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Kase, Karri and Blaser, Annika Reintam and Koitmäe, Merli and Talving, Peep and Tamme, Kadri and Acosta, Stefan and Björck, Martin and Bala, Miklosh and Bodnar, Zsolt and Cahenzli, Martin and Casian, Dumitru and Demetrashvili, Zaza and D’oria, Mario and Muñoz-Cruzado, Virginia Durán and Forbes, Alastair and Vetrhus, Morten and Itzhaki, Moran Hellerman and Lein, Kristoffer and Lindner, Matthias and Loudet, Cecilia I. and Damaskos, Dimitrios and Nuzzo, Alexandre and Saar, Sten and Scheiterle, Maximilian and Starkopf, Joel and Voomets, Anna Liisa and Voon, Kenneth and Yunus, Mohammad Alif and Murruste, Marko and Castier, Yves and Ronot, Maxime and Biloslavo, Alan and Paiano, Lucia and Elke, Gunnar and Nagel, Denise and Radke, David I. and Becerra, Jacqueline Vilca and Abeleyra, María Elina and Hess, Benjamin and Kirov, Mikhail and Semenkova, Tatjana and Nikonov, Anton and Smetkin, Alexey and Nedredal, Geir Ivar and Irtun, Øivind and Cohen-Arazi, Oded and Keda, Asaf and Rojnoveanu, Gheorghe and Malcova, Tatiana and Ciuró, Felipe Pareja and Garcia-Leon, Anabel and Garcia-Sanchez, Carlos Javier and Hui, Lim Jia and Ling, Loy Yuan and Kagan, Ilya and Singer, Pierre and Lipping, Edgar and Tvaladze, Ana and Mole, Damian and Clinch, Darja and Qing, Too Xiao and Fuglseth, Hanne and Martellucci, Jacopo and Cerino, Giulia and Hong, Donghuang and Liu, Jinsheng and Ong, Ernest and Kundogan, Kursat and Talih, Tutkun and Bains, Lovenish and Visconti, Diego and Gibello, Lorenzo and Jailani, Ruhi Fadzlyana and Ashra, Muhammad Amirul and Zakaria, Andee Dzulkarnaen and Mohd Ghazi, Ahmad Faiz Najmuddin and Abd Ghani, Nur Suriyana and Ab Rahim, Mohd Fadliyazid and Augustin, Goran and Halužan, Damir and Gurjar, Mohan and Rahul, Rahul and Hayati, Firdaus and Mah, Jin Jiun and Corcos, Olivier and Kipshidze, N.
(2025)
Comparison between endovascular and surgical treatment of acute arterial occlusive mesenteric ischemia.
World Journal of Emergency Surgery, 20 (1).
art. no. 46.
pp. 1-12.
ISSN 1749-7922
Abstract
Background The optimal strategy for initial treatment of acute occlusion of superior mesenteric artery (SMA) is debated. The aim of the study was to compare the effectiveness, timelines and outcomes of endovascular versus open surgical treatment in patients with acute SMA occlusion. This was a preplanned substudy of the prospective observational multicenter AMESI (Acute MESenteric Ischaemia) study. Methods Patients with SMA occlusion were divided into surgical and endovascular treatment groups. The surgical group included patients initially subjected to open surgical treatment with surgical or hybrid revascularization or intestinal resection only. The endovascular group included patients initially revascularized endovascularly and was further divided according to treatment effectiveness. Patients were also categorized according to revascularization or no revascularization, and subanalysis performed for different revascularization methods. Baseline and outcome comparisons were made using Fisher and Mann–Whitney U tests. Risk-factors for in-hospital mortality were analysed using a logistic regression model. Results Of 158 patients 107 had surgical and 51 endovascular treatment. The surgical group had higher baseline illness severity scores, higher C-reactive protein and lactate values. The mortality in the endovascular effective, endovascular insufficient as monotherapy and surgical groups was 2.9%, 41.2% and 45.8%, respectively. In multivariable analysis surgery was not an independent risk factor for in-hospital mortality. The rate of arterial embolism was higher in the endovascular revascularization as monotherapy insufficient treatment group (10/17) compared to the endovascular revascularization as monotherapy effective (5/34) and surgical (27/107) groups. We could not identify useful best thresholds for discriminating between effective and insufficient endovascular treatment. Analysis comparing the effect of any revascularization versus no revascularization on in-hospital mortality did not show a clear benefit of revascularization and the method of revascularization did not independently influence mortality. Conclusion The beneficial effect of endovascular compared to surgical treatment in unadjusted analyses is largely explained by selection of patients. None of the compared management approaches had an independent effect on mortality. The choice between endovascular and surgical treatment should not be based solely on the time elapsed from symptom onset but rather on the patient’s general condition and possibly on the cause of SMA occlusion.
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