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. 2013 Feb;11(2):158-65.e2.
doi: 10.1016/j.cgh.2012.10.027. Epub 2012 Oct 25.

Effects of a multimodal management strategy for acute mesenteric ischemia on survival and intestinal failure

Olivier Corcos  1 , Yves Castier, Annie Sibert, Sebastien Gaujoux, Maxime Ronot, Francisca Joly, Catherine Paugam, Frederic Bretagnol, Mohamed Abdel-Rehim, Fadi Francis, Vanessa Bondjemah, Marianne Ferron, Magaly Zappa, Aurelien Amiot, Carmen Stefanescu, Guy Leseche, Jean-Pierre Marmuse, Jacques Belghiti, Philippe Ruszniewski, Valerie Vilgrain, Yves Panis, Jean Mantz, Yoram Bouhnik
Affiliations

Effects of a multimodal management strategy for acute mesenteric ischemia on survival and intestinal failure

Olivier Corcos et al. Clin Gastroenterol Hepatol. 2013 Feb.

Abstract

Background & aims: Acute mesenteric ischemia (AMI) is an emergency with a high mortality rate; survivors have high rates of intestinal failure. We performed a prospective study to assess a multidisciplinary and multimodal management approach, focused on intestinal viability.

Methods: In an Intestinal Stroke Center, we developed a multimodal management strategy involving gastroenterologists, vascular and abdominal surgeons, radiologists, and intensive care specialists; it was tested in a pilot study on 18 consecutive patients with occlusive AMI, admitted to a tertiary center from July 2009 to November 2011. Patients with left ischemic colitis, nonocclusive AMI, chronic mesenteric ischemia, and other emergencies were excluded. Patients received specific medical management: revascularization of viable small bowel and/or resection of nonviable small bowel; 12 patients received arterial revascularization. We evaluated the percentages of patients who survived for 30 days or 2 years, the number with permanent intestinal failure, and morbidity. Lengths and rates of intestinal resection were compared with or without revascularization, and in patients with early or late-stage disease.

Results: Patients were followed up for a mean of 497 days (range, 7-2085 d); 95% survived for 30 days, 89% survived for 2 years, and 28% had morbidities within 30 days. Intestinal resection was necessary for 7 cases (39%), with mean lengths of intestinal resection of 30 cm and 207 cm, with or without revascularization, respectively (P = .03). Among patients with early or late-stage AMI, rates of resection were 18% and 71%, respectively (P = .049). Patients with early stage disease had shorter lengths of intestinal resection than those with late-stage disease (7 vs 94 cm; P = .02), and spent less time in intensive care (2.5 vs 49.8; P = .02).

Conclusions: A multidisciplinary and multimodal management approach might increase survival of patients with AMI and prevent intestinal failure.

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