Acute Mesenteric Ischemia

Rebecca J. Lendzion; Gert Frahm-Jensen; James Keck

doi:10.1055/s-0042-1743283

Clinics in Colon and Rectal Surgery, Inhaltsverzeichnis

Clin Colon Rectal Surg 2022; 35(03): 227-236
DOI: 10.1055/s-0042-1743283

Review Article

Acute Mesenteric Ischemia

Autoren

Rebecca J. Lendzion

¹Colorectal Fellow, St Vincent's Health, Melbourne, Australia
Gert Frahm-Jensen

²Department of Vascular Surgery, The Canberra Hospital, Australia
James Keck

³Colorectal Department, St. Vincent's Health, Melbourne, Australia

⁴Department of Colorectal Surgery, Eastern Health, Melbourne, Australia

Abstract

The surgical treatment of occlusive acute mesenteric ischemia (AMI) without revascularization is associated with an 80% overall mortality. Early diagnosis is crucial, and revascularization may reduce overall mortality in AMI by up to 50%. A diagnosis of AMI requires a high index of clinical suspicion and the collaborative effort of emergency department physicians, general and vascular surgeons, and radiologists. This article provides an overview of the etiology, physiology, evaluation, and management of acute mesenteric ischemia.

Keywords

acute mesenteric ischemia - nonocclusive mesenteric ischemia - mesenteric venous thrombosis - endovascular procedures - endovascular therapy - angioplasty - embolectomy - mechanical thrombolysis - surgical treatment

Volltext

Referenzen

References
1 Clair DG, Beach JM. Mesenteric ischemia. N Engl J Med 2016; 374 (10) 959-968
2 Bala M, Kashuk J, Moore EE. et al. Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery. World J Emerg Surg 2017; 12: 38
3 Huerta C, Rivero E, Montoro MA, García-Rodriguez LA. Risk factors for intestinal ischaemia among patients registered in a UK primary care database: a nested case-control study. Aliment Pharmacol Ther 2011; 33 (08) 969-978
4 Acosta S. Epidemiology of mesenteric vascular disease: clinical implications. Semin Vasc Surg 2010; 23 (01) 4-8
5 Acosta S, Ogren M, Sternby NH, Bergqvist D, Björck M. Incidence of acute thrombo-embolic occlusion of the superior mesenteric artery–a population-based study. Eur J Vasc Endovasc Surg 2004; 27 (02) 145-150
6 Kärkkäinen JM, Acosta S. Acute mesenteric ischemia (part I) - Incidence, etiologies, and how to improve early diagnosis. Best Pract Res Clin Gastroenterol 2017; 31 (01) 15-25
7 Tilsed JV, Casamassima A, Kurihara H. et al. ESTES guidelines: acute mesenteric ischaemia. Eur J Trauma Emerg Surg 2016; 42 (02) 253-270
8 Oldenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD. Acute mesenteric ischemia: a clinical review. Arch Intern Med 2004; 164 (10) 1054-1062
9 Berland T, Oldenburg WA. Acute mesenteric ischemia. Curr Gastroenterol Rep 2008; 10 (03) 341-346
10 Wyers MC, Zwolak RM. The management of splanchnic vascular disorders. In: In Vascular Surgery, edn 6. Edited by Seeger JM. Philadelphia: Rutherford-Elsevier-Saunders; 2005: 1707-1717
11 Cohn DM, Roshani S, Middeldorp S. Thrombophilia and venous thromboembolism: implications for testing. Semin Thromb Hemost 2007; 33 (06) 573-581
12 Kolkman JJ, Mensink PB. Non-occlusive mesenteric ischaemia: a common disorder in gastroenterology and intensive care. Best Pract Res Clin Gastroenterol 2003; 17 (03) 457-473
13 Granger DN, Seifert H, Senchenkova E. Intestinal Ischemia and Reperfusion: Consequences and Mechanisms. In: Lanzer P. (eds) PanVascular Medicine. Springer; Berlin, Heidelberg: 2014
14 Freeman BA, Crapo JD. Biology of disease: free radicals and tissue injury. Lab Invest 1982; 47 (05) 412-426
15 Syk I, Brunkwall J, Ivancev K. et al. Postoperative fever, bowel ischaemia and cytokine response to abdominal aortic aneurysm repair–a comparison between endovascular and open surgery. Eur J Vasc Endovasc Surg 1998; 15 (05) 398-405
16 Boley SJ, Feinstein FR, Sammartano R, Brandt LJ, Sprayregen S. New concepts in the management of emboli of the superior mesenteric artery. Surg Gynecol Obstet 1981; 153 (04) 561-569
17 van den Heijkant TC, Aerts BAC, Teijink JA, Buurman WA, Luyer MDP. Challenges in diagnosing mesenteric ischemia. World J Gastroenterol 2013; 19 (09) 1338-1341
18 Acosta S, Björck M. Acute thrombo-embolic occlusion of the superior mesenteric artery: a prospective study in a well defined population. Eur J Vasc Endovasc Surg 2003; 26 (02) 179-183
19 Treskes N, Persoon AM, van Zanten ARH. Diagnostic accuracy of novel serological biomarkers to detect acute mesenteric ischemia: a systematic review and meta-analysis. Intern Emerg Med 2017; 12 (06) 821-836
20 Furukawa A, Kanasaki S, Kono N. et al. CT diagnosis of acute mesenteric ischemia from various causes. AJR Am J Roentgenol 2009; 192 (02) 408-416
21 Wiesner W, Khurana B, Ji H, Ros PR. CT of acute bowel ischemia. Radiology 2003; 226 (03) 635-650
22 Lehtimäki TT, Kärkkäinen JM, Saari P, Manninen H, Paajanen H, Vanninen R. Detecting acute mesenteric ischemia in CT of the acute abdomen is dependent on clinical suspicion: Review of 95 consecutive patients. Eur J Radiol 2015; 84 (12) 2444-2453
23 Wyers MC. Acute mesenteric ischemia: diagnostic approach and surgical treatment. Semin Vasc Surg 2010; 23 (01) 9-20
24 Acosta S, Björck M. Modern treatment of acute mesenteric ischaemia. Br J Surg 2014; 101 (01) e100-e108
25 Acosta S. Surgical management of peritonitis secondary to acute superior mesenteric artery occlusion. World J Gastroenterol 2014; 20 (29) 9936-9941
26 Darwood R, Smith FCT. Mesenteric ischaemia. Journal of Vascular Surgery 2012; 30 (08) 420-426
27 Kärkkäinen JM, Acosta S. Acute mesenteric ischemia (Part II) - Vascular and endovascular surgical approaches. Best Pract Res Clin Gastroenterol 2017; 31 (01) 27-38
28 Acosta S, Sonesson B, Resch T. Endovascular therapeutic approaches for acute superior mesenteric artery occlusion. Cardiovasc Intervent Radiol 2009; 32 (05) 896-905
29 Kärkkäinen JM, Lehtimäki TT, Saari P. et al. Endovascular therapy as a primary revascularization modality in acute mesenteric ischemia. Cardiovasc Intervent Radiol 2015; 38 (05) 1119-1129
30 Mellander S, Hellberg R, Karlqvist PA, Svahn M. Local fibrinolysis in acute thromboembolism of the superior mesenteric artery. Eur J Surg 2001; 167 (04) 308-311
31 Björnsson S, Björck M, Block T, Resch T, Acosta S. Thrombolysis for acute occlusion of the superior mesenteric artery. J Vasc Surg 2011; 54 (06) 1734-1742
32 Oderich GS, de Souza LR. Techniques of endovascular mesenteric revascularization. In: Oderich GS. editor. Mesenteric vascular disease: current therapy. Springer; 2015: 165-86
33 Wyers MC, Powell RJ, Nolan BW, Cronenwett JL. Retrograde mesenteric stenting during laparotomy for acute occlusive mesenteric ischemia. J Vasc Surg 2007; 45 (02) 269-275
34 Kougias P, Lau D, El Sayed HF, Zhou W, Huynh TT, Lin PH. Determinants of mortality and treatment outcome following surgical interventions for acute mesenteric ischemia. J Vasc Surg 2007; 46 (03) 467-474
35 Edwards MS, Cherr GS, Craven TE. et al. Acute occlusive mesenteric ischemia: surgical management and outcomes. Ann Vasc Surg 2003; 17 (01) 72-79
36 David RA, Kalra M. Results of Open and Endovascular Revascularization for Acute Mesenteric Ischemia. In: Oderich G. (eds) Mesenteric Vascular Disease. Springer; New York: 2015: 265-276
37 Arthurs ZM, Titus J, Bannazadeh M. et al. A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia. J Vasc Surg 2011; 53 (03) 698-704 , discussion 704–705
38 Semmlow JL, Orland PJ, Reddell MT, Brolin RE. Evaluation of quantitative approaches to assessment of bowel viability. Biomed Instrum Technol 1997; 31 (06) 591-599
39 Mulholland JH, Ellison EH, Friesen SR. Current surgical management; a book of alternative viewpoints on controversial surgical problems. In: Mulholland JH, Ellison EH, Friesen SR. eds. Current surgical management. Philadelphia: Saunders; 1957: 1957-1965
40 Guzmán-de la Garza FJ, Ibarra-Hernández JM, Cordero-Pérez P. et al. Temporal relationship of serum markers and tissue damage during acute intestinal ischemia/reperfusion. Clinics (São Paulo) 2013; 68 (07) 1034-1038
41 Chang JX, Chen S, Ma LP. et al. Functional and morphological changes of the gut barrier during the restitution process after hemorrhagic shock. World J Gastroenterol 2005; 11 (35) 5485-5491
42 Stone WC, Bjorling DE, Southard JH, Galbreath EJ, Lindsay WA. Evaluation of intestinal villus height in rats after ischemia and reperfusion by administration of superoxide dismutase, polyethylene glycol-conjugated superoxide dismutase, and two 21-aminosteroids. Am J Vet Res 1992; 53 (11) 2153-2156
43 Illyés G, Hamar J. Sequence of morphological alterations in a small intestinal ischaemia/reperfusion model of the anesthetized rat. A light microscopy study. Int J Exp Pathol 1992; 73 (02) 161-172
44 Kundi R, Rasmussen TE. Second-Look Laparotomy, the Open Abdomen, and Temporary Abdominal Closure in Acute Mesenteric Ischemia. In: Oderich G. (eds) Mesenteric Vascular Disease. Springer; New York, NY: 2015: 253-263
45 Bryski MG, Frenzel Sulyok LG, Kaplan L, Singhal S, Keating JJ. Techniques for intraoperative evaluation of bowel viability in mesenteric ischemia: a review. Am J Surg 2020; 220 (02) 309-315
46 Bulkley GB, Zuidema GD, Hamilton SR, O'Mara CS, Klacsmann PG, Horn SD. Intraoperative determination of small intestinal viability following ischemic injury: a prospective, controlled trial of two adjuvant methods (Doppler and fluorescein) compared with standard clinical judgment. Ann Surg 1981; 193 (05) 628-637
47 Tollefson DF, Wright DJ, Reddy DJ, Kintanar EB. Intraoperative determination of intestinal viability by pulse oximetry. Ann Vasc Surg 1995; 9 (04) 357-360
48 Freeman DE, Gentile DG, Richardson DW. et al. Comparison of clinical judgment, Doppler ultrasound, and fluorescein fluorescence as methods for predicting intestinal viability in the pony. Am J Vet Res 1988; 49 (06) 895-900
49 Mordon S, Devoisselle JM, Soulie-Begu S, Desmettre T. Indocyanine green: physicochemical factors affecting its fluorescence in vivo. Microvasc Res 1998; 55 (02) 146-152
50 Liot E, Assalino M, Buchs NC. et al. Does near-infrared (NIR) fluorescence angiography modify operative strategy during emergency procedures?. Surg Endosc 2018; 32 (10) 4351-4356
51 Karampinis I, Keese M, Jakob J. et al. Indocyanine green tissue angiography can reduce extended bowel resections in acute mesenteric ischemia. J Gastrointest Surg 2018; 22 (12) 2117-2124
52 Beaulieu RJ, Arnaoutakis KD, Abularrage CJ, Efron DT, Schneider E, Black III JH. Comparison of open and endovascular treatment of acute mesenteric ischemia. J Vasc Surg 2014; 59 (01) 159-164
53 Cocorullo G, Mirabella A, Falco N. et al. An investigation of bedside laparoscopy in the ICU for cases of non-occlusive mesenteric ischemia. World J Emerg Surg 2017; 12: 4
54 Alemanno G, Somigli R, Prosperi P. et al. Combination of diagnostic laparoscopy and intraoperative indocyanine green fluorescence angiography for the early detection of intestinal ischemia not detectable at CT scan. Int J Surg Case Rep 2016; 26: 77-80
55 Paral J, Cecka F, Chobola M. Fluorescein dye and ultraviolet light technique in diagnosis of small bowel ischaemia. ANZ J Surg 2010; 80 (10) 762-763