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Lei Y, Tang W, Zhang X, Wang Y. The geriatric index of comorbidity as an outcome predictor of patients with acute mesenteric ischemia due to superior mesentery artery thromboembolism. Vascular 2024; 32:48-56. [PMID: 36173006 DOI: 10.1177/17085381221128333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the impact of comorbidities on in-hospital mortality and overall survival in patients with acute mesenteric ischemia (AMI) due to superior mesentery artery (SMA) thromboembolism. METHODS A retrospective study was conducted for 40 patients with AMI due to SMA thromboembolism who were treated in our hospital between February 2013 and December 2019. The presence of comorbidities was described and their severities were classified into 1-4 levels by Geriatric Index of Comorbidity (GIC), the comorbidities were defined as any distinct additional clinical entity that has existed. Univariate and cox proportional-hazards analyses were performed to determine the effect of comorbidities on in-hospital mortality and overall survival. RESULTS During a mean follow-up of 15.05 ± 18.02 months (range from 0.3 to 58 months) for the 40 patients with AMI due to SMA thromboembolism, In-hospital mortality rate was 52.5% (21/40). One-year, 2-year, and 3-year overall estimated survival rates by the Kaplan-Meier method were 45%, 34%, and 26.5%, respectively, the average overall survival time was 20.84 ± 3.95 (95% CI: 13.10-28.58) months. In-hospital mortality was significantly related to the GIC classification (χ2 = 7.86, p = 0.049). The average overall survival was significantly related to the malignant tumor in pre-existing comorbidities and GIC classification (log-rank, p = 0.001). Cox proportional-hazards regressions analysis showed that the class 4 of comorbidities was an independent prognostic factor of mortality (p = 0.031, HR = 10.45 [95% CI: 1.24-87.70]). CONCLUSION Comorbidity is common and an important factor associated with all-cause mortality in AMI patients due to SMA thromboembolism. In managing AMI patients, we recommend a timely diagnosis of both AMI condition and its associated comorbidities.
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Affiliation(s)
- Yan Lei
- Department of Clinical Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Wei Tang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Department of Nuclear Medicine, Daping Hospital, Army Medical University, Chongqing, China
| | - Xiaoming Zhang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yi Wang
- Department of Nuclear Medicine, Daping Hospital, Army Medical University, Chongqing, China
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2
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Gries JJ, Virk HUH, Chen B, Sakamoto T, Alam M, Krittanawong C. Advancements in Revascularization Strategies for Acute Mesenteric Ischemia: A Comprehensive Review. J Clin Med 2024; 13:570. [PMID: 38276076 PMCID: PMC10816895 DOI: 10.3390/jcm13020570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
Even with modern advancements in the management of acute mesenteric ischemia over the past decade, morbidity and mortality remain high, and the best primary treatment modality is still debated amongst interventionalists. Traditionally, interventionalists have favored an open surgical approach but are now trending for endovascular interventions due to apparent reduced mortality and complications. Newer studies suggest hybrid approaches, and intestinal stroke centers may be superior to either strategy alone. This narrative review will explore the natural history of acute mesenteric ischemia with the aim of increasing interventionalist awareness of modern advancements in revascularization strategies for this devastating disease.
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Affiliation(s)
- Jacob J. Gries
- Department of Internal Medicine, Geisinger Medical Center, Danville, PA 17822, USA;
| | - Hafeez Ul Hassan Virk
- Harrington Heart & Vascular Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Bing Chen
- Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA 17822, USA
| | - Takashi Sakamoto
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo 113-0033, Japan
- Department of Clinical Epidemiology & Health Economics, School of Public Health, The University of Tokyo, Tokyo 113-0033, Japan
| | - Mahboob Alam
- Section of Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Chayakrit Krittanawong
- Cardiology Division, NYU Langone Health and NYU School of Medicine, New York, NY 10016, USA
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3
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Soltanzadeh-Naderi Y, Acosta S. Trends in population-based incidence, diagnostics, and mortality of acute superior mesenteric artery occlusion. Front Surg 2024; 10:1334655. [PMID: 38234455 PMCID: PMC10791993 DOI: 10.3389/fsurg.2023.1334655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/08/2023] [Indexed: 01/19/2024] Open
Abstract
Acute occlusion of the superior mesenteric artery (SMA) results in lethal intestinal ischemia. Results from two previous population-based studies in Malmö, Sweden, suggest a decreasing incidence of acute SMA occlusion. This study aimed to evaluate trends in the epidemiology of acute SMA occlusion in Malmö. The report was a retrospective population-based study conducted from 2014 to 2019 on patients with acute SMA occlusion residing in Malmö municipality. Patient data were retrieved from Skåne University Hospital and postmortem examinations. Epidemiological data were compared to those of the two earlier studies, in particular to the one conducted from 2000 to 2006. Sixteen patients with acute SMA occlusion resided in Malmö municipality. The incidence of acute SMA occlusion significantly decreased from 5.4/100,000 person-years to 0.8/100,000 person-years. The ratio of acute SMA occlusion to non-occlusive mesenteric ischemia (NOMI) decreased from 12.5:1 to 0.9:1 (p < 0.0001), the proportion of inhabitants aged 80 years or above in the population decreased from 6.0% to 4.3% (p < 0.0001), and the autopsy rate decreased from 25% to 14% (p < 0.0001). The in-hospital mortality rate decreased from 63% to 44% (p = 0.14). The incidence of acute SMA occlusion seems to have decreased significantly in Malmö, probably due to high-resolution computed tomography angiographies being available around the clock to distinguish acute SMA occlusion from NOMI, a reduced proportion of elderly individuals, improved control of medical risk factors, and a decrease in autopsy rates.
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Affiliation(s)
| | - S. Acosta
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
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4
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Jiang T, Cai Z, Mu M, Zhao Z, Shen C, Zhang B. The Global Burden of Vascular Intestinal Disorders in 204 Countries and Territories From 1990 to 2019: Global Burden of Diseases Study. Int J Public Health 2023; 68:1606297. [PMID: 37822566 PMCID: PMC10562586 DOI: 10.3389/ijph.2023.1606297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 08/21/2023] [Indexed: 10/13/2023] Open
Abstract
Objectives: Assess the prevalence, mortality, and disability-adjusted life years (DALYs) of vascular intestinal disorders (VID) from 1990 to 2019. Methods: This study conducted a secondary data analysis utilizing the Global Burden of Diseases Study 2019. The prevalence, mortality and DALYs of VID were analyzed by sex, age and socio-demographic index (SDI), respectively. Analyses were performed by using R software. Results: Globally, the number of prevalent VID cases increased from 100,158 (95% uncertainty interval: 89,428-114,013) in 1,990-175,740 (157,941-198,969) in 2019. However, the age-standardized rates (ASR) of VID prevalence declined from 2.47 (95% uncertainty interval: 2.24-2.76) per 100,000 population to 2.21 (1.98-2.48) per 100,000 population between 1990 and 2019. Furthermore, the ASR of mortality also decreased from 1990 to 2019. Between 1990 and 2019, the regions with high and high-middle level exhibited the highest diseases burden. Conclusion: Globally, the diseases burden associated with VID demonstrated a decline from 1990 to 2019. However, concerted efforts are still required to enhance measures to combat VID within countries categorized as high and high-middle SDI.
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Affiliation(s)
- Tianxiang Jiang
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zhaolun Cai
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Mingchun Mu
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zhou Zhao
- Department of Gastrointestinal Cancer Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Chaoyong Shen
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Zhang
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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5
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Yin L, Gao M, Xu L, Qi Y, Han L, Peng J. Single-cell analysis of cellular heterogeneity and interactions in the ischemia-reperfusion injured mouse intestine. J Pharm Anal 2023; 13:760-775. [PMID: 37577387 PMCID: PMC10422115 DOI: 10.1016/j.jpha.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 01/12/2023] [Accepted: 02/01/2023] [Indexed: 02/10/2023] Open
Abstract
Nine major cell populations among 46,716 cells were identified in mouse intestinal ischemia‒reperfusion (II/R) injury by single-cell RNA sequencing. For enterocyte cells, 11 subclusters were found, in which enterocyte cluster 1 (EC1), enterocyte cluster 3 (EC3), and enterocyte cluster 8 (EC8) were newly discovered cells in ischemia 45 min/reperfusion 720 min (I 45 min/R 720 min) group. EC1 and EC3 played roles in digestion and absorption, and EC8 played a role in cell junctions. For TA cells, after ischemia 45 min/reperfusion 90 min (I 45 min/R 90 min), many TA cells at the stage of proliferation were identified. For Paneth cells, Paneth cluster 3 was observed in the resting state of normal jejunum. After I 45 min/R 90 min, three new subsets were found, in which Paneth cluster 1 had good antigen presentation activity. The main functions of goblet cells were to synthesize and secrete mucus, and a novel subcluster (goblet cluster 5) with highly proliferative ability was discovered in I 45 min/R 90 min group. As a major part of immune system, the changes in T cells with important roles were clarified. Notably, enterocyte cells secreted Guca2b to interact with Gucy2c receptor on the membranes of stem cells, TA cells, Paneth cells, and goblet cells to elicit intercellular communication. One marker known as glutathione S-transferase mu 3 (GSTM3) affected intestinal mucosal barrier function by adjusting mitogen-activated protein kinases (MAPK) signaling during II/R injury. The data on the heterogeneity of intestinal cells, cellular communication and the mechanism of GSTM3 provide a cellular basis for treating II/R injury.
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Affiliation(s)
- Lianhong Yin
- College of Pharmacy, Dalian Medical University, Dalian, Liaoning, 116044, China
| | - Meng Gao
- College of Pharmacy, Dalian Medical University, Dalian, Liaoning, 116044, China
| | - Lina Xu
- College of Pharmacy, Dalian Medical University, Dalian, Liaoning, 116044, China
| | - Yan Qi
- College of Pharmacy, Dalian Medical University, Dalian, Liaoning, 116044, China
| | - Lan Han
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei, 230012, China
| | - Jinyong Peng
- College of Pharmacy, Dalian Medical University, Dalian, Liaoning, 116044, China
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6
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Treffalls RN, Stonko DP, DeMartino RR, Morrison JJ. Acute management of mesenteric emergencies: Tailoring the solution to the problem. Semin Vasc Surg 2023; 36:234-249. [PMID: 37330237 DOI: 10.1053/j.semvascsurg.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/10/2023] [Accepted: 04/17/2023] [Indexed: 06/19/2023]
Abstract
Acute mesenteric ischemia (AMI) constitutes a life-threatening problem that can result in death, multiorgan failure, and severe nutritional disability. Although AMI is a rare cause of acute abdominal emergencies, ranging between 1 and 2 individuals per 10,000, the morbidity and mortality rates are high. Arterial embolic etiology composes nearly one-half of AMIs, with a sudden onset of severe abdominal pain considered the most common symptom. Arterial thrombosis is the second most common cause of AMI, which presents similarly to arterial embolic AMI, although often more severe due to anatomic differences. Veno-occlusive causes of AMI are the third most common and are associated with an insidious onset of vague abdominal pain. Each patient is unique, and the treatment plan should be tailored to their individual needs. This may include considering the patient's age, comorbidities, and overall health, as well as their preferences and personal circumstances. A multidisciplinary approach involving specialists from different fields, such as surgeons, interventional radiologists, and intensivists, is recommended for the best possible outcome. Potential challenges in tailoring an optimal treatment plan for AMI may include delayed diagnosis, limited availability of specialized care, or patient factors that make some interventions less feasible. Addressing these challenges requires a proactive and collaborative approach, with regular review and adjustment of the treatment plan as needed to ensure the best possible outcome for each patient.
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Affiliation(s)
- Rebecca N Treffalls
- Division of Vascular and Endovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - David P Stonko
- Division of Vascular and Endovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905; Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Randall R DeMartino
- Division of Vascular and Endovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Jonathan J Morrison
- Division of Vascular and Endovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
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7
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Deen R, Sia ZK. Review article: Acute superior mesenteric vessel ischaemia: A review of clinical practice and biomarkers. Emerg Med Australas 2023; 35:14-17. [PMID: 36509512 DOI: 10.1111/1742-6723.14145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022]
Abstract
A patient with acute occlusion of the superior mesenteric vessels resulting in superior mesenteric vessel ischaemia (SMVI) who presents to the ED with abdominal pain and unremarkable abdominal examination risks delay in diagnosis and treatment with adverse outcome. A comprehensive literature search was performed, and the evidence was reviewed. To-date, there are no accurate biomarkers of SMVI and so, heightened awareness among ED staff and rapidly actioning diagnostic imaging and surgical referral will help fast-track the patient with SMVI to surgical management. Management of SMVI is challenging and requires ongoing communication. Prompt surgical intervention may help reduce mortality and morbidity in SMVI. SMVI is associated with significant mortality and morbidity. With the lack of accurate biomarkers, diagnosis and management is challenging and requires heightened awareness among ED staff for prompt surgical referral and intervention.
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Affiliation(s)
- Raeed Deen
- Department of Vascular Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Zhi Kiat Sia
- Department of General Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
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8
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Dias-Neto M, Tenorio ER, Baumgardt Barbosa Lima G, Baghbani-Oskouei A, Oderich GS. Postoperative management in patients with complex aortic aneurysms. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:587-596. [PMID: 35687066 DOI: 10.23736/s0021-9509.22.12359-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Patients with complex aortic aneurysms (CAA) are often high risk due to advanced age and widespread atherosclerosis affecting numerous vascular territories. Therefore, a thorough perioperative evaluation is needed prior to performing in any type of aortic repair, regardless of whether an endovascular or open surgical approach is selected. Because these operations are technically demanding and often result in end organ ischemia, it is not surprising that complex aortic repair carries significant risk of morbidity and mortality. Disabling complications such as dialysis, major stroke and paraplegia constitute the main limitation of complex aortic repair. The aim of this article was to review postoperative management to mitigate complications after CAA repair.
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Affiliation(s)
- Marina Dias-Neto
- McGovern Medical School, Department of Cardiothoracic and Vascular Surgery, Health Science Center at Houston, University of Texas, Houston, TX, USA
| | - Emanuel R Tenorio
- McGovern Medical School, Department of Cardiothoracic and Vascular Surgery, Health Science Center at Houston, University of Texas, Houston, TX, USA
| | - Guilherme Baumgardt Barbosa Lima
- McGovern Medical School, Department of Cardiothoracic and Vascular Surgery, Health Science Center at Houston, University of Texas, Houston, TX, USA
| | - Aidin Baghbani-Oskouei
- McGovern Medical School, Department of Cardiothoracic and Vascular Surgery, Health Science Center at Houston, University of Texas, Houston, TX, USA
| | - Gustavo S Oderich
- McGovern Medical School, Department of Cardiothoracic and Vascular Surgery, Health Science Center at Houston, University of Texas, Houston, TX, USA -
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9
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Collange O, Lopez M, Lejay A, Pessaux P, Ouattara A, Dewitte A, Rimmele T, Girardot T, Arnaudovski D, Augustin P, Chakfe N, Tacquard C, Oulehri W, Zieleskiewicz L, Severac F, Leone M, Mertes PM. Serum lactate and acute mesenteric ischaemia: An observational, controlled multicentre study. Anaesth Crit Care Pain Med 2022; 41:101141. [DOI: 10.1016/j.accpm.2022.101141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 11/01/2022]
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10
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Giulio F, Ruggiero S, Vicini S, Bellini D, Rengo M, Carbone I. Unusual computed tomography findings of gas in the superior mesenteric artery system with no signs of porto-mesenteric venous gas in a case of acute mesenteric ischemia. Radiol Case Rep 2022; 17:2568-2572. [PMID: 35634014 PMCID: PMC9130093 DOI: 10.1016/j.radcr.2022.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 11/24/2022] Open
Abstract
Acute Mesenteric Ischemia (AMI) is a rare life-threatening entity caused by sudden interruption of the blood supply to a segment of the bowel due to impairment of mesenteric arterial blood flow or venous drainage. Clinical presentation varies according to the time course of vascular occlusion. Contrast-enhanced Computed Tomography (CT) of the abdomen represents the main diagnostic test for AMI diagnosis, enabling fast and excellent evaluation of the intestine, mesenteric vasculature, and other ancillary characteristics of AMI. Typical CT findings of AMI include paralytic ileus, decreased or absent bowel wall contrast-enhancement, pneumatosis intestinalis, and porto-mesenteric venous gas. We hereby report a case of an 89-year-old man presenting with AMI due to Superior Mesenteric Artery (SMA) thrombotic occlusion following endovascular stenting superficial femoral arteries. Typical findings were observed on abdominal CT imaging, yet associated with the presence of gas exclusively in the SMA district, without any involvement of the porto-mesenteric venous system. Different imaging features and pitfalls can help radiologists to accurately diagnose AMI, especially when irreversible bowel damage is about to occur. Therefore, radiologists and emergency physicians should be aware of the unusual association between gas in the SMA arterial district and AMI, even in the absence of porto-mesenteric venous system involvement, in order to urge prompt surgical consultation when observed.
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11
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Badripour A, Behzadi M, Hassanipour A, Azar PRS, Rahbar A, Abbaslou Z, Ehghaghi E, Piranviseh A, Khavandi MM, Ahmadi-Tafti SM, Ashouri M, Soltani ZE, Dehpour A. Albendazole ameliorates inflammatory response in a rat model of acute mesenteric ischemia reperfusion injury. Biomed Pharmacother 2022; 153:113320. [PMID: 35752010 DOI: 10.1016/j.biopha.2022.113320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/14/2022] [Accepted: 06/20/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Acute mesenteric ischemia is known as a life threatening condition. Re-establishment of blood flow in this condition can lead to mesenteric ischemia reperfusion (MIR) injury which is accompanied by inflammatory response. Still, clear blueprint of inflammatory mechanism underlying MIR injury has not been provided. Interestingly, Albendazole has exhibited notable effects on inflammation and cytokine production. In this study, we aimed to evaluate outcomes of MIR injury following pretreatment with Albendazole with respect to assessment of mesenteric inflammation and ischemia threshold. METHODS Male rats were randomly divided into sham operated, vehicle treated, Albendazole 100 mg/kg and Albendazole 200 mg/kg groups. MIR injury was induced by occlusion of superior mesenteric artery for 30 min followed by 120 min of reperfusion. Samples were utilized for assessment of epithelial survival and villous height. Immunohistochemistry study revealed intestinal expression of TNF-α and HIF-1-α. Gene expression of NF-κB/TLR4/TNF-α/IL-6 was measured using RTPCR. Also protein levels of inflammatory cytokines in serum and intestine were assessed by ELISA method. RESULTS Histopathological study demonstrated that pretreatment with Albendazole could ameliorate decline in villous height and epithelial survival following MIR injury. Also, systemic inflammation was suppressed after administration of Albendazole. Analysis of possible participating inflammatory pathway could demonstrate that intestinal expression of NF-κB/TLR4/TNF-α/IL-6 is significantly attenuated in treated groups. Eventually, IHC study illustrated concordant decline in mesenteric expression of HIF-1-α/TNF-α. CONCLUSION Single dose pretreatment with Albendazole could ameliorate inflammatory response and enhance ischemia threshold following induction of MIR injury. More studies would clarify existing causality in this phenomenon.
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Affiliation(s)
- Abolfazl Badripour
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran; Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Colorectal Surgery Research Center, Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohamad Behzadi
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Hassanipour
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran; Colorectal Surgery Research Center, Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Pasha Reza Shams Azar
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran; Colorectal Surgery Research Center, Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Rahbar
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zhaleh Abbaslou
- Faculty of Pharmacy, Eastern Mediterranean University, Famagusta, North Cyprus Via Mersin 10, Turkey
| | - Elnaz Ehghaghi
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran; Faculty of Pharmacy, Eastern Mediterranean University, Famagusta, North Cyprus Via Mersin 10, Turkey
| | - Ashkan Piranviseh
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran; Colorectal Surgery Research Center, Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mahdi Khavandi
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran; Colorectal Surgery Research Center, Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohsen Ahmadi-Tafti
- Colorectal Surgery Research Center, Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran; Department of Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ashouri
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran; Department of Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
| | - Zahra Ebrahim Soltani
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmadreza Dehpour
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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12
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Acute Superior Mesenteric Arterial Occlusion Caused by a Thoracic Aortic Mural Thrombus in a Patient Without Coagulation Disorder or Aortic Disease: A Case Report. Int Surg 2022. [DOI: 10.9738/intsurg-d-16-00150.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction
Aortic mural thrombus (AMT) formation in a patient without hypercoagulability and preexisting aortic disease is very rare, and acute superior mesenteric artery (SMA) occlusion resulting from AMT is clinically infrequent.
Case presentation
A 70-year-old woman was transferred to our institute with a diagnosis of acute SMA occlusion. Contrast-enhanced computed tomography (CECT) revealed thromboemboli in the SMA and a thoracic AMT. She immediately underwent angiography and subsequent endovascular aspiration and transcatheter infusion, which recanalized the SMA. However, CECT suggested intestinal ischemia; therefore, she underwent intestinal resection, and we administered anticoagulant therapy with heparin and warfarin postoperatively for the thoracic AMT. Although repeat thrombus formation developed in an ileal branch despite anticoagulant therapy, she had no abdominal symptoms; therefore, we continued the anticoagulant therapy. CECT 3 months later confirmed the absence of thoracic AMT and normal ileal findings.
Conclusion
We report a case of acute SMA occlusion and preceding splenic infarction that resulted from thoracic AMT in a patient without hypercoagulability and preexisting aortic disease. AMT should always be considered as a cause of acute SMA occlusion in patients without heart disease, including atrial fibrillation or severe arteriosclerosis.
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13
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Lendzion RJ, Frahm-Jensen G, Keck J. Acute Mesenteric Ischemia. Clin Colon Rectal Surg 2022; 35:227-236. [PMID: 35966379 PMCID: PMC9374525 DOI: 10.1055/s-0042-1743283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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.
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Affiliation(s)
| | | | - James Keck
- Colorectal Department, St. Vincent's Health, Melbourne, Australia
- Department of Colorectal Surgery, Eastern Health, Melbourne, Australia
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14
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Sinha D, Kale S, Kundaragi NG, Sharma S. Mesenteric ischemia: a radiologic perspective. Abdom Radiol (NY) 2022; 47:1514-1528. [PMID: 33230592 DOI: 10.1007/s00261-020-02867-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 02/08/2023]
Abstract
Mesenteric ischemia is a broad term encompassing several clinical conditions leading to impaired vascularity of bowel loops. Absence of specific clinical presentation and a definitive laboratory marker often lead to delayed diagnosis with high morbidity and mortality in the acute setting. Imaging plays a crucial role in the diagnosis and management. Multi-detector CT (MDCT) is the first line imaging modality for the evaluation of patients with suspected mesenteric ischemia and plays an important role for assessing its severity and complications. This review article highlights the causes, pathophysiology, imaging features and possible endovascular treatment options of mesenteric ischemia.
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González-Pacheco H, Gopar-Nieto R, Torres-Machorro A, Pérez-Pinetta PE, Arias-Mendoza A. Acute Mesenteric Ischemia Prior to Emergency Cardiac Surgery for Infective Endocarditis: Can We Design a Strategy to Improve Outcomes? Cureus 2022; 14:e24532. [PMID: 35506119 PMCID: PMC9053355 DOI: 10.7759/cureus.24532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 12/03/2022] Open
Abstract
Infective endocarditis (IE) can be complicated by systemic embolization. Unfortunately, in some situations, it requires radical and urgent therapeutic approaches. Herein, we describe a case of IE complicated by acute mesenteric ischemia (AMI) due to septic embolism prior to emergent cardiac surgery. A previously healthy 38-year-old woman was admitted to our emergency department with a diagnosis of mitral valve IE. She presented with tachycardia and was tachypneic. In addition, a systolic murmur in the mitral area and Janeway lesions were documented. Transthoracic and transesophageal echocardiography confirmed large mobile vegetations on the mitral valve and the presence of mitral regurgitation. A thoracic computed tomography scan showed splenic and bilateral renal infarctions. Emergency mitral valve replacement was scheduled. Prior to surgery, AMI developed because of occlusion of the superior mesenteric artery (SMA). Endovascular treatment was performed with percutaneous aspiration, thrombectomy, and in situ fibrinolysis, yielding satisfactory results. Ten hours later, she underwent cardiac surgery. AMI developed postoperatively due to re-occlusion of the SMA, requiring an open laparotomy with mesenteric revascularization and extensive resection of the necrotic bowel. The patient died 18 days after hospitalization. In the IE setting, AMI is a very rare, potentially life-threatening complication. This case highlights the importance of recognizing this complication and designing a better therapeutic strategy to reduce the associated mortality rate.
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Yu Z, Wang S, Lang D, Yin X, Lin Z, Hu S, Wang D, Xu Q, Hu J. Percutaneous mechanical thrombectomy in the management of early acute superior mesenteric artery embolism. Vascular 2022:17085381221085150. [PMID: 35420466 DOI: 10.1177/17085381221085150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE This study was performed to summarize our experience in the management of early-stage acute superior mesenteric artery embolism (ASMAE) by percutaneous mechanical thrombectomy (PMT). METHODS The clinical data of 12 patients with early-stage ASMAE treated by PMT in our institution from November 2019 to September 2021 were retrospectively analyzed. The patients had no obvious evidence of bowel infarction as shown by peritoneal puncture and computed tomography angiography. Thrombectomy of the superior mesenteric artery was performed using a 6F AngioJet catheter. RESULTS The emboli were completely removed in 10 (83.3%) patients. Six patients were treated only by the AngioJet device. The other six patients underwent combined treatment with a 6F multipurpose drainage catheter after PMT, including one patient who underwent simultaneous stent implantation. Two patients showed no significant improvement in their symptoms after the operation; one was found to have intestinal necrosis and underwent resection by exploratory laparotomy, and the other died of septic shock 3 days after PMT (further intervention had been discontinued because of complications with multiple underlying diseases). No other PMT-related complications occurred. Only one patient was found to have a pseudoaneurysm of the superior mesenteric artery 1 week after PMT and underwent resection by exploratory laparotomy. The 11 surviving patients were smoothly discharged from the hospital after their symptoms were relieved. At a mean follow-up of 13.2 months, computed tomography angiography showed smooth patency of the superior mesenteric artery. No patients developed serious symptoms during follow-up. CONCLUSIONS PMT by the AngioJet device is a minimally invasive, safe, and effective technique to remove ASMAE. Early application of PMT can avoid acute intestinal necrosis. Combining the AngioJet device with a 6F multipurpose drainage catheter might be more helpful to remove residual emboli.
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Affiliation(s)
- Zuanbiao Yu
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Shuyuan Wang
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Dehai Lang
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Xiaoliang Yin
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Zuodong Lin
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Songjie Hu
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Di Wang
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Qiyang Xu
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Jiangnan Hu
- Department of Pharmaceutical Sciences, 538800University of North Texas Health Science Center, Fort Worth, TX, USA
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Yadong S, Haobo S, Liang C, Hao H, Zhaoxuan L, Jianping G. Endovascular Revascularization as Primary Treatment for Acute Embolic Mesenteric Ischemia: Stent Thrombectomy plus Aspiration versus Aspiration Alone. J Vasc Interv Radiol 2021; 33:295-303. [PMID: 34915163 DOI: 10.1016/j.jvir.2021.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/05/2021] [Accepted: 12/04/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the outcomes of stent thrombectomy combined with aspiration versus aspiration alone in acute mesenteric ischemia (AMI). METHODS This was a single-center, retrospective cohort study. Between 1 May 2012 and 1 January 2021, 41 patients (mean age, 73.8±7.9 years) with AMI who underwent stent thrombectomy plus aspiration (Group 1, n=14) or aspiration alone (Group 2, n=27) were included. Patients' treatment regimens, clinical and follow-up outcomes were reviewed and analyzed. The group differences were compared using a Chi square test, Fisher's exact test, independent t test, or Mann-Whitney U test. The cumulative survival rate was calculated using a Kaplan-Meier curve. RESULTS The overall clinical success rate was 78.0% (32/41), and no significant difference was found between Group 1 and Group 2 (78.6% vs. 77.8%, p = 1.00). Whereas Group 1 was associated with a higher complete clearance rate (78.6% vs. 44.4%, p = 0.04), less adjunctive local thrombolysis (14.3% vs. 48.1%, p = 0.03), and shorter length of hospital stay (5.7±4.7 vs. 10.7±9.0 days, p = 0.03). The estimated survival rate at 1 month, 3 months, 6 months, 1 year, and 2 years was 73.2%, 72.5%, 71.4%, 65.3%, and 59.8%, respectively. No significant difference was found in survival rate between the groups (log-rank, p = 0.96). The recurrence rate for Group 1 and Group 2 were 8.3% (1/12) and 4.0% (1/25), respectively. CONCLUSIONS Compared with aspiration alone, additional stent thrombectomy showed superiorities in higher complete clearance rate, reduced adjunctive thrombolysis, and shorter length of hospital stay.
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Affiliation(s)
- Shi Yadong
- The Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, China
| | - Su Haobo
- The Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, China
| | - Chen Liang
- The Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, China
| | - Huang Hao
- The Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, China
| | - Lu Zhaoxuan
- The Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, China
| | - Gu Jianping
- The Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, China.
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Beloborodov V, Vorobev V, Sokolova S, Frolov A, Kornilov D, Sorokina L, Golub I. Mesenteric Vessel Thrombosis Treatment Experience. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: One of the most serious diseases among all emergency abdominal pathology is an acute violation of the mesenteric blood circulation. The rapid development of intestinal ischemia results in its infarction and necrosis.
AIM: The study aims to assess the survival rate of patients with mesenteric vascular thrombosis, taking into account, the predictor characteristics influence of disease development factors.
METHODS: The study presents a retrospective analysis of mesenteric vascular thrombosis clinical cases for 2016–2019. During this period, there were 147 patients with an established diagnosis at the Irkutsk Clinical Hospital No. 1, 21 of them met the study criteria.
RESULTS: According to the type of thrombosis, there were two groups – occlusive (Group I, n = 11) and non occlusive (Group II, n = 10). Four patients (36.3%) of Group I and 7 patients (70%) of Group II (p = 0.388) recovered from the disease. Three patients (27.2%) of Group I and 4 patients (40%) of Group II (p = 0.662) received conservative therapy, 2 of them (66.6%) in Group I and 4 (100%) in Group II (p = 0.724) recovered from the disease. In addition, the authors performed a mortality assessment, according to the timing of the visit to a medical institution. Four (50%) out of eight patients who applied in the first 12 h, 2 (66%) out of three – in the first 12–24 h, and 5 (50%) out of 10 for more than 24 h of illness had a positive treatment result in the combined group.
CONCLUSION: The patients over 70 years old with peritoneal symptoms and established intestinal necrosis have an extremely unfavorable prognosis. The primary mesenteric vessel thrombosis with additional contrast angiography still gives a moderate treatment prognosis.
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Olson KA, Teixeira PG. Mesenteric Ischemia: When and How to Revascularize. Adv Surg 2021; 55:75-87. [PMID: 34389101 DOI: 10.1016/j.yasu.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Kristofor A Olson
- Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, 1500 Red River Street, Annex, Austin, TX 78701, USA
| | - Pedro G Teixeira
- Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, 1500 Red River Street, Annex, Austin, TX 78701, USA.
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Tolonen M, Lemma A, Vikatmaa P, Peltola E, Mentula P, Björkman P, Leppäniemi A, Sallinen V. The implementation of a pathway and care bundle for the management of acute occlusive arterial mesenteric ischemia reduced mortality. J Trauma Acute Care Surg 2021; 91:480-488. [PMID: 34086659 PMCID: PMC8404963 DOI: 10.1097/ta.0000000000003305] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/20/2021] [Accepted: 05/20/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Acute mesenteric ischemia (AMI) is a disease with high mortality and requires a multidisciplinary approach for effective management. A pathway and care bundle were developed and implemented with the objective to reduce mortality. The aim of this retrospective comparative study was to analyze the effects of the pathway on patient management and outcome. METHODS All consecutive patients operated in a secondary and tertiary referral center because of occlusive arterial AMI were identified between 2014 and April 2020. The pathway aimed to increase overall awareness, and hasten and improve diagnostics and management. Patients treated before implementation of the pathway (pregroup, years 2014-2017) were compared with patients treated using the pathway (postgroup, May 2018 to April 2020). Univariate and multivariate analyses were used to compare the groups. RESULTS There were 78 patients in the pregroup and 67 patients in the postgroup with comparable baseline characteristics and disease acuity. The postgroup was more often diagnosed with contrast-enhanced computed tomography (58 [74%] vs. 63 [94%], p = 0.001) and had shorter mean in-hospital delay to operating room (7 hours [interquartile range, 3.5-12.5] vs. 3 hours [interquartile range, 2-11], p = 0.023). Revascularization was done more often in the postgroup (53 [68%] vs. 56 [84%], p = 0.030) especially using endovascular treatment (26 [33%] vs. 43 [64%], p < 0.001). Thirty-day mortality was lower in the postgroup (23 [51%] vs. 17 [25%], p = 0.001). Being managed in the postgroup remained as a protective factor (odds ratio, 0.32; 95% confidence interval, 0.14-0.75; p = 0.008) for 30-day mortality in the multivariate analysis. CONCLUSION Implementing a pathway and care bundle resulted in enhanced regional and in-hospital awareness of AMI, more appropriate computed tomography imaging, shorter in-hospital delays, increased number of revascularizations, and, hence, lower mortality. LEVEL OF EVIDENCE Therapeutic/Care Management, level IV.
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21
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Intraoperative quality assessment of tissue perfusion with indocyanine green (ICG) in a porcine model of mesenteric ischemia. PLoS One 2021; 16:e0254144. [PMID: 34283875 PMCID: PMC8291700 DOI: 10.1371/journal.pone.0254144] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/18/2021] [Indexed: 11/19/2022] Open
Abstract
Background Mesenteric ischemia is a severe and potentially lethal event. Assessment of intestine perfusion is eminently depending on the skills, and the experience of the surgeon. Thus, the therapy is biased by the right evaluation. Aim of this study is to determine the applicability, and the usefulness of fluorescent-imaging (FI) with indocyanine green (ICG) in a porcine model of mesenteric ischemia. Second end-point is the verification of a visual and quantitative assessment tool of the intestinal perfusion. Methods In 18 pigs (54,2 ±2,9kg) an occlusion of a side-branch of the mesenteric artery was performed for 3 (group I, n = 7), 6 (group II, n = 7), and 10 hours (group III, n = 4). After reperfusion a 60 minutes observation period was carried out. 3 regions of interest were defined: ischemic bowel (D1), transitional zone (D2), and non-ischemic bowel (D3). ICG-FI was performed during baseline (T0), occlusion (T1), reperfusion (T2) and after an observation period of 60 minutes (T4). Results All experiments could be finished successfully. ICG-FI was assessed using assessment of background-subtracted peak fluorescence intensity (BSFI), slope of fluorescence intensity (SFI), and a baseline adjusted ratio of both parameters. ICG-FI confirmed loss of perfusion in D1, decreased perfusion in D2, and increased perfusion in D3. After reperfusion ICG-FI increased in group 2 due to a severe tissue damage resulting in a capillary leakage. In group I ICG-FI was equal to baseline values indicating the totally reversible loss of perfusion. Conclusion Using ICG-FI to estimate intestine perfusion after different durations of ischemia is viable using a porcine model of mesenteric ischemia. Even small differences in perfusion can be reliably determined by ICG-FI. Thus, ICG-FI is an encouraging method to evaluate intestine perfusion intraoperatively.
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22
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Tang W, Zhang J, Kuang LQ, Yi KM, Li CX, Wang Y. Relationship of superior mesenteric artery thrombus density with transmural intestinal necrosis on multidetector computed tomography in acute mesenteric ischemia. Quant Imaging Med Surg 2021; 11:3120-3132. [PMID: 34249639 DOI: 10.21037/qims-20-604] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 03/12/2021] [Indexed: 01/16/2023]
Abstract
Background Acute arterial occlusive mesenteric ischemia with transmural intestinal necrosis (TIN) is a fatal disease, which is difficult to diagnose on multidetector computed tomography (MDCT). The aim of the present study was to determine the relationship of superior mesenteric artery (SMA) thrombus density with TIN on MDCT in patients with acute mesenteric ischemia (AMI) due to SMA thromboembolism. Methods In this retrospective study, 33 patients who underwent abdominal MDCT and angiography for AMI due to SMA thromboembolism were divided into two groups: the AMI with TIN group and the AMI without TIN group. We analyzed the relationships of clinical characteristics, qualitative MDCT signs, and SMA thrombus density with TIN. The SMA thrombus density was measured on non-contrast MDCT. Univariate and multivariate analyses were performed to determine the risk factors for predicting TIN. The diagnostic performances of risk factors were evaluated by receiver-operating characteristic (ROC) curve analysis. Results Of the patients with AMI enrolled in this study, 33.3% (11/33) were diagnosed with TIN. Peritonitis (P=0.042), bowel wall thinning (P=0.033), and pneumatosis/portomesenteric gas (P=0.010) were significantly associated with TIN. AMI patients with TIN exhibited a higher SMA thrombus density than AMI patients without TIN [41.2±6.1 vs. 34.2±3.0 Hounsfield unit (HU), P=0.003]. Multivariate analysis showed that SMA thrombus density was an independent predictor of TIN [P=0.044, hazard ratio (HR): 1.82, 95% confidence interval (CI): 1.02-3.25]. For diagnosing AMI with TIN, the area under the ROC curve (AUC) of SMA thrombus density (0.83) was larger than those of peritonitis (0.68), bowel wall thinning (0.66), and pneumatosis/portomesenteric gas (0.71). Conclusions In patients with AMI, erythrocyte-rich thrombus blocking the SMA trunk which has a higher density on MDCT is prone to the occurrence of TIN compared with erythrocyte-scarce thrombus with a lower density. SMA thrombus density could be an independent risk factor for TIN in patients with AMI due to SMA thromboembolism.
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Affiliation(s)
- Wei Tang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, China.,Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jing Zhang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Lian-Qin Kuang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Kun-Ming Yi
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Chun-Xue Li
- Department of Gastrointestinal Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Yi Wang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, China
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Janež J, Klen J. Multidisciplinary diagnostic and therapeutic approach to acute mesenteric ischaemia: A case report with literature review. SAGE Open Med Case Rep 2021; 9:2050313X211004804. [PMID: 34094562 PMCID: PMC8142014 DOI: 10.1177/2050313x211004804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 01/16/2023] Open
Abstract
Superior mesenteric artery embolisation is the most common cause of acute mesenteric ischaemia. Superior mesenteric artery embolisation can be caused by various cardiac diseases (myocardial ischaemia or infarction, atrial tachyarrhythmias, endocarditis, cardiomyopathies, ventricular aneurysms and valvular disorders), arterial aneurysms, ulcerated atherosclerotic plaques of the major arteries and others. A case of 65-year-old, previously healthy man with superior mesenteric artery embolism, who was found to also have mural aortic thrombi, is presented. The patient underwent an emergency procedure; small intestine and cecum were resected and jejuno-ascendo anastomosis was performed. The patient was put on lifelong anticoagulation therapy. Neither cardiac diseases nor arterial aneurysms were detected. There were no signs of underlying atherosclerosis. Work-up for antiphospholipid antibodies and rheumatic diseases was negative. Tumour markers were within normal levels and blood cultures were negative. This case represents the challenges in recognising an underlying cause of acute mesenteric embolism and highlights the importance of multidisciplinary diagnostic and treatment approach.
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Affiliation(s)
- Jurij Janež
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jasna Klen
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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24
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Learning from Our Complications Will Be Rewarding. Eur J Vasc Endovasc Surg 2021; 62:64. [PMID: 33947617 DOI: 10.1016/j.ejvs.2021.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 03/25/2021] [Indexed: 11/21/2022]
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25
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Acosta S, Gonçalves FB. Management of Spontaneous Isolated Mesenteric Artery Dissection: A Systematic Review. Scand J Surg 2021; 110:130-138. [PMID: 33724090 PMCID: PMC8258720 DOI: 10.1177/14574969211000546] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background and Aims: There are increasing reports on case series on spontaneous isolated mesenteric artery dissection, that is, dissections of the superior mesenteric artery and celiac artery, mainly due to improved diagnostic capacity of high-resolution computed tomography angiography performed around the clock. A few case–control studies are now available, while randomized controlled trials are awaited. Material and Methods: The present systematic review based on 97 original studies offers a comprehensive overview on risk factors, management, conservative therapy, morphological modeling of dissection, and prognosis. Results and Conclusions: Male gender, hypertension, and smoking are risk factors for isolated mesenteric artery dissection, while the frequency of diabetes mellitus is reported to be low. Large aortomesenteric angle has also been considered to be a factor for superior mesenteric artery dissection. The overwhelming majority of patients can be conservatively treated without the need of endovascular or open operations. Conservative therapy consists of blood pressure lowering therapy, analgesics, and initial bowel rest, whereas there is no support for antithrombotic agents. Complete remodeling of the dissection after conservative therapy was found in 43% at mid-term follow-up. One absolute indication for surgery and endovascular stenting of the superior mesenteric artery is development of peritonitis due to bowel infarction, which occurs in 2.1% of superior mesenteric artery dissections and none in celiac artery dissections. The most documented end-organ infarction in celiac artery dissections is splenic infarctions, which occurs in 11.2%, and is a condition that should be treated conservatively. The frequency of ruptured pseudoaneurysm in the superior mesenteric artery and celiac artery dissection is very rare, 0.4%, and none of these patients were in shock at presentation. Endovascular therapy with covered stents should be considered in these patients.
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Affiliation(s)
- S Acosta
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Vascular Center, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
| | - F B Gonçalves
- Department of Angiology and Vascular Surgery, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central and NOVA Medical School, Lisboa, Portugal
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Wu J, Liu Q, Zhang X, Wu X, Zhao Y, Ren J. STING-dependent induction of lipid peroxidation mediates intestinal ischemia-reperfusion injury. Free Radic Biol Med 2021; 163:135-140. [PMID: 33347986 DOI: 10.1016/j.freeradbiomed.2020.12.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 01/16/2023]
Abstract
Stimulator of interferon genes (STING) is essential for the type I interferon response against DNA pathogens. Recent evidence has indicated that STING also plays a critical role in various diseases such as systemic lupus erythematous, nonalcoholic fatty liver disease, and cancer. However, the exact function and mechanism of STING in ischemia/reperfusion (I/R) injury, especially in the intestine, remains unknown. In the current study, we evaluated the contribution of STING to the intestinal I/R progression. The data indicate a robust STING activation, specifically in the reperfusion period, with the evidence of interferon response and NF-κB pathway activation. The intestinal I/R injury and distant organ damage was absent in STING-/- mice. Mechanically, this detrimental effect relies on excess level of lipid peroxidation, which was proved by the level of 4-hydroxynonenal (4-HNE) and the malondialdehyde (MDA). Additionally, bone marrow derived macrophage (BMDM) was stimulated with mtDNA or STING agonist showed a dose- and time-dependent lipid peroxidation and cell death, which could be reverse by STING-/- or pretreatment of lipid peroxidation inhibitor. Liproxstatin-1 could also ameliorate injury I/R induced multiple-organ damage. Similar results were also identified in the GSE96733 database, which indicated that STING activation was associated with the disbalance of lipid peroxidation and antioxidant system. Collectively, our results indicate a novel role for STING activation in the regulation of lipid peroxidation is closely associated with intestinal I/R injury, and that anti-lipid peroxidation is a unique and effective mechanistic approach for intestinal I/R injury and STING activation associated damage prevention and treatment.
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Affiliation(s)
- Jie Wu
- Department of General Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, 210002, PR China.
| | - Qinjie Liu
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, PR China; Research Institute of General Surgery, Jinling Hospital, Nanjing, 210002, PR China.
| | - Xufei Zhang
- Research Institute of General Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, PR China.
| | - Xiuwen Wu
- Research Institute of General Surgery, Jinling Hospital, Nanjing, 210002, PR China.
| | - Yun Zhao
- Department of General Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, 210002, PR China.
| | - Jianan Ren
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, PR China; Research Institute of General Surgery, Jinling Hospital, Nanjing, 210002, PR China; Research Institute of General Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, PR China.
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27
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Endo A, Saida F, Mochida Y, Kim S, Otomo Y, Nemoto D, Matsubara H, Yamagishi S, Murao Y, Mashiko K, Hirano S, Yoshikawa K, Sera T, Inaba M, Koami H, Kobayashi M, Murata K, Shoko T, Takiguchi N. Planned Versus On-Demand Relaparotomy Strategy in Initial Surgery for Non-occlusive Mesenteric Ischemia. J Gastrointest Surg 2021; 25:1837-1846. [PMID: 32935272 PMCID: PMC7491869 DOI: 10.1007/s11605-020-04792-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 09/06/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND There has been insufficient evidence regarding a treatment strategy for patients with non-occlusive mesenteric ischemia (NOMI) due to the lack of large-scale studies. We aimed to evaluate the clinical benefit of strategic planned relaparotomy in patients with NOMI using detailed perioperative information. METHODS We conducted a multicenter retrospective cohort study that included NOMI patients who underwent laparotomy. In-hospital mortality, 28-day mortality, incidence of total adverse events, ventilator-free days, and intensive care unit (ICU)-free days were compared between groups experiencing the planned and on-demand relaparotomy strategies. Analyses were performed using a multivariate mixed effects model and a propensity score matching model after adjusting for pre-operative, intra-operative, and hospital-related confounders. RESULTS A total of 181 patients from 17 hospitals were included, of whom 107 (59.1%) were treated using the planned relaparotomy strategy. The multivariate mixed effects regression model indicated no significant differences for in-hospital mortality (61 patients [57.0%] in the planned relaparotomy group vs. 28 patients [37.8%] in the on-demand relaparotomy group; adjusted odds ratio [95% confidence interval] = 1.94 [0.78-4.80]), as well as in 28-day mortality, adverse events, and ICU-free days. Significant reduction in ventilator-free days was observed in the planned relaparotomy group. Propensity score matching analysis of 61 matched pairs with comparable patient severity did not show superiority of the planned relaparotomy strategy. CONCLUSIONS The planned relaparotomy strategy, compared with on-demand relaparotomy strategy, did not show clinical benefits after the initial surgery of patients with NOMI. Further studies estimating potential subpopulations who may benefit from this strategy are required.
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Affiliation(s)
- Akira Endo
- grid.474906.8Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan
| | - Fumitaka Saida
- grid.413376.40000 0004 1761 1035Emergency and Critical Care Medicine, Tokyo Women’s Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, Japan
| | - Yuzuru Mochida
- Department of Trauma and Emergency Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi Tsurumi-ku, Yokohama, Kanagawa Japan
| | - Shiei Kim
- grid.410821.e0000 0001 2173 8328Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, Japan
| | - Yasuhiro Otomo
- grid.474906.8Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan
| | - Daisuke Nemoto
- Senshu Trauma and Critical Care Center, Rinku General Medical Center, 2-23 Rinku Ourai Kita, Izumisano, Osaka, Japan
| | - Hisahiro Matsubara
- grid.136304.30000 0004 0370 1101Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Japan
| | - Shigeru Yamagishi
- Department of Surgery, Fujisawa Municipal Hospital, 2-6-1, Fujisawa, Kanagawa Japan
| | - Yoshinori Murao
- grid.258622.90000 0004 1936 9967Department of Emergency and Critical Care Medicine, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka, Japan
| | - Kazuki Mashiko
- grid.416273.50000 0004 0596 7077Shock and Trauma Center, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, Japan
| | - Satoshi Hirano
- grid.39158.360000 0001 2173 7691Department of Gastroenterological Surgery II, Division of Surgery, Graduate School of Medicine, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido Japan
| | - Kentaro Yoshikawa
- Department of General Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba, Japan
| | - Toshiki Sera
- grid.414173.40000 0000 9368 0105Critical Care Medical Center, Hiroshima Prefectural Hospital, 1-5-54 Ujinakanda, Minami-ku, Hiroshima, Japan
| | - Mototaka Inaba
- grid.416814.e0000 0004 1772 5040Department of Emergency Medicine, Okayama Saiseikai General Hospital, 2-25 Kokutaicho, Kita-ku, Okayama, Japan
| | - Hiroyuki Koami
- grid.412339.e0000 0001 1172 4459Department of Emergency and Critical Cere Medicine, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga, Japan
| | - Makoto Kobayashi
- Tajima Emergency and Critical Care Medical Center, Toyooka Public Hospital, 1094 Tobera, Toyooka, Hyogo Japan
| | - Kiyoshi Murata
- Department of Emergency Medicine and Acute Care Surgery, Matsudo City General Hospital, 993-1 Sendabori, Matsudo, Chiba, Japan
| | - Tomohisa Shoko
- grid.413376.40000 0004 1761 1035Emergency and Critical Care Medicine, Tokyo Women’s Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, Japan
| | - Noriaki Takiguchi
- grid.410824.b0000 0004 1764 0813Department of Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, Japan
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Acosta-Mérida MA, Marchena-Gómez J, Saavedra-Santana P, Silvestre-Rodríguez J, Artiles-Armas M, Callejón-Cara MM. Surgical Outcomes in Acute Mesenteric Ischemia: Has Anything Changed Over the Years? World J Surg 2020; 44:100-107. [PMID: 31531725 DOI: 10.1007/s00268-019-05183-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite increases in knowledge and advances in the management of acute mesenteric ischemia syndrome (AMI), there have been no significant improvements in mortality in recent years. The objective of this study was to assess the changes in clinical characteristics and surgical outcomes in patients who underwent AMI over time. METHODS A total of 323 consecutive patients who underwent acute mesenteric ischemia at our institution between 1990 and 2015 were examined. The occurrence of significant changes over this 25-year period in demographic data, comorbidity, clinical characteristics, laboratory results, operative findings, etiology of the AMI, and operative mortality were evaluated. The evolution mortality rates for the studied period were analyzed using the additive logistic regression, and the significant effect was determined using the Akaike Information Criterion (AIC). RESULTS A significant increasing linear trend was observed in recent years in Charlson score values (p = 0.008), antiplatelet drug intake (p < 0.001), use of CT scan (p < 0.001), arterial thrombosis (p < 0.001), and intestinal resection (p = 0.047), while a decreasing linear trend was observed in digoxin intake (p < 0.001), angiography use (p = 0.004), and embolia (p < 0.001). The rest of the parameters did not present changes over time. Regarding the evolution of the adjusted surgical mortality, a significant decrease according the AIC criterion was observed. CONCLUSIONS In recent years, the characteristics of patients with AMI requiring surgery have changed. Changes in operative mortality have also been detected, showing a tendency toward a progressive and significant decrease.
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Affiliation(s)
- María Asunción Acosta-Mérida
- Department of General and Digestive Surgery, Hospital Universitario de Gran Canaria "Dr. Negrín", University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, The Canary Islands, Spain
| | - Joaquín Marchena-Gómez
- Department of General Surgery, Hospital Universitario de Gran Canaria Dr. Negrín, Barranco de la Ballena s/n, 35010, Las Palmas de Gran Canaria, Spain.
| | - Pedro Saavedra-Santana
- Departament of Mathematics, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, The Canary Islands, Spain
| | - José Silvestre-Rodríguez
- Department of General and Digestive Surgery, Hospital Universitario de Gran Canaria "Dr. Negrín", University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, The Canary Islands, Spain
| | - Manuel Artiles-Armas
- Department of General and Digestive Surgery, Hospital Universitario de Gran Canaria "Dr. Negrín", University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, The Canary Islands, Spain
| | - María Mar Callejón-Cara
- Department of General and Digestive Surgery, Hospital Universitario de Gran Canaria "Dr. Negrín", University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, The Canary Islands, Spain
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IL-37 Gene Modification Enhances the Protective Effects of Mesenchymal Stromal Cells on Intestinal Ischemia Reperfusion Injury. Stem Cells Int 2020; 2020:8883636. [PMID: 32849879 PMCID: PMC7439787 DOI: 10.1155/2020/8883636] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/15/2020] [Accepted: 07/24/2020] [Indexed: 12/14/2022] Open
Abstract
Background Ischemia reperfusion injury (IRI) is the major cause of intestinal damage in clinic. Although either mesenchymal stromal cells (MSCs) or interleukin 37 (IL-37) shows some beneficial roles to ameliorate IRI, their effects are limited. In this study, the preventative effects of IL-37 gene-modified MSCs (IL-37-MSCs) on intestinal IRI are investigated. Methods Intestinal IRI model was established by occluding the superior mesenteric artery for 30 minutes and then reperfused for 72 hours in rats. Forty adult male Sprague-Dawley rats were randomly divided into the sham control, IL-37-MSC-treated, MSC-treated, recombinant IL-37- (rIL-37-) treated, and untreated groups. Intestinal damage was assessed by H&E staining. The levels of gut barrier function factors (diamine oxidase and D-Lactate) and inflammation cytokine IL-1β were assayed using ELISA. The synthesis of tissue damage-related NLRP3 inflammasome and downstream cascade reactions including cleaved caspase-1, IL-1β, and IL-18 was detected by western blot. The mRNA levels of proinflammatory mediators IL-6 and TNF-α, which are downstream of IL-1β and IL-18, were determined by qPCR. Data were analyzed by one-way analysis of variance (ANOVA) after the normality test and followed by post hoc analysis with the least significant difference (LSD) test. Results IL-37-MSCs were able to migrate to the damaged tissue and significantly inhibit intestinal IRI. As compared with MSCs or the rIL-37 monotherapy group, IL-37-MSC treatment both improved gut barrier function and decreased local and systemic inflammation cytokine IL-1β level in IRI rats. In addition, tissue damage-related NLRP3 and downstream targets (cleaved caspase-1, IL-1β, and IL-18) were significantly decreased in IRI rats treated with IL-37-MSCs. Furthermore, IL-1β- and IL-18-related proinflammatory mediator IL-6 and TNF-α mRNA expressions were all significantly decreased in IRI rats treated with IL-37-MSCs. Conclusion The results suggest that IL-37 gene modification significantly enhances the protective effects of MSCs against intestinal IRI. In addition, NLRP3-related signaling pathways could be associated with IL-37-MSC-mediated protection.
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Madurska MJ, Anderson RG, Anderson DJ, McNeill CJ, Jansen JO, Stuart WP, Morrison JJ. Mesenteric vascular disease: A population-based cohort study. Vascular 2020; 29:54-60. [PMID: 32605533 DOI: 10.1177/1708538120937954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Mesenteric vascular disease carries a high risk of mortality and morbidity; however, due to obscure clinical presentation, it can be under-recognized. Currently, epidemiology of mesenteric vascular disease remains poorly defined. The aim of this study is to analyze changes in Scottish mortality rates from mesenteric vascular disease overtime. METHODS This is a retrospective, longitudinal population-based cohort study using data extracted from death certificates and Scottish Index of Multiple Deprivation. All deaths related to a vascular disorder of the intestines recorded as an underlying cause of death between 1979 and 2014 were identified using International Classification of Disease-9 or International Classification of Disease-10 code groups. Data included demographics and location of death. The residence postcodes were used to classify socio-economic status using the Scottish Index of Multiple Deprivation. RESULTS From 2,142,921 deaths over 36 years, 14,530 (0.7%) were due to mesenteric vascular disease with a median (interquartile range) age of 77 and a 2:1 female to male gender ratio. The mean ± standard deviation age significantly increased from 72.6 ± 12.1 in 1979 to 76.8 ± 11.1 in 2014 (p < 0.001, R2 = 0.772). Males were consistently younger than females at the time of death. The two lowest Scottish Index of Multiple Deprivation categories accounted for half of the cohort, throughout the study period (p = 0.068). The adjusted death rate per 100,000 population increased from 7.6 in 1979 to 12.1 in 2014. CONCLUSIONS The reported death rates of mesenteric vascular disease in Scotland between 1979 and 2014 have nearly doubled. Mesenteric vascular disease affects twice as many women as men and is associated with social deprivation. The increased reporting of mesenteric vascular disease is likely due to increased recognition and incidence. These implications should be considered when planning healthcare provision in Scotland.
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Affiliation(s)
- Marta J Madurska
- R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, USA
| | | | | | | | - Jan O Jansen
- University of Alabama at Birmingham Hospital, Birmingham, USA
| | | | - Jonathan J Morrison
- R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, USA
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31
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Khripun AI, Mironkov AB, Pryamikov AD, Tyurin IN, Abashin MV, Alimov AN, Shurygin SN, Agasyan GA. [Endovascular surgery for acute mesenteric ischemia]. Khirurgiia (Mosk) 2020:61-66. [PMID: 32271739 DOI: 10.17116/hirurgia202003161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To demonstrate the results of endovascular treatment of 15 patients with acute mesenteric ischemia. MATERIAL AND METHODS There were 15 patients with acute mesenteric ischemia who underwent surgery (9 men and 6 women). Mean age was 77±11 years. Acute intestinal ischemia was caused by thromboembolism of superior mesenteric artery (9 patients), thrombosis of superior mesenteric artery (5 patients) and critical stenosis of the ostia of superior mesenteric artery and celiac trunk (1 patient). Mean time from clinical manifestation of disease to admission to the hospital was 13 hours (range 2-72 hours). In-hospital development of acute mesenteric ischemia was noted in 2 patients. Indications for endovascular intervention and techniques of endovascular revascularization of superior mesenteric artery are described in the article. RESULTS Blood flow restoration in superior mesenteric artery was achieved in 14 (93%) out of 15 patients. Laparotomy was required in 4 (27%) patients for extensive resection of necrotic intestine (n=1, 6.7%), local resection of small bowel (n=2, 13%). In another (6.7%) patient, intestine was recognized as viable after laparotomy. A bulk of intestine was preserved in most patients (n=14, 93%). In-hospital mortality rate was 47% (7 patients died). The main cause of nosocomial death (6 cases) was reperfusion syndrome followed by respiratory distress syndrome and multiple organ failure. CONCLUSION New methods of prevention and treatment of reperfusion syndrome can improve the results of treatment of acute mesenteric ischemia.
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Affiliation(s)
- A I Khripun
- Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Department of Surgery and Endoscopy of the Faculty of Additional Professional Education, Moscow, Russia
| | - A B Mironkov
- Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Department of Surgery and Endoscopy of the Faculty of Additional Professional Education, Moscow, Russia; V.M. Buyanov Municipal Clinical Hospital of the Moscow Healthcare Department, Moscow, Russia
| | - A D Pryamikov
- Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Department of Surgery and Endoscopy of the Faculty of Additional Professional Education, Moscow, Russia; V.M. Buyanov Municipal Clinical Hospital of the Moscow Healthcare Department, Moscow, Russia
| | - I N Tyurin
- V.M. Buyanov Municipal Clinical Hospital of the Moscow Healthcare Department, Moscow, Russia; Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Department of Anesthesiology and Resuscitation of the Faculty of Additional Professional Education, Moscow, Russia
| | - M V Abashin
- Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Department of Surgery and Endoscopy of the Faculty of Additional Professional Education, Moscow, Russia; V.M. Buyanov Municipal Clinical Hospital of the Moscow Healthcare Department, Moscow, Russia
| | - A N Alimov
- Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Department of Surgery and Endoscopy of the Faculty of Additional Professional Education, Moscow, Russia
| | - S N Shurygin
- V.M. Buyanov Municipal Clinical Hospital of the Moscow Healthcare Department, Moscow, Russia
| | - G A Agasyan
- Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Department of Surgery and Endoscopy of the Faculty of Additional Professional Education, Moscow, Russia; V.M. Buyanov Municipal Clinical Hospital of the Moscow Healthcare Department, Moscow, Russia
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32
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Selected Disorders of the Digestive System. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_101-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zhang Z, Chen X, Li C, Feng H, Yu H, Zhu R. Percutaneous Mechanical Thrombectomy for Acute Superior Mesenteric Artery Embolism: Preliminary Experience in Five Cases. Ann Vasc Surg 2019; 63:186-192. [PMID: 31629130 DOI: 10.1016/j.avsg.2019.08.096] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/08/2019] [Accepted: 08/20/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND This study was performed to summarize our experience in treating acute superior mesenteric artery embolism (SMAE) by percutaneous mechanical thrombectomy (PMT). METHODS The clinical data of five patients with acute SMAE treated by PMT in our center from October 2015 to May 2018 were retrospectively analyzed. PMT was performed under local anesthesia. Access was established via the femoral artery or brachial artery. Thrombectomy was performed on the superior mesenteric artery using a 6F Rotarex catheter (Straub Medical, Wangs, Switzerland). RESULTS Technical success of PMT was achieved in all five patients; emboli were completely removed in three patients and partially removed in two patients. No PMT-related complications were noted after surgery. Four patients were smoothly discharged from the hospital after their symptoms were relieved. One patient still had symptoms of intestinal ischemia after the operation, and massive small intestinal necrosis was found by exploratory laparotomy. Intestinal resection was performed, and the patient died 4 months later. CONCLUSIONS PMT by the Rotarex system is a minimally invasive, safe, and effective technique in removing SMAE. Early application of PMT can avoid intestinal necrosis.
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Affiliation(s)
- Zhe Zhang
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Xueming Chen
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Chenyu Li
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hai Feng
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hongzhi Yu
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Renming Zhu
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Genzel P, van Dijk LC, Veger HTC, Wever JJ, van Eps RGS, Slangen RME, van Overhagen H. Case report: direct revascularization in acute mesenteric ischemia by an endovascular approach. CVIR Endovasc 2019; 2:31. [PMID: 32026117 PMCID: PMC6966365 DOI: 10.1186/s42155-019-0074-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 08/22/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Acute mesenteric ischemia is a relatively rare but life-threatening clinical condition. Outcome depends on early diagnosis and prompt intervention. CASE PRESENTATION A 85-year-old man and a 75-year-old woman developed acute mesenteric ischemia due to cardiac embolism. The first patient received an insufficient dose of anticoagulants for atrial fibrillation and the second patient dicontinued her anticoagulantia to avoid bleeding during a routine colonoscopy. Both patients presented with severe abdominal pain and computed tomography showed thrombus in de superior mesenteric artery. Successfulrevascularization with good clinical outcome was achieved by means of an endovascular first approach. CONCLUSION This case report shows that an endovascular approach - in contrast to open surgery - not only enables to revascularize main trunk lesions but can also facilitate revascularization of side branches. Endovascular treatment used to be limited to a selected group of patients without signs of bowel necrosis, but there is a tendency to initiate endovascular revascularization in all patients because it is associated with a reduced mortality, a reduced laparotomy rate and reduction in the resected length of bowel.
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Affiliation(s)
- P Genzel
- HagaZiekenhuis, Els Borst-Eilersplein 275, 2545, Den Haag, AA, Netherlands.
| | - L C van Dijk
- HagaZiekenhuis, Els Borst-Eilersplein 275, 2545, Den Haag, AA, Netherlands
| | - H T C Veger
- HagaZiekenhuis, Els Borst-Eilersplein 275, 2545, Den Haag, AA, Netherlands
| | - J J Wever
- HagaZiekenhuis, Els Borst-Eilersplein 275, 2545, Den Haag, AA, Netherlands
| | - R G S van Eps
- HagaZiekenhuis, Els Borst-Eilersplein 275, 2545, Den Haag, AA, Netherlands
| | - R M E Slangen
- HagaZiekenhuis, Els Borst-Eilersplein 275, 2545, Den Haag, AA, Netherlands
| | - H van Overhagen
- HagaZiekenhuis, Els Borst-Eilersplein 275, 2545, Den Haag, AA, Netherlands
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Memet O, Zhang L, Shen J. Serological biomarkers for acute mesenteric ischemia. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:394. [PMID: 31555708 DOI: 10.21037/atm.2019.07.51] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Acute mesenteric ischemia (AMI) defines a complex of conditions characterized by an interruption of the splanchnic circulation, leading to insufficient oxygen delivery or utilization to fill the metabolic needs of the visceral organs. Early diagnosis and immediate therapy are the cornerstones of early ischemia to reach a successful outcome and are necessary to reduce the high mortality. Although there is still lack of specific biomarkers to assist the diagnosis of AMI in clinical practice, there are several biomarkers with high specificity, may become a potential tools in early diagnosis of AMI, including intestinal fatty acid binding protein (I-FABP), a-glutathione S-transferase (a-GST), D-dimer, L- and D-lactate, citrulline, ischemia modified albumin, procalcitonin (PCT). However, they use in clinical limited duo to the many studies about these makers finished with small patient populations, and heterogeneous among these populations. This review describes the etiology of AMI, the current most studied promising biomarkers, the current research situation and future of biomarker research.
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Affiliation(s)
- Obulkasim Memet
- Center of Emergency & Intensive Care Unit, Medical Center of Chemical Injury, Jinshan Hospital, Fudan University, Shanghai 201508, China
| | - Lin Zhang
- Center of Emergency & Intensive Care Unit, Medical Center of Chemical Injury, Jinshan Hospital, Fudan University, Shanghai 201508, China
| | - Jie Shen
- Center of Emergency & Intensive Care Unit, Medical Center of Chemical Injury, Jinshan Hospital, Fudan University, Shanghai 201508, China
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Acute mesenteric ischaemia: imaging and intervention. Clin Radiol 2019; 75:398.e19-398.e28. [PMID: 31320112 DOI: 10.1016/j.crad.2019.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 06/11/2019] [Indexed: 11/22/2022]
Abstract
Acute mesenteric ischaemia (AMI) is an abdominal emergency in which an acute reduction in mesenteric arterial supply threatens bowel viability and may result in bowel infarction, perforation, and death. Despite improvements in diagnosis and treatment over recent decades, mortality rates in AMI remain very high. This article discusses the aetiological classification, pathophysiology, and clinical aspects of AMI. The specific imaging characteristics of each aetiological type of AMI are detailed and the role of different imaging methods in the diagnosis of AMI is discussed. Surgery is the established treatment of choice for AMI, but there is increasing use of endovascular techniques in treating AMI in cases where there are no clinical features of peritonism or radiological evidence of irreversible ischaemia. This article reviews the evidence for different diagnostic and management strategies for patients with AMI and discusses the advantages and disadvantages of surgical and endovascular treatments. Endovascular techniques have been reported to have high technical success rates and favourable outcomes when compared to open surgery; however, patient selection bias and a paucity of data limit the conclusions that can be drawn.
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Keighley J, Howlett D. Acute abdominal pain in an older patient. BMJ 2019; 365:l1337. [PMID: 31043375 DOI: 10.1136/bmj.l1337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Imran S, Tanweer A. Postoperative nutritional support of the patient with gut gangrene-a case report. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2019; 38:11. [PMID: 30967150 PMCID: PMC6454718 DOI: 10.1186/s41043-019-0169-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 01/18/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Bowel necrosis is a commonly observed condition in elderly patients with longstanding diabetes. In such condition, intestinal resection is usually performed for the removal of the gangrenous part. Post-surgical dietary management after bowel resection poses several challenges for the health care team. CASE PRESENTATION The case presented in this study is that of an elderly diabetic male who developed acute renal failure as a result of neglect in post-surgical feeding after intestinal resection. After the intervention by a trained dietitian, a transitional diet was planned and successfully executed, resulting in reversal of acute renal failure, dehydration, and post-surgical stress. Several complications including hepatic dysfunction and mouth ulcers were resolved through well-planned transitional diet. The patient was finally discharged in a stable health condition and was regularly followed up for any nutritional or medical issues. CONCLUSION Neglects in nutritional care of patients can have severe implications including development of medical complications, resulting in increased length of hospital stay, augmenting the disease stress of the patient and family, and finally the preventable drainage of several human and monetary resources. Therefore, recognition of nutritional intervention as an important part of in-hospital health care may have social as well as economic impacts.
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Affiliation(s)
- Samra Imran
- Department of Food and Nutrition, Government College of Home Economics, Lahore, Pakistan
| | - Afifa Tanweer
- School of Health Sciences, University of Management and Technology, Lahore, Pakistan
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Activation of G protein-coupled estrogen receptor protects intestine from ischemia/reperfusion injury in mice by protecting the crypt cell proliferation. Clin Sci (Lond) 2019; 133:449-464. [PMID: 30705108 DOI: 10.1042/cs20180919] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/14/2019] [Accepted: 01/30/2019] [Indexed: 12/13/2022]
Abstract
The intestinal ischemia/reperfusion (I/R) injury is a common clinical event related with high mortality in patients undergoing surgery or trauma. Estrogen exerts salutary effect on intestinal I/R injury, but the receptor type is not totally understood. We aimed to identify whether the G protein-coupled estrogen receptor (GPER) could protect the intestine against I/R injury and explored the mechanism. Adult male C57BL/6 mice were subjected to intestinal I/R injury by clamping (45 min) of the superior mesenteric artery followed by 4 h of intestinal reperfusion. Our results revealed that the selective GPER blocker abolished the protective effect of estrogen on intestinal I/R injury. Selective GPER agonist G-1 significantly alleviated I/R-induced intestinal mucosal damage, neutrophil infiltration, up-regulation of TNF-α and cyclooxygenase-2 (Cox-2) expression, and restored impaired intestinal barrier function. G-1 could ameliorate the impaired crypt cell proliferation ability induced by I/R and restore the decrease in villus height and crypt depth. The up-regulation of inducible nitric oxide synthase (iNOS) expression after I/R treatment was attenuated by G-1 administration. Moreover, selective iNOS inhibitor had a similar effect with G-1 on promoting the proliferation of crypt cells in the intestinal I/R model. Both GPER and iNOS were expressed in leucine-rich repeat containing G-protein coupled receptor 5 (Lgr5) positive stem cells in crypt. Together, these findings demonstrate that GPER activation can prompt epithelial cell repair following intestinal injury, which occurred at least in part by inhibiting the iNOS expression in intestinal stem cells (ISCs). GPER may be a novel therapeutic target for intestinal I/R injury.
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Liao G, Chen S, Cao H, Wang W, Gao Q. Review: Acute superior mesenteric artery embolism: A vascular emergency cannot be ignored by physicians. Medicine (Baltimore) 2019; 98:e14446. [PMID: 30732209 PMCID: PMC6380707 DOI: 10.1097/md.0000000000014446] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Acute mesenteric ischemia (AMI) is a life-threatening medical condition that occurs when a sudden decreased perfusion to the intestines which leads to bowel infarction, and acute superior mesenteric artery embolism (ASMAE) is the main cause of AMI. Unfortunately, with the improvement of diagnosis and treatment technology, the mortality remains high due to less frequent clinical suspicion resulted from the unclear clinical manifestation and non-specific laboratory findings. METHODS Relevant studies published were identified by searching the PubMed, Embase and Cochrane Library databases. This review presented the literatures to introduce the research progress of ASMAE in recent years. RESULTS Patients with the history of atrial fibrillation, heart valve disease and atherosclerosis should be considered as ASMAE. Laboratory findings are insensitive and unspecific, however, angiography and Computed tomography angiography (CTA) can provide a clear diagnosis sensitively and specifically. Endovascular approaches have been increasingly reported in multiple case series. The key to successful treatment of AMI involves early clinical recognition and early intervention to move the embolus, which can reduce the rate of misdiagnosis and save the precious time and lives of patients. CONCLUSIONS Loss of time eventually leads to progression of ischemia to transmural bowel necrosis with peritonitis and septicemia, which may further worsen patients' outcomes. It is important for physicians to make a timely and accurate diagnosis, which can save precious time and reduce the mortality.
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Affiliation(s)
| | | | | | - Wuwan Wang
- Department of Cardiology, the First Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Clinical Features and Outcomes of Patients With Acute Mesenteric Ischemia and Concomitant Colon Ischemia: A Retrospective Cohort Study. J Surg Res 2019; 233:231-239. [DOI: 10.1016/j.jss.2018.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 07/16/2018] [Accepted: 08/02/2018] [Indexed: 12/15/2022]
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Abstract
Mesenteric ischemia and infarction are infrequent but often deadly conditions in acute and critically ill patients. Mesenteric ischemia may be a primary admission diagnosis or may develop secondary to another diagnosis. Having a high index of suspicion for patients at risk of mesenteric ischemia and mesenteric infarction can alter a poor outcome. This article reviews the pathophysiology, risk factors, assessment, medical and nursing diagnoses, as well as collaborative management for mesenteric ischemia. Early identification of patients at risk and the appropriate diagnostic testing are stressed. Nurses armed with the knowledge of this condition are better able to provide safe care to their patients.
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Affiliation(s)
- Rosemary K Lee
- Rosemary K. Lee is a clinical nurse specialist for critical and progressive care at Homestead Hospital in Homestead, Florida. .,Ana M. Cabrera is assistant vice president for critical and progressive care, obstetrics, emergency and surgical services at Homestead Hospital.
| | - Ana M Cabrera
- Rosemary K. Lee is a clinical nurse specialist for critical and progressive care at Homestead Hospital in Homestead, Florida.,Ana M. Cabrera is assistant vice president for critical and progressive care, obstetrics, emergency and surgical services at Homestead Hospital
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Murphy KC, Kay D, Davenport DL, Bernard A. Decision Tool for Predicting Outcomes in Geriatric Acute Mesenteric Ischemia. Am Surg 2018. [DOI: 10.1177/000313481808400830] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Acute mesenteric ischemia is a morbid disease process that is most common in elderly patients who often have multiple medical comorbidities. Intervention can progress to costly and futile care. The goal of this study was to develop a tool for practitioners to assess the risk of mortality. Patients treated at our institution over the past decade diagnosed with acute mesenteric ischemia were identified. Patients aged less than 65 years were excluded. Data were collected by retrospective chart review. Univariate analysis was used to identify significant risk factors for death. Decision tree analysis yielded a prognostic tool to assess death risk. Univariate analysis demonstrated that lactate (P ≤ 0.001) and pressor requirement (P ≤ 0.001) were predictive of death. Decision tree analysis showed that 79 per cent of patients with day of surgery (DOS) lactate ≥5.4 died postoperatively. Seventy per cent of patients with DOS lactate <5.4 progressed to death if they required pressors and had a creatinine >1.18. Only 6.1 per cent patients with a DOS lactate <5.4, creatinine <1.54, and no pressor requirement progressed to death. Several variables can be used to set expectations for families and help guide decision-making. Our tool was predictive of outcomes in 82 per cent of our study population.
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Affiliation(s)
- Kyle C. Murphy
- From the University of Kentucky College of Medicine, Lexington, Kentucky
| | - Danielle Kay
- From the University of Kentucky College of Medicine, Lexington, Kentucky
| | | | - Andrew Bernard
- From the University of Kentucky College of Medicine, Lexington, Kentucky
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Duplex ultrasound in the early diagnosis of acute mesenteric ischemia: a longitudinal cohort multicentric study. Eur J Emerg Med 2018; 24:e21-e26. [PMID: 26891086 DOI: 10.1097/mej.0000000000000378] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Acute mesenteric ischemia (AMI) is a life-threatening condition requiring time-dependent treatment; thus, early recognition may improve outcomes. We hypothesized that clinician-performed mesenteric vessels duplex ultrasound (DUS) could facilitate early identification of patients with AMI in high-risk patients presenting with abdominal pain. METHODS This was a single-operator, observational, prospective cohort study. Patients aged at least 65 presenting to Emergency Departments with acute abdominal pain and no clear diagnosis after an initial work-up were enrolled. All patients underwent multidetector computed tomography and these findings provided the reference standard in this study. DUS of the celiac artery and superior mesenteric artery (SMA) were obtained to measure the peak systolic velocity (PSV) and were performed within 24 h of admission. PSVs outside the normal range were considered to indicate AMI. RESULTS Of 49 patients identified, 47 were consented to enrollment and diagnostic images were obtained in 45 (96%). Fifteen patients (33%) had AMI (six occlusive, nine nonocclusive disease). Among these, 12 (80%) had abnormal DUS velocities. SMA PSV showed a sensitivity of 78.57% [95% confidence interval (CI): 49.2-95.34], a specificity of 64.52% (95% CI: 45.37-80.77), a positive predictive value of 50% (95% CI: 28.22-71.78), and a negative predictive value of 86.96% (95% CI: 66.41-97.22) for AMI. DUS had a sensitivity of 100%, a specificity of 64%, and a negative predictive value of 100% for occlusive AMI. Assessment of celiac artery PSV did not improve diagnostic performance. CONCLUSION In this single-operator pilot study, mesenteric vessel DUS was performed successfully in the Emergency Department, with a high proportion of diagnostic images obtained. A normal SMA PSV was associated with a low risk of occlusive AMI.
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Bertoni S, Ballabeni V, Barocelli E, Tognolini M. Mesenteric ischemia-reperfusion: an overview of preclinical drug strategies. Drug Discov Today 2018; 23:1416-1425. [DOI: 10.1016/j.drudis.2018.05.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/27/2018] [Accepted: 05/24/2018] [Indexed: 02/06/2023]
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Kanasaki S, Furukawa A, Fumoto K, Hamanaka Y, Ota S, Hirose T, Inoue A, Shirakawa T, Nguyen LDH, Tulyeubai S. Acute Mesenteric Ischemia: Multidetector CT Findings and Endovascular Management. Radiographics 2018; 38:945-961. [DOI: 10.1148/rg.2018170163] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Liu L, Yao J, Li Z, Zu G, Feng D, Li Y, Qasim W, Zhang S, Li T, Zeng H, Tian X. miR-381-3p knockdown improves intestinal epithelial proliferation and barrier function after intestinal ischemia/reperfusion injury by targeting nurr1. Cell Death Dis 2018. [PMID: 29540663 PMCID: PMC5852084 DOI: 10.1038/s41419-018-0450-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Impairment in gut barrier function induced by intestinal ischemia/reperfusion (I/R) injury is associated with high morbidity and mortality. Intestinal barrier function requires the tight coordination of epithelial migration, proliferation and differentiation. We previously observed that nuclear receptor-related protein 1 (nurr1)-mediated proliferative pathway was impaired in intestinal I/R injury. Here, we aimed to assess the effect of nurr1 on intestinal barrier function and to evaluate microRNA (miRNA)-nurr1-mediated restoration of intestinal barrier function in intestinal I/R injury. We induced an in vivo intestinal I/R injury mouse model by clamping and then releasing the superior mesenteric artery. We also performed an in vitro study in which we exposed Caco-2 and IEC-6 cells to hypoxia/reoxygenation (H/R) conditions to stimulate intestinal I/R injury. Our results demonstrated that nurr1 regulated intestinal epithelial development and barrier function after intestinal I/R injury. miR-381-3p, which directly suppressed nurr1 translation, was identified by microarray and bioinformatics analysis. miR-381-3p inhibition enhanced intestinal epithelial proliferation and barrier function in vitro and in vivo and also attenuated remote organ injury and improved survival. Importantly, nurr1 played an indispensable role in the protective effect of miR-381-3p inhibition. Collectively, these findings show that miR-381-3p inhibition mitigates intestinal I/R injury by enhancing nurr1-mediated intestinal epithelial proliferation and barrier function. This discovery may lead to the development of therapeutic interventions for intestinal I/R injury.
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Affiliation(s)
- Liwei Liu
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, China
| | - Jihong Yao
- Department of Pharmacology, Dalian Medical University, Dalian, 116044, China.
| | - Zhenlu Li
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, China
| | - Guo Zu
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, China
| | - Dongcheng Feng
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, China
| | - Yang Li
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, China
| | - Wasim Qasim
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, China
| | - Su Zhang
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, China
| | - Tong Li
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, China
| | - Huizhi Zeng
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, China
| | - Xiaofeng Tian
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, China.
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Oderich GS, Macedo R, Stone DH, Woo EY, Panneton JM, Resch T, Dias NV, Sonesson B, Schermerhorn ML, Lee JT, Kalra M, DeMartino RR, Sandri GDA, Ramos Tenorio EJ. Multicenter study of retrograde open mesenteric artery stenting through laparotomy for treatment of acute and chronic mesenteric ischemia. J Vasc Surg 2018; 68:470-480.e1. [PMID: 29548812 DOI: 10.1016/j.jvs.2017.11.086] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 11/10/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Retrograde open mesenteric stenting (ROMS) through laparotomy was introduced as an alternative to surgical bypass in patients with acute mesenteric ischemia (AMI). The purpose of this study was to evaluate the indications and outcomes of ROMS for treatment of AMI and chronic mesenteric ischemia. METHODS We reviewed the clinical data and outcomes of all consecutive patients treated by ROMS in seven academic centers from 2001 to 2013. ROMS was performed through laparotomy with retrograde access into the target mesenteric artery and stent placement using a retrograde or antegrade approach. End points were early (<30 days) and late mortality, morbidity, patency rates, and freedom from symptom recurrence and reintervention. RESULTS There were 54 patients, 13 male and 41 female, with a mean age of 72 ± 11 years. Indications for ROMS were AMI in 44 patients (81%) and subacute-on-chronic mesenteric ischemia with flush mesenteric occlusion in 10 patients (19%). A total of 56 target mesenteric vessels were stented, including 52 superior mesenteric arteries and 4 celiac axis lesions, with a mean treatment length of 42 ± 26 mm. Retrograde mesenteric access was used in all patients, but 16 patients also required a simultaneous antegrade brachial approach. The retrograde puncture was closed primarily in 34 patients and with patch angioplasty in 17 patients; 1 patient had manual compression. Bowel resection was needed in 29 patients (66%) with AMI because of perforation or gangrene. Technical success was achieved in all (98%) except one patient for whom ROMS failed, who was treated by bypass. Early mortality was 45% (20/44) for AMI and 10% (1/10) for subacute-on-chronic mesenteric ischemia (P = .04). Early morbidity was 73% for AMI and 50% for subacute-on-chronic mesenteric ischemia (P = .27). Patient survival for the entire cohort was 43% ± 9% at 2 years. Primary patency and secondary patency at 2 years were 76% ± 8% and 90% ± 8%, respectively. Freedom from symptom recurrence and freedom from reinterventions were 72% ± 8% and 74% ± 8% at the same interval. CONCLUSIONS ROMS offers an alternative to bypass or percutaneous stenting in patients with AMI who require abdominal exploration and in those who have flush mesenteric occlusions and have failed to respond to or are considered unsuitable for stenting by a percutaneous approach. Despite high technical success, mortality remains elevated in patients with AMI. Patency rates and freedom from symptom recurrence and reinterventions are comparable to the results achieved with stenting using percutaneous technique.
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Affiliation(s)
- Gustavo S Oderich
- Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
| | - Rodrigo Macedo
- Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - David H Stone
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Edward Y Woo
- Department of Vascular Surgery, MedStar Health, Washington, D.C
| | - Jean M Panneton
- Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, Va
| | - Timothy Resch
- Department of Thoracic Surgery and Vascular Disease, Vascular Centre, Skane University Hospital, Malmö, Sweden
| | - Nuno V Dias
- Department of Thoracic Surgery and Vascular Disease, Vascular Centre, Skane University Hospital, Malmö, Sweden
| | - Björn Sonesson
- Department of Thoracic Surgery and Vascular Disease, Vascular Centre, Skane University Hospital, Malmö, Sweden
| | - Marc L Schermerhorn
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Jason T Lee
- Division of Vascular Surgery, Stanford University Medical Center, Palo Alto, Calif
| | - Manju Kalra
- Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Randall R DeMartino
- Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Giuliano de A Sandri
- Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Emanuel J Ramos Tenorio
- Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
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