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Published in: BMC Surgery 1/2024

Open Access 01-12-2024 | Visceral Ischemia | Research

Factors that may affect the outcome of acute occlusive mesenteric ischemia. A single-center study

Authors: Qian Zhang, Tianyi Ma, Hongwei Zhao, Yuanxin Li, Peng Zhang

Published in: BMC Surgery | Issue 1/2024

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Abstract

Background

Acute mesenteric ischemia is a rare but lethal disease. Acute occlusive mesenteric ischemia consists of mesenteric artery embolism, mesenteric artery thrombosis, and mesenteric vein thrombosis. This study aimed to investigate the factors that may affect the outcome of acute occlusive mesenteric ischemia.

Methods

Data from acute occlusive mesenteric ischemia patients admitted between May 2016 and May 2022 were reviewed retrospectively. Patients were divided into 2 groups according to whether complications(Clavien‒Dindo ≥ 2) occurred within 6 months of the first admission. Demographics, symptoms, signs, laboratory results, computed tomography angiography features, management and outcomes were analyzed.

Results

59 patients were enrolled in this study. Complications(Clavien‒Dindo ≥ 2) occurred within 6 months of the first admission in 17 patients. Transmural intestinal necrosis, peritonitis, white blood cell count, percentage of neutrophils, percentage of lymphocytes, neutrophil-to-lymphocyte ratio, lactate dehydrogenase, creatine kinase isoenzyme, cardiac troponin I, laparoscopic exploration rate, open embolectomy rate, enterostomy rate, length of necrotic small bowel, length of healthy small bowel, surgical time and intraoperative blood loss differed significantly between groups. Creatine kinase isoenzyme (OR = 1.415, 95% CI: 1.060–1.888) and surgical time (OR = 1.014, 95% CI: 1.001–1.026) were independent risk factors associated with complications(Clavien‒Dindo ≥ 2).

Conclusions

Our analysis suggests that acute occlusive mesenteric ischemia patients with a creatine kinase isoenzyme level greater than 2.22 ng/mL or a surgical time longer than 156 min are more likely to experience complications’(Clavien‒Dindo ≥ 2) occurrence within 6 months of the first admission.
Literature
1.
go back to reference Huerta C, Rivero E, Montoro MA, Garcia-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(8):969–78.CrossRefPubMed Huerta C, Rivero E, Montoro MA, Garcia-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(8):969–78.CrossRefPubMed
2.
go back to reference Acosta S. Epidemiology of mesenteric vascular disease: clinical implications. Semin Vasc Surg. 2010;23(1):4–8.CrossRefPubMed Acosta S. Epidemiology of mesenteric vascular disease: clinical implications. Semin Vasc Surg. 2010;23(1):4–8.CrossRefPubMed
3.
go back to reference Tsai MS, Lin CL, Chen HP, Lee PH, Sung FC, Kao CH. Long-term risk of mesenteric ischemia in patients with inflammatory bowel disease: a 13-year nationwide cohort study in an Asian population. Am J Surg. 2015;210(1):80–6.CrossRefPubMed Tsai MS, Lin CL, Chen HP, Lee PH, Sung FC, Kao CH. Long-term risk of mesenteric ischemia in patients with inflammatory bowel disease: a 13-year nationwide cohort study in an Asian population. Am J Surg. 2015;210(1):80–6.CrossRefPubMed
4.
go back to reference Bala M, Catena F, Kashuk J, De Simone B, Gomes CA, Weber D, Sartelli M, Coccolini F, Kluger Y, Abu-Zidan FM, et al. Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery. World J Emerg Surg. 2022;17(1):54.CrossRefPubMedPubMedCentral Bala M, Catena F, Kashuk J, De Simone B, Gomes CA, Weber D, Sartelli M, Coccolini F, Kluger Y, Abu-Zidan FM, et al. Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery. World J Emerg Surg. 2022;17(1):54.CrossRefPubMedPubMedCentral
5.
go back to reference Zientara A, Domenghino AR, Schwegler I, Bruijnen H, Schnider A, Weber M, Gutknecht S, Attigah N. Interdisciplinary approach in emergency revascularization and treatment for acute mesenteric ischemia. BMC Surg. 2021;21(1):89.CrossRefPubMedPubMedCentral Zientara A, Domenghino AR, Schwegler I, Bruijnen H, Schnider A, Weber M, Gutknecht S, Attigah N. Interdisciplinary approach in emergency revascularization and treatment for acute mesenteric ischemia. BMC Surg. 2021;21(1):89.CrossRefPubMedPubMedCentral
6.
go back to reference Yang S, Zhao Y, Chen J, Ni Q, Guo X, Huang X, Xue G, Zhang L. Clinical features and outcomes of patients with acute mesenteric ischemia and concomitant colon ischemia: a retrospective cohort study. J Surg Res. 2019;233:231–9.CrossRefPubMed Yang S, Zhao Y, Chen J, Ni Q, Guo X, Huang X, Xue G, Zhang L. Clinical features and outcomes of patients with acute mesenteric ischemia and concomitant colon ischemia: a retrospective cohort study. J Surg Res. 2019;233:231–9.CrossRefPubMed
7.
go back to reference Chen FF, Ye XN, Jiang HT, Zhu GX, Miao SL, Yu GF, Qiu YH, Huang JY. Role of frailty and comorbidity status in predicting morbidity and mortality in patients with acute mesenteric ischemia. Ann Vasc Surg. 2020;67:105–14.CrossRefPubMed Chen FF, Ye XN, Jiang HT, Zhu GX, Miao SL, Yu GF, Qiu YH, Huang JY. Role of frailty and comorbidity status in predicting morbidity and mortality in patients with acute mesenteric ischemia. Ann Vasc Surg. 2020;67:105–14.CrossRefPubMed
8.
go back to reference Jagielski M, Piatkowski J, Jackowski M. Challenges encountered during the treatment of Acute Mesenteric Ischemia. Gastroenterol Res Pract. 2020;2020:5316849.CrossRefPubMedPubMedCentral Jagielski M, Piatkowski J, Jackowski M. Challenges encountered during the treatment of Acute Mesenteric Ischemia. Gastroenterol Res Pract. 2020;2020:5316849.CrossRefPubMedPubMedCentral
9.
go back to reference Lareyre F, Augene E, Chikande J, Guidi L, Ballaith A, Caradu C, Hassen-Khodja R, Raffort J. Evaluation of the impact of Sarcopenia in patients with acute mesenteric ischemia. Ann Vasc Surg. 2020;63:170–178e171.CrossRefPubMed Lareyre F, Augene E, Chikande J, Guidi L, Ballaith A, Caradu C, Hassen-Khodja R, Raffort J. Evaluation of the impact of Sarcopenia in patients with acute mesenteric ischemia. Ann Vasc Surg. 2020;63:170–178e171.CrossRefPubMed
10.
go back to reference Miao SL, Ye XN, Lin TT, Qiu YH, Huang JY, Zheng XW, Chen FF. The psoas muscle density as a predictor of postoperative complications and 30-day mortality for acute mesenteric ischemia patients. Abdom Radiol (NY) 2020. Miao SL, Ye XN, Lin TT, Qiu YH, Huang JY, Zheng XW, Chen FF. The psoas muscle density as a predictor of postoperative complications and 30-day mortality for acute mesenteric ischemia patients. Abdom Radiol (NY) 2020.
11.
go back to reference Karadeniz E, Bayramoglu A, Atamanalp SS. Sensitivity and specificity of the platelet-lymphocyte ratio and the neutrophil-lymphocyte ratio in diagnosing Acute Mesenteric Ischemia in patients operated on for the diagnosis of mesenteric ischemia: a retrospective case-control study. J Invest Surg. 2020;33(8):774–81.CrossRefPubMed Karadeniz E, Bayramoglu A, Atamanalp SS. Sensitivity and specificity of the platelet-lymphocyte ratio and the neutrophil-lymphocyte ratio in diagnosing Acute Mesenteric Ischemia in patients operated on for the diagnosis of mesenteric ischemia: a retrospective case-control study. J Invest Surg. 2020;33(8):774–81.CrossRefPubMed
12.
go back to reference Tanrikulu Y, Sen Tanrikulu C, Sabuncuoglu MZ, Temiz A, Kokturk F, Yalcin B. Diagnostic utility of the neutrophil-lymphocyte ratio in patients with acute mesenteric ischemia: a retrospective cohort study. Ulus Travma Acil Cerrahi Derg. 2016;22(4):344–9.PubMed Tanrikulu Y, Sen Tanrikulu C, Sabuncuoglu MZ, Temiz A, Kokturk F, Yalcin B. Diagnostic utility of the neutrophil-lymphocyte ratio in patients with acute mesenteric ischemia: a retrospective cohort study. Ulus Travma Acil Cerrahi Derg. 2016;22(4):344–9.PubMed
13.
go back to reference Mothes H, Mueller-Mau V, Lehmkuhl L, Lehmann T, Settmacher U, Teichgraber U, Ludewig S. The role of computed tomography in the diagnostic pathway of acute mesenteric ischemia: a nested case-control study. Acta Radiol. 2020;61(11):1444–51.CrossRefPubMed Mothes H, Mueller-Mau V, Lehmkuhl L, Lehmann T, Settmacher U, Teichgraber U, Ludewig S. The role of computed tomography in the diagnostic pathway of acute mesenteric ischemia: a nested case-control study. Acta Radiol. 2020;61(11):1444–51.CrossRefPubMed
14.
go back to reference Nuzzo A, Maggiori L, Paugam-Burtz C, Cazals-Hatem D, Ronot M, Huguet A, Becq A, Castier Y, Weiss E, Plessier A, et al. Oral antibiotics reduce intestinal necrosis in Acute Mesenteric Ischemia: a prospective cohort study. Am J Gastroenterol. 2019;114(2):348–51.CrossRefPubMed Nuzzo A, Maggiori L, Paugam-Burtz C, Cazals-Hatem D, Ronot M, Huguet A, Becq A, Castier Y, Weiss E, Plessier A, et al. Oral antibiotics reduce intestinal necrosis in Acute Mesenteric Ischemia: a prospective cohort study. Am J Gastroenterol. 2019;114(2):348–51.CrossRefPubMed
15.
go back to reference Wang X, Chu C, Sun S, Xie T, Duan Z, Wang K, Liu B, Fan X, Wu X, Ding W. Outcomes and clinical characteristics of transmural intestinal necrosis in acute mesenteric ischemia. Scand J Gastroenterol. 2019;54(8):953–9.CrossRefPubMed Wang X, Chu C, Sun S, Xie T, Duan Z, Wang K, Liu B, Fan X, Wu X, Ding W. Outcomes and clinical characteristics of transmural intestinal necrosis in acute mesenteric ischemia. Scand J Gastroenterol. 2019;54(8):953–9.CrossRefPubMed
16.
go back to reference Wei Tang BJ, Kuang L-Q, Zhang J, Li C-X, Wang Y. Risk factors of geriatrics index of comorbidity and MDCT findings for predicting mortality in patients with acute mesenteric ischemia due to superior mesenteric artery thromboembolism. Br J Radiol 2020, 93(1116). Wei Tang BJ, Kuang L-Q, Zhang J, Li C-X, Wang Y. Risk factors of geriatrics index of comorbidity and MDCT findings for predicting mortality in patients with acute mesenteric ischemia due to superior mesenteric artery thromboembolism. Br J Radiol 2020, 93(1116).
17.
go back to reference Augene E, Lareyre F, Chikande J, Guidi L, Ballaith A, Bossert JN, Pelletier Y, Caradu C, Hassen-Khodja R, Raffort J. Platelet to lymphocyte ratio as a predictive factor of 30-day mortality in patients with acute mesenteric ischemia. PLoS ONE. 2019;14(7):e0219763.CrossRefPubMedPubMedCentral Augene E, Lareyre F, Chikande J, Guidi L, Ballaith A, Bossert JN, Pelletier Y, Caradu C, Hassen-Khodja R, Raffort J. Platelet to lymphocyte ratio as a predictive factor of 30-day mortality in patients with acute mesenteric ischemia. PLoS ONE. 2019;14(7):e0219763.CrossRefPubMedPubMedCentral
18.
go back to reference Caluwaerts M, Castanares-Zapatero D, Laterre PF, Hantson P. Prognostic factors of acute mesenteric ischemia in ICU patients. BMC Gastroenterol. 2019;19(1):80.CrossRefPubMedPubMedCentral Caluwaerts M, Castanares-Zapatero D, Laterre PF, Hantson P. Prognostic factors of acute mesenteric ischemia in ICU patients. BMC Gastroenterol. 2019;19(1):80.CrossRefPubMedPubMedCentral
19.
go back to reference Matthaei H, Klein A, Branchi V, Kalff JC, Koscielny A. Acute mesenteric ischemia (AMI): absence of renal insufficiency and performance of early bowel resection may indicate improved outcomes. Int J Colorectal Dis. 2019;34(10):1781–90.CrossRefPubMed Matthaei H, Klein A, Branchi V, Kalff JC, Koscielny A. Acute mesenteric ischemia (AMI): absence of renal insufficiency and performance of early bowel resection may indicate improved outcomes. Int J Colorectal Dis. 2019;34(10):1781–90.CrossRefPubMed
20.
go back to reference Wu W, Yang L, Zhou Z. Clinical features and factors affecting postoperative mortality for obstructive Acute Mesenteric Ischemia in China: A Hospital- based survey. Vasc Health Risk Manag. 2020;16:479–87.CrossRefPubMedPubMedCentral Wu W, Yang L, Zhou Z. Clinical features and factors affecting postoperative mortality for obstructive Acute Mesenteric Ischemia in China: A Hospital- based survey. Vasc Health Risk Manag. 2020;16:479–87.CrossRefPubMedPubMedCentral
21.
go back to reference Lareyre F, Augene E, Massalou D, Chikande J, Guidi L, Jean-Baptiste E, Hassen-Khodja R, Raffort J. Vascular calcifications are Associated with increased mortality in patients with Acute Mesenteric Ischemia. Ann Vasc Surg 2020. Lareyre F, Augene E, Massalou D, Chikande J, Guidi L, Jean-Baptiste E, Hassen-Khodja R, Raffort J. Vascular calcifications are Associated with increased mortality in patients with Acute Mesenteric Ischemia. Ann Vasc Surg 2020.
22.
go back to reference Wu WW, Liu J, Zhou Z. Preoperative risk factors for short-term postoperative mortality of Acute Mesenteric Ischemia after Laparotomy: a systematic review and Meta-analysis. Emerg Med Int. 2020;2020:1382475.CrossRefPubMedPubMedCentral Wu WW, Liu J, Zhou Z. Preoperative risk factors for short-term postoperative mortality of Acute Mesenteric Ischemia after Laparotomy: a systematic review and Meta-analysis. Emerg Med Int. 2020;2020:1382475.CrossRefPubMedPubMedCentral
23.
go back to reference Bala M, Kashuk J, Moore EE, Kluger Y, Biffl W, Gomes CA, Ben-Ishay O, Rubinstein C, Balogh ZJ, Civil I, et al. Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery. World J Emerg Surg. 2017;12:38.CrossRefPubMedPubMedCentral Bala M, Kashuk J, Moore EE, Kluger Y, Biffl W, Gomes CA, Ben-Ishay O, Rubinstein C, Balogh ZJ, Civil I, et al. Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery. World J Emerg Surg. 2017;12:38.CrossRefPubMedPubMedCentral
24.
go back to reference Massironi S, Cavalcoli F, Rausa E, Invernizzi P, Braga M, Vecchi M. Understanding short bowel syndrome: current status and future perspectives. Dig Liver Dis. 2020;52(3):253–61.CrossRefPubMed Massironi S, Cavalcoli F, Rausa E, Invernizzi P, Braga M, Vecchi M. Understanding short bowel syndrome: current status and future perspectives. Dig Liver Dis. 2020;52(3):253–61.CrossRefPubMed
25.
go back to reference Mehta HB, Mehta V, Girman CJ, Adhikari D, Johnson ML. Regression coefficient-based scoring system should be used to assign weights to the risk index. J Clin Epidemiol. 2016;79:22–8.CrossRefPubMed Mehta HB, Mehta V, Girman CJ, Adhikari D, Johnson ML. Regression coefficient-based scoring system should be used to assign weights to the risk index. J Clin Epidemiol. 2016;79:22–8.CrossRefPubMed
26.
go back to reference Cakir M, Yildirim D, Sarac F, Donmez T, Mirapoglu S, Hut A, Erozgen F, Ozer OF, Gecer MO, Tigrel LZ, et al. In the experimental model of Acute Mesenteric Ischemia, the correlation of blood diagnostic parameters with the duration of Ischemia and their effects on Choice of Treatment. J Invest Surg. 2019;32(6):507–14.CrossRefPubMed Cakir M, Yildirim D, Sarac F, Donmez T, Mirapoglu S, Hut A, Erozgen F, Ozer OF, Gecer MO, Tigrel LZ, et al. In the experimental model of Acute Mesenteric Ischemia, the correlation of blood diagnostic parameters with the duration of Ischemia and their effects on Choice of Treatment. J Invest Surg. 2019;32(6):507–14.CrossRefPubMed
27.
go back to reference Hayashi K, Hayashi K, Narita M, Tsunoda A, Kusanagi H. Still time to perform intestinal revascularization in patients with acute mesenteric ischemia with peritonitis: an analysis of bowel viability in resections. SAGE Open Med. 2020;8:2050312120923227.CrossRefPubMedPubMedCentral Hayashi K, Hayashi K, Narita M, Tsunoda A, Kusanagi H. Still time to perform intestinal revascularization in patients with acute mesenteric ischemia with peritonitis: an analysis of bowel viability in resections. SAGE Open Med. 2020;8:2050312120923227.CrossRefPubMedPubMedCentral
28.
go back to reference Grotelueschen R, Miller V, Heidelmann LM, Melling N, Ghadban T, Grupp K, Reeh M, Welte MN, Uzunoglu FG, Izbicki JR et al. Acute Mesenteric Infarction: the Chameleon of Acute Abdomen evaluating the quality of the Diagnostic parameters in Acute Mesenteric Ischemia. Dig Surg 2021:1–9. Grotelueschen R, Miller V, Heidelmann LM, Melling N, Ghadban T, Grupp K, Reeh M, Welte MN, Uzunoglu FG, Izbicki JR et al. Acute Mesenteric Infarction: the Chameleon of Acute Abdomen evaluating the quality of the Diagnostic parameters in Acute Mesenteric Ischemia. Dig Surg 2021:1–9.
29.
go back to reference Sindall ME, Davenport DL, Wallace P, Bernard AC. Validation of the American Association for the Surgery of Trauma grading system for acute mesenteric ischemia-more than anatomic severity is needed to determine risk of mortality. J Trauma Acute Care Surg. 2020;88(5):671–6.CrossRefPubMed Sindall ME, Davenport DL, Wallace P, Bernard AC. Validation of the American Association for the Surgery of Trauma grading system for acute mesenteric ischemia-more than anatomic severity is needed to determine risk of mortality. J Trauma Acute Care Surg. 2020;88(5):671–6.CrossRefPubMed
30.
go back to reference Calame P, Malakhia A, Turco C, Grillet F, Piton G, Delabrousse E. Transmural Bowel Necrosis from Acute Mesenteric Ischemia and Strangulated Small-Bowel obstruction: distinctive CT features. AJR Am J Roentgenol. 2020;214(1):90–5.CrossRefPubMed Calame P, Malakhia A, Turco C, Grillet F, Piton G, Delabrousse E. Transmural Bowel Necrosis from Acute Mesenteric Ischemia and Strangulated Small-Bowel obstruction: distinctive CT features. AJR Am J Roentgenol. 2020;214(1):90–5.CrossRefPubMed
31.
go back to reference Gopee-Ramanan P, Patlas MN, Pindiprolu B, Katz DS. Utility of biphasic multi-detector computed tomography in suspected acute mesenteric ischemia in the emergency department. Emerg Radiol. 2019;26(5):523–9.CrossRefPubMed Gopee-Ramanan P, Patlas MN, Pindiprolu B, Katz DS. Utility of biphasic multi-detector computed tomography in suspected acute mesenteric ischemia in the emergency department. Emerg Radiol. 2019;26(5):523–9.CrossRefPubMed
32.
go back to reference Atre ID, Eurboonyanun K, O’Shea A, Lahoud RM, Shih A, Kalva S, Harisinghani MG, Hedgire S. Predictors of transmural intestinal necrosis in patients presenting with acute mesenteric ischemia on computed tomography. Abdom Radiol (NY) 2020. Atre ID, Eurboonyanun K, O’Shea A, Lahoud RM, Shih A, Kalva S, Harisinghani MG, Hedgire S. Predictors of transmural intestinal necrosis in patients presenting with acute mesenteric ischemia on computed tomography. Abdom Radiol (NY) 2020.
33.
go back to reference Rebelo A, Mammadov M, Partsakhashvili J, Sekulla C, Ronellenfitsch U, Kleeff J, John E, Ukkat J. Acute and chronic mesenteric ischemia: single center analysis of open, endovascular, and hybrid surgery. BMC Surg. 2022;22(1):56.CrossRefPubMedPubMedCentral Rebelo A, Mammadov M, Partsakhashvili J, Sekulla C, Ronellenfitsch U, Kleeff J, John E, Ukkat J. Acute and chronic mesenteric ischemia: single center analysis of open, endovascular, and hybrid surgery. BMC Surg. 2022;22(1):56.CrossRefPubMedPubMedCentral
34.
go back to reference Brillantino A, Lanza M, Antropoli M, Amendola A, Squillante S, Bottino V, Renzi A, Castriconi M. Usefulness of damage control approach in patients with limited acute mesenteric ischemia: a prospective study of 85 patients. Updates Surg 2021. Brillantino A, Lanza M, Antropoli M, Amendola A, Squillante S, Bottino V, Renzi A, Castriconi M. Usefulness of damage control approach in patients with limited acute mesenteric ischemia: a prospective study of 85 patients. Updates Surg 2021.
35.
go back to reference Witte M, Neese M, Leuchter M, Philipp M, Klar E, Schafmayer C. Acute Mesenteric Ischemia: Preexisting Comorbidity determines short-term outcome and quality of life in long-term survivors. Visc Med. 2022;38(6):393–9.CrossRefPubMedPubMedCentral Witte M, Neese M, Leuchter M, Philipp M, Klar E, Schafmayer C. Acute Mesenteric Ischemia: Preexisting Comorbidity determines short-term outcome and quality of life in long-term survivors. Visc Med. 2022;38(6):393–9.CrossRefPubMedPubMedCentral
Metadata
Title
Factors that may affect the outcome of acute occlusive mesenteric ischemia. A single-center study
Authors
Qian Zhang
Tianyi Ma
Hongwei Zhao
Yuanxin Li
Peng Zhang
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Surgery / Issue 1/2024
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/s12893-024-02310-9

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