ischemia. J Vasc Surg2007; 46(3): 467–474.
25.
SafioleasMCMoulakakisKGPapavassiliouVG, et al.Acute mesenteric ischaemia, a highly lethal disease with a devastating outcome. Vasa2006;35(2):106–111.
26.
FreemanAJGrahamJC. Damage control surgery and angiography in cases of acute mesenteric ischaemia. ANZ J Surg2005; 75(5): 308–314.
27.
BingolHZeybekNCingozF, et al.Surgical therapy for acute superior mesenteric artery embolism. Am J Surg2004; 188(1): 68–70.
28.
AcostaSBjorckM. Acute thrombo-embolic occlusion of the superior mesenteric artery: a prospective study in a well defined population. Eur J Vasc Endovascu Surg2003; 26(2): 179–183.
29.
BjörckMAcostaSLindbergF, et al.Revascularization of the superior mesenteric artery after acute thromboembolic occlusion. The Br J Surg2002; 89(7): 923–927.
30.
ParkWMGloviczkiPCherryKJJr., et al.Contemporary management of acute mesenteric ischemia: Factors associated with survival. J Vasc Surg2002; 35(3): 445–452.
31.
BarakateMSCappeICurtinA, et al.Management of acute superior mesenteric artery occlusion. ANZ J Surg2002; 72(1): 25–29.
32.
EndeanEDBarnesSLKwolekCJ, et al.Surgical management of thrombotic acute intestinal ischemia. Ann Surg2001; 233(6): 801–808.
33.
FoleyMIMonetaGLAbou-ZamzamAMJr., et al.Revascularization of the superior mesenteric artery alone for treatment of intestinal ischemia. J Vasc Surg2000; 32(1): 37–47.
34.
LiuYRTongZHouCB, et al.Aspiration therapy for acute embolic occlusion of the superior mesenteric artery. World J Gastroenterol2019; 25(7): 848–858.
35.
ShiYGuJChenL, et al.Mechanical thrombectomy using the solitaire AB device for acute embolic mesenteric ischemia. J Vasc Interv Radiol2019; 30(1): 43–48.
36.
ForbrigRRennerPKasprzakP, et al.Outcome of primary percutaneous stent-revascularization in patients with atherosclerotic acute mesenteric ischemia. Acta radiologica2017; 58(3): 311–315.
37.
BulutTOosterhof-BerktasRGeelkerkenRH, et al.Long-term results of endovascular treatment of atherosclerotic stenoses or occlusions of the coeliac and superior mesenteric artery in patients with mesenteric ischaemia. Eur J Vasc Endovasc Surg2017; 53(4): 583–590.
38.
RaupachJLojikMChovanecV, et al.Endovascular management of acute embolic occlusion of the superior mesenteric artery: A 12-year single-centre experience. Cardiovasc Interv Radiol2015; 39(2): 195–203.
39.
KärkkäinenJMLehtimäkiTTSaariP, et al.Endovascular therapy as a primary revascularization modality in acute mesenteric ischemia. Cardiovasc Intervent Radiol2015; 38(5): 1119–1129.
40.
ChoiKSKimJDKimHC, et al.Percutaneous aspiration embolectomy using guiding catheter for the superior mesenteric artery embolism. Korean J Radiol2015; 16(4): 736–743.
41.
JiaZJiangGTianF, et al.Early endovascular treatment of superior mesenteric occlusion secondary to thromboemboli. Eur J Vasc Endovasc Surg2014; 47(2): 196–203.
42.
HawkinsBMKhanZAbu-FadelMS, et al.Endovascular treatment of mesenteric ischemia. Catheterization Cardiovasc Intervent2011; 78(6): 948–952.
43.
HeissPLoewenhardtBMankeC, et al.Primary percutaneous aspiration and thrombolysis for the treatment of acute embolic superior mesenteric artery occlusion. Eur Radiol2010; 20(12): 2948–2958.
44.
AcostaSSonessonBReschT. Endovascular therapeutic approaches for acute superior mesenteric artery occlusion. Cardiovasc Intervent Radiol2009; 32(5): 896–905.
45.
RousselADella SchiavaNCoscasR, et al.Results of retrograde open mesenteric stenting for acute thrombotic mesenteric ischemia. J Vasc Surg2019; 69(4): 1137–1142.
46.
OderichGSMacedoRStoneDH, et al.Multicenter study of retrograde open mesenteric artery stenting through laparotomy for treatment of acute and chronic mesenteric ischemia. J Vasc Surg2018; 68(2): 470–480.e1.
47.
BlauwJTMeerwaldtRBrusse-KeizerM, et al.Retrograde open mesenteric stenting for acute mesenteric ischemia. J Vasc Surg2014; 60(3): 726–734.
48.
WyersMCPowellRJNolanBW, et al.Retrograde mesenteric stenting during laparotomy for acute occlusive mesenteric ischemia. J Vasc Surg2007; 45(2): 269–275.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
