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Endovascular Therapy as a Primary Revascularization Modality in Acute Mesenteric Ischemia

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Abstract

Purpose

To evaluate endovascular therapy (EVT) as the primary revascularization method for acute mesenteric ischemia (AMI).

Methods

A retrospective review was performed on all consecutive patients treated for AMI during a 5-year period (January 2009 to December 2013). EVT was attempted in all patients referred for emergent revascularization. Surgical revascularization was performed selectively after failure of EVT. Patient characteristics, clinical presentation, and outcomes were studied. Failures and complications of EVT were recorded.

Results

Fifty patients, aged 79 ± 9 years (mean ± SD), out of 66 consecutive patients with AMI secondary to embolic or thrombotic obstruction of the superior mesenteric artery were referred for revascularization. The etiology of AMI was embolism in 18 (36 %) and thrombosis in 32 (64 %) patients. EVT was technically successful in 44 (88 %) patients. Mortality after successful or failed EVT was 32 %. The rates of emergency laparotomy, bowel resection, and EVT-related complication were 40, 34, and 10 %, respectively. Three out of six patients with failure of EVT were treated with surgical bypass. EVT failure did not significantly affect survival.

Conclusions

EVT is feasible in most cases of AMI, with favorable patient outcome and acceptable complication rate.

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Conflict of interest

Dr. Petri Saari has received travel expenses from Medtronic and WL Gore to scientific congresses in 2014, unrelated to the current study. Dr. Jussi M Kärkkäinen, Dr. Tiina T Lehtimäki, Prof. Juha Hartikainen, Dr. Tuomo Rantanen, Prof. Hannu Paajanen, and Prof. Hannu Manninen declared that they have no conflict of interest.

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Authors and Affiliations

  1. Heart Center, Kuopio University Hospital, PL 100, 70029 KYS, Kuopio, Finland

    Jussi M. Kärkkäinen & Juha Hartikainen

  2. Department of Gastrointestinal Surgery, Kuopio University Hospital, PL 100, 70029 KYS, Kuopio, Finland

    Jussi M. Kärkkäinen, Tuomo Rantanen & Hannu Paajanen

  3. Department of Clinical Radiology, Kuopio University Hospital, PL 100, 70029 KYS, Kuopio, Finland

    Tiina T. Lehtimäki, Petri Saari & Hannu Manninen

  4. University of Eastern Finland, PL 1627, 70211, Kuopio, Finland

    Juha Hartikainen, Hannu Paajanen & Hannu Manninen

Authors
  1. Jussi M. Kärkkäinen
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  2. Tiina T. Lehtimäki
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  3. Petri Saari
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  4. Juha Hartikainen
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  5. Tuomo Rantanen
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  6. Hannu Paajanen
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  7. Hannu Manninen
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Corresponding author

Correspondence to Jussi M. Kärkkäinen.

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Kärkkäinen, J.M., Lehtimäki, T.T., Saari, P. et al. Endovascular Therapy as a Primary Revascularization Modality in Acute Mesenteric Ischemia. Cardiovasc Intervent Radiol 38, 1119–1129 (2015). https://doi.org/10.1007/s00270-015-1064-9

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  • DOI: https://doi.org/10.1007/s00270-015-1064-9

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