OBJECTIVE

To improve diagnosis and treatment outcomes in patients with acute mesenteric ischemia in a multi-filed hospital.

MATERIAL AND METHODS

We analyzed 42 patients with acute mesenteric ischemia between 2017 to 2019. Gender, age, comorbidities, damaged arterial pool, methods of diagnosis, period between clinical manifestation and surgical intervention, as well as treatment outcomes depending on visceral revascularization were assessed. Mean age of patients was 75±11 years. Women and men accounted for 29% and 71% of patients, respectively. Lesion of superior mesenteric artery (SMA) was more common (76%).

RESULTS

Angiography of mesenteric vessels was performed in 24 (57%) cases, diagnostic laparotomy — in 20 (48%) patients. Hemicolectomy was performed in 8 (19%) cases, resection of stomach and gallbladder — in 1 (2.4%) case, resection of sigmoid colon — in 1 (2.4%) case, resection of small intestine — in 8 (19%) patients, resection of small intestine combined with right-sided hemicolectomy — in 4 (10%) cases. Endovascular recanalization of SMA and celiac axis was performed in 5 (12%) and 4 (10%) patients, respectively. Open repair of SMA and celiac axis was required in 3 (7%) patients. Thus, arterial recanalization was carried out in 12 (29%) cases. Among the deceased patients, no vascular revascularization was performed in 26 (62%) ones. There was a correlation between the outcome and lesion of certain arterial pool. The maximum mortality was observed among patients with SMA lesion (n=22, 52%, p<0.02) and total lesion (n=6, 14%. Overall mortality was 71.4%. The number of favorable outcomes was higher after visceral revascularization.

CONCLUSION

Early diagnosis with angiography and optimal surgical strategy including revascularization techniques provide higher survival. A multidisciplinary approach involves general, cardiovascular and endovascular surgeons in decision-making. The period between clinical manifestation and surgical treatment should be no more than 8 hours.