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Acute mesenteric ischemia (AMI): absence of renal insufficiency and performance of early bowel resection may indicate improved outcomes

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Acute mesenteric ischemia (AMI) is still associated with very high morbidity and mortality while the rareness and heterogeneity hamper the establishment of evidence-based guidelines. We sought to help standardize contemporary treatment by a cohort study at our tertiary center in the rising endovascular age.

Methods

A retrospective cohort study was conducted from 2005 to 2015. Patients with occlusive (OMI), non-occlusive (NOMI), and venous mesenteric ischemia (VMI) were compared with respect to clinical and treatment parameters as well as outcome.

Results

The study cohort consisted of 48 patients composed of 27 males and 21 females with an average age of 63 years and an average BMI of 25.1 kg/m2. In 48% of patients (N=23), an acute arterial OMI had occurred while NOMI was present in 31% (N=15) and VMI in 21% (N=10). Interventional and intraoperative recanalizations were significantly more often required in OMI patients compared with other entities (p=0.003). Patients with venous mesenteric ischemia had a significant better overall survival than patients with OMI or NOMI in the univariate analysis (p=0.027). Patients with renal failure had a 14.7-fold higher relative risk (Cox p=0.013) and patients without bowel resection during primary surgery had a 17.8-fold higher relative risk (Cox p=0.047) to die of AMI in the postoperative course.

Conclusions

AMI remains a rare but oftentimes fatal disease. Our study provides evidence that outcome may depend on the AMI subtype, presence of renal insufficiency, and early bowel resection. Further research should help individualize treatment for optimized outcomes.

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Authors and Affiliations

  1. Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany

    Hanno Matthaei, Alina Klein, Vittorio Branchi, Jörg C. Kalff & Arne Koscielny

Authors
  1. Hanno Matthaei
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  2. Alina Klein
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  3. Vittorio Branchi
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  4. Jörg C. Kalff
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  5. Arne Koscielny
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Hanno Matthaei, Arne Koscielny, and Alina Klein. The first draft of the manuscript was written by Hanno Matthaei and Arne Koscielny. Vittorio Branchi contributed to drafting of figures. All authors commented on previous versions of the manuscript. Jörg C. Kalff co-supervised the study together with Arne Koscielny. All authors read and approved the final manuscript.

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Correspondence to Arne Koscielny.

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Ethical standards of the University of Bonn were fully acknowledged.

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Matthaei, H., Klein, A., Branchi, V. et al. Acute mesenteric ischemia (AMI): absence of renal insufficiency and performance of early bowel resection may indicate improved outcomes. Int J Colorectal Dis 34, 1781–1790 (2019). https://doi.org/10.1007/s00384-019-03388-x

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  • DOI: https://doi.org/10.1007/s00384-019-03388-x

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