Article ; Online: Long-term outcome after implementation of endovascular-first strategy to treat acute mesenteric ischemia.
2023 Volume 78, Issue 6, Page(s) 1524–1530
Abstract: Objective: To evaluate the rationale of an aggressive endovascular-first strategy to treat elderly patients with acute mesenteric ischemia (AMI) by studying long-term survival, readmissions, and patients' discharge to home vs nursing facility a decade ... ...
| Abstract | Objective: To evaluate the rationale of an aggressive endovascular-first strategy to treat elderly patients with acute mesenteric ischemia (AMI) by studying long-term survival, readmissions, and patients' discharge to home vs nursing facility a decade after an episode of AMI. Methods: The retrospective study cohort included 66 consecutive patients (all-comers) treated for arterial occlusive AMI between 2009 and 2013. Endovascular revascularization (EVR) was attempted in 50 patients (EVR+), whereas 16 patients were treated without attempted revascularization (EVR-). All patients were followed until death or September 2022. Studied outcomes included discharge status, long-term survival and cause of death and readmissions related to AMI. Results: The mean age of all 66 patients was 78 ± 10 years: 79 ± 9 years in the EVR+ group and 76 ± 12 years in the EVR- group. EVR was technically successful in 44 patients (88%); three patients underwent subsequent open revascularization after EVR failure. One-third required bowel resection after EVR. The 30-day mortality for all patients was 44%; 32% in the EVR+ group and 81% in the EVR- group. Only two survivors were permanently institutionalized, whereas all others were discharged to the same place they lived prior to the AMI episode. There were four AMI-related readmissions during the follow-up; all were in the EVR+ group. Two patients underwent reinterventions for recurrent AMI. One-year survival was 52% for EVR+ and 19% for EVR- patients. Five-year survival rates were 18% and 13%, respectively. The causes of deaths were mesenteric ischemia in 22, other cardiovascular event in 21, and non-cardiovascular cause in 19 patients. Four patients were alive at the end of the follow-up. Conclusions: In this unselected elderly population with AMI, the aggressive strategy to attempt EVR resulted in a high revascularization rate and favorable outcomes. The high proportion of patients returning to their prior living status and low readmission rate after survival from AMI encourages active treatment of high-functioning elderly patients. |
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| MeSH term(s) | Humans ; Aged ; Aged, 80 and over ; Mesenteric Ischemia/diagnostic imaging ; Mesenteric Ischemia/surgery ; Endovascular Procedures/adverse effects ; Retrospective Studies ; Risk Factors ; Treatment Outcome ; Time Factors ; Ischemia/surgery |
| Language | English |
| Publishing date | 2023-08-14 |
| Publishing country | United States |
| Document type | Journal Article |
| ZDB-ID | 605700-7 |
| ISSN | 1097-6809 ; 0741-5214 |
| ISSN (online) | 1097-6809 |
| ISSN | 0741-5214 |
| DOI | 10.1016/j.jvs.2023.08.100 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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