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Mesenteric Ischemia
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Thromboembolic occlusion of the superior mesenteric artery is the most common cause of acute mesenteric ischemia (Acosta et al., 2005). Less frequent etiologies include venous thrombosis and non-occlusive hypoperfusion. Embolism is seen in patients with cardiac arrhythmias, recent myocardial infarction, cardiac valvular disease, infective endocarditis, aortic atherosclerosis, or aneurysmal disease. Embolism usually involves the SMA just distal to the origin of the middle colic and jejunal arteries. Compared to the celiac artery and the IMA, the SMA has a less acute angle of takeoff from the aorta. The SMA's diameter also decreases beyond the middle colic artery, resulting in a classical duodenal and transverse colon sparing distribution of ischemia.
Contemporary Management of Acute Mesenteric Ischemia: Factors Associated with Survival
Published in Juan Carlos Jimenez, Samuel Eric Wilson, 50 Landmark Papers Every Vascular and Endovascular Surgeon Should Know, 2020
Juan Carlos Jimenez, Samuel Eric Wilson
Relevant Studies This paper provided an analysis of a large operative series of patients undergoing surgical treatment of acute mesenteric ischemia. Since its publication, Ryer et al.2 updated this Mayo Clinic series, comparing a subsequent decade of patients (1990s vs. 2000s), excluding nonocclusive mesenteric ischemia, and found that while the patients were older, no difference in mortality was found between eras (27% vs. 17%, P = 0.28). This was despite an increase in the utilization of endovascular therapies. No difference in outcomes could be discerned between patients treated with endovascular versus open surgical revascularization. A contemporary publication of acute mesenteric ischemia from Kougias et al.3 from Baylor College of Medicine found a similarly high rate of 30-day mortality (31%) in 72 patients from 1993 to 2005. Scali et al.4 compared antegrade versus retrograde bypass configurations for revascularization in acute mesenteric ischemia found an overall mortality rate of 26% with no difference in outcomes between configurations.
Vascular
Published in Michael Gaunt, Tjun Tang, Stewart Walsh, General Surgery Outpatient Decisions, 2018
The blood supply of the intestinal tract is particularly rich in collaterals. Therefore, mesenteric ischaemia only occurs if two out of the three main intestinal arteries are occluded or severely stenosed. Isolated mesenteric artery disease is unlikely to result in mesenteric ischaemia unless previous abdominal surgery has been performed and the collateral pathways have been disrupted. The most important artery for intestinal blood supply is the SMA. Therefore, isolated stenosis of the coeliac or IMA rarely causes intestinal ischaemia.
Basic demographic characteristics and prevalence of comorbidities in acute mesenteric ischemia: a systematic review and proportional meta-analysis
Published in Scandinavian Journal of Gastroenterology, 2023
Wenhan Wu, Jia He, Shijian Zhang, Changtong Zeng, Qifa Wang
Acute mesenteric ischemia (AMI) is a collection of surgical emergencies in which the mesenteric vascular obstruction or reduced circulatory pressure results in reduced blood flow in the mesentery, making it difficult to meet the metabolic demands of the corresponding organs [1]. This set of diseases usually includes occlusive AMI (OAMI) and nonocclusive mesenteric ischemia (NOMI), while OAMI is composed of arterial occlusive mesenteric ischemia (AOMI) and mesenteric venous thrombosis (MVT). The atypical clinical manifestations and delay in diagnosis allow AMI to rapidly progress to the stage of irreversible intestinal necrosis, which in turn leads to multiple organ dysfunction and even death [2]. Therefore, early diagnosis and timely and effective intervention are the keys to preventing intestinal necrosis and saving lives for AMI patients [3,4].
Peri-operative nutrition in cardiovascular surgery: current pitfalls and future directions
Published in Acta Chirurgica Belgica, 2022
Eric E. Vinck, Katherine M. van Ierland, Juan C. Rendón, José J. Escobar, Alejandro Quintero Gómez, Clara I. Saldarriaga, Thomas van Brakel, Robert J. M. Klautz, Diana Cárdenas
Another critically and frequently overlooked nutritional influencer during cardiac surgery is aortic clamping time. Because of the sustained circulation provided by cardiopulmonary by-pass in cardiac surgery, mesenteric ischemia does not occur as with aortic clamping in thoraco-abdominal surgeries. There is however, a change in gastrointestinal circulation pattern from a physiological pulsatile flow to a non-physiologically sustained laminar flow. This alters normal gastrointestinal physiology during the postoperative period with regard to mucosal integrity, esophageal/gastric emptying, and mucosal absorption as a result from changes to the mesenteric circulation. This same effect is seen with left ventricular assist devices (LVADs) [7,18]. In the study by Lee and colleagues, nutritionally high-risk patients were found to have longer aortic clamping times (115.89 min ± 59.79) and low-risk patients had shorter aortic clamping times (103.73 min ± 55.23) [7]. As a result, aortic clamping duration should be implemented into future cardiac surgery nutritional guidelines. In nutritionally high-risk patients, taking aortic clamping time into account may benefit these patients keeping ischemic duration to a minimum of (103.73 min ± 55.23) [1–4,7,18].
In the Experimental Model of Acute Mesenteric Ischemia, The Correlation of Blood Diagnostic Parameters with the Duration of Ischemia and their Effects on Choice of Treatment
Published in Journal of Investigative Surgery, 2019
Mikail Cakir, Dogan Yildirim, Fatma Sarac, Turgut Donmez, Semih Mirapoglu, Adnan Hut, Fazilet Erozgen, Omer Faruk Ozer, Melih Ozgun Gecer, Leyla Zeynep Tigrel, Oguzhan Tas
AMI is a life-threatening, acute abdominal disorder that results in sudden failure of the mesenteric blood supply.7 Superior mesenteric artery (SMA) or its branches embolism are the most common clinical causes of AMI.8 In 70%–80% of cases, arterial embolus or thrombosis within the SMA is the main cause of AMI. Superior mesenteric vein (SMV) thrombosis (5%–10%) and non-occlusive mesenteric ischemia (NOMI, 20%) are other vascular and extravascular causes.9,10 Vasculitis is a common cause of mesenteric ischemia in younger people with autoimmune disease.10 Despite the differences in its etiology, intestinal gangrene and necrosis is the fatal end of AMI.9,10 Volvulus is within the scope of this study since it is the ultimate cause of intestinal gangrene and necrosis. In this study, we compare the main vascular cause of AMI with other nonvascular causes, such as volvulus and strangulation. One-third of the small intestines of rats were experimentally manually strangulated, and AMI models were created. Intestinal intussusception, volvulus, strangulated hernias, and obstruction are rare extravascular causes of AMI. Although venous outflow seems impaired, it still causes increase in biomarker levels in this study, perhaps because of partial impairment. Volvulus was fixed before obtaining the blood sample; also we think that there is still somewhat venous circulation in the first 2 hr.