Determinant of Mortality and Treatment Outcome following Surgical Interventions for Acute Mesenteric Ischemia

Back to Annual Meeting
Back to Program

Panagiotis Kougias, MD, Donald Lau, BS, Peter H. Lin, MD, Ruth L. Bush, MD, Eric K. Peden, MD, Wei Zhou, MD, Alan B. Lumsden, MD.
Baylor College of Medicine, Houston, TX, USA.

BACKGROUND: Acute mesenteric ischemia (AMI) is associated with high morbidity and mortality due in part to its diagnostic difficulty and operative challenges. The purpose of this study was to review our experience of surgical management in patients with this condition and identify variables associated with adverse outcomes following surgical interventions.
METHODS: Hospital records and clinical data of all patients undergoing surgical interventions for AMI were reviewed during a recent 12-year period. Clinical outcome as well as factors affecting treatment morbidity and mortality were analyzed.
RESULTS: A total of 72 patients (41 females, overall mean age 65 years, range 34 to 83 years) were included in the study. Thrombosis and embolism were the cause of AMI in 48 patients (67%) and 24 patients (33%), respectively. Abdominal pain was the most common presenting symptom (96%), followed by nausea (43%). Preoperative angiogram was performed in 61 patients (85%). All patients underwent operative interventions, which thromboembolectomy (n=22, 13%), mesenteric bypass grafting (n=33, 46%), patch angioplasty (n=9, 12%), reimplantation (n=5, 7%), and endarterectomy (n=3, 4%). Bowel resection was necessary in 45 patients (63%) during the initial operation, and second-look operation was performed in 38 patients (53%). Actuarial survival rates at six months, two year, and four years were 55%, 40%, and 28%, respectively. Perioperative morbidity and 30-day mortality rates were 39% and 31%, respectively. Univariate analysis showed renal insufficiency (p<0.02), age > 65 (p <0.001), metabolic acidosis (p< 0.02), and symptom duration (p<0.005), and bowel resection in second-look operations (p<0.01) were associated with mortality. Logistic regression analysis showed age > 70 (OR, 3.64; p=0.03) and prolonged symptom duration (OR, 4.62; p=0.02) were independent predictors of mortality.
CONCLUSIONS: Elderly patients and those with prolonged symptom duration had poor prognosis following surgical intervention for AMI. A high index of suspicion with prompt diagnostic evaluation may reduce potential time delay prior to surgical intervention, and this seems to be a prognostic factor influencing survival over which clinicians have some control. Aggressive surgical intervention should be performed as promptly as possible in patients diagnosed with AMI.

Back to Annual Meeting
Back to Program