Chronic mesenteric ischemia and therapeutic paradigm of mesenteric revascularization

Hospital frailty risk score and outcomes of chronic mesenteric ischemia revascularization: Nationwide Inpatient Sample 2005-2020 analysis

Chronic mesenteric ischemia (CMI) typically affects older adults, and often requiring revascularization. Frailty, a state of decreased physiological reserve, may impact the outcomes of CMI treatment. The purpose of was to determine the impact of frailty, assessed by the Hospital Frailty Risk Score, on in-hospital outcomes after CMI revascularization. Data from the Nationwide Inpatient Sample 2005-2020, were analyzed in this retrospective study. Inclusion criteria were adults ≥20 years old who underwent revascularization for CMI. Patients were categorizing patients into low-, intermediate-, and high-frailty risk groups. Logistic regression analyses, adjusted for confounders, was used to assess associations between frailty risk and outcomes. The study included 4100 patients with a mean age of 71.2 years, of whom 71% were female. Patients in the intermediate and high frailty risk groups had significantly increased odds of in-hospital mortality (intermediate risk: adjusted odds ratio [aOR] = 3.33, 95% confidence interval [CI]: 2.07-5.35; high risk: aOR = 3.68, 95% CI: 2.15-6.31), unfavorable discharge (intermediate risk: aOR = 2.25, 95% CI: 1.83-2.77; high risk: aOR = 3.77, 95% CI: 2.91-4.88), prolonged hospital stay (intermediate risk: aOR = 2.40; high risk: aOR = 4.85), transfusions (intermediate risk: aOR = 1.97; high risk: aOR = 4.58), and overall complications (intermediate risk: aOR = 3.84; high risk: aOR = 8.74) compared to low-risk patients. Frailty is associated with worse outcomes of patients with CMI undergoing revascularization. Thus, it is important to incorporate frailty assessment in preoperative risk stratification and management of CMI revascularization.

Outcomes of open revascularization for chronic mesenteric ischemia at a tertiary care center in India

OBJECTIVE

Chronic mesenteric ischemia (CMI) is a rare, debilitating disease associated with higher morbidity and mortality if not treated on time. In the past two decades, there has been a paradigm shift in its management with endovascular modality due to reduced perioperative morbidity and mortality. In the endovascular era, only a few patients require surgical therapy. We conducted this study to report our experience with open surgical revascularization at our hospital.

METHODS

We have conducted a retrospective study after obtaining approval from Institutional Ethics Committee. Data regarding patients who underwent open revascularization for CMI with long-segment occlusion from 2016 to 2021 has been retrieved from the institutional database. The demographic data, clinical presentation, type of surgery and graft used, perioperative mortality and morbidity and length of hospital stay were evaluated. Overall survival and disease-free survival were assessed using Kaplan-Meier analysis.

RESULTS

Twenty-one patients underwent open surgical revascularization; 16 were males and five females. The median age was 43 years. Fourteen (66.7%) were smokers. The mean duration of follow-up was 28.4 ± 13.6 months. Thirty-day postoperative mortality was 0% and morbidity was 28%. The average duration of hospital stay and postoperative weight gain were 6.9 ± 3.7 days and 11 ± 4.9 kgs, respectively. One patient died at two years of follow-up due to myocardial infarction and one had a recurrence. Long-term survival at 60 months of follow-up was 91.6% and the primary-patency rate was 95.2%.

CONCLUSION

Owing to better long-term and reintervention-free patency, open revascularization should be considered in patients who are fit for surgery, particularly in patients with long-segment mesenteric artery occlusion.

Recurrent Mesenteric Ischemia from Celiomesenteric Trunk Stenosis

A common origin of the celiac trunk and superior mesenteric artery (SMA), also termed as celiomesenteric trunk (CMT), is a rare occurrence. We report a rare case of symptomatic CMT stenosis requiring multiple interventions. The patient underwent an initial superior mesenteric artery bypass graft but required a subsequent endoluminal intervention. We present this case for the rarity of CMT stenosis and its potential to cause recurrent mesenteric ischemia. The treatment outcome in this patient suggests that revascularization of the SMA alone can result in adequate perfusion of the entire mesenteric bed and resolve symptoms of mesenteric ischemia including weight loss and food avoidance.

Radiology and mesenteric ischaemia

This review focuses on the radiology of mesenteric ischaemia. Covering the acute and chronic presentations, both of which result from impaired vascularisation of the gastrointestinal tract, we evaluate the role of radiographs, ultrasound, CT, MRI, and catheter angiography in the diagnosis of these conditions. Looking to the future, we also assess some of the emerging imaging techniques. Across medicine and surgery there has been a significant shift towards minimally invasive interventions. Although percutaneous revascularisation of chronic mesenteric ischaemia has been performed for some time, there has been a developing trend for the use of such techniques in acute mesenteric ischaemia. We evaluate the available evidence for the use of these percutaneous interventions and assess how they compare with or in some instances compliment traditional surgical alternatives.