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Observational Study
. 2025 Jun 2;20(1):46.
doi: 10.1186/s13017-025-00616-4.

Comparison between endovascular and surgical treatment of acute arterial occlusive mesenteric ischemia

Karri Kase  1   2 , Annika Reintam Blaser  3   4 , Merli Koitmäe  5   6 , Peep Talving  3   7 , Kadri Tamme  3   8 , Stefan Acosta  9 , Martin Björck  3   10 , Miklosh Bala  11 , Zsolt Bodnar  12 , Martin Cahenzli  4 , Dumitru Casian  13 , Zaza Demetrashvili  14 , Mario D'Oria  15 , Virginia Durán Muñoz-Cruzado  16 , Alastair Forbes  3 , Morten Vetrhus  17 , Moran Hellerman Itzhaki  18 , Kristoffer Lein  19 , Matthias Lindner  20 , Cecilia I Loudet  21 , Dimitrios Damaskos  22 , Alexandre Nuzzo  23 , Sten Saar  7 , Maximilian Scheiterle  24 , Joel Starkopf  3   8 , Anna-Liisa Voomets  3 , Kenneth Voon  25 , Mohammad Alif Yunus  26 , Marko Murruste  3   8 ; AMESI Investigators (Collaborators); Yves Castier, Maxime Ronot, Alan Biloslavo, Lucia Paiano, Gunnar Elke, Denise Nagel, David I Radke, Jacqueline Vilca Becerra, María Elina Abeleyra, Benjamin Hess, Mikhail Kirov, Tatjana Semenkova, Anton Nikonov, Alexey Smetkin, Geir Ivar Nedredal, Øivind Irtun, Oded Cohen-Arazi, Asaf Keda, Gheorghe Rojnoveanu, Tatiana Malcova, Felipe Pareja Ciuró, Anabel García-Leon, Carlos Javier García-Sánchez, Lim Jia Hui, Loy Yuan Ling, Ilya Kagan, Pierre Singer, Edgar Lipping, Ana Tvaladze, Damian Mole, Darja Clinch, Too Xiao Qing, Hanne Fuglseth, Jacopo Martellucci, Giulia Cerino, Donghuang Hong, Jinsheng Liu, Ernest Ong, Kursat Kundogan, Tutkun Talih, Lovenish Bains, Diego Visconti, Lorenzo Gibello, Ruhi Fadzlyana Jailani, Muhammad Amirul Ashra, Andee Dzulkarnaen Zakaria, Ahmad Faiz Najmuddin Mohd Ghazi, Nur Suriyana Abd Ghani, Mohd Fadliyazid Ab Rahim, Goran Augustin, Damir Halužan, Mohan Gurjar, Rahul Rahul, Firdaus Hayati, Jin-Jiun Mah
Collaborators, Affiliations
Observational Study

Comparison between endovascular and surgical treatment of acute arterial occlusive mesenteric ischemia

Karri Kase et al. World J Emerg Surg. .

Abstract

Background: The optimal strategy for initial treatment of acute occlusion of superior mesenteric artery (SMA) is debated. The aim of the study was to compare the effectiveness, timelines and outcomes of endovascular versus open surgical treatment in patients with acute SMA occlusion. This was a preplanned substudy of the prospective observational multicenter AMESI (Acute MESenteric Ischaemia) study.

Methods: Patients with SMA occlusion were divided into surgical and endovascular treatment groups. The surgical group included patients initially subjected to open surgical treatment with surgical or hybrid revascularization or intestinal resection only. The endovascular group included patients initially revascularized endovascularly and was further divided according to treatment effectiveness. Patients were also categorized according to revascularization or no revascularization, and subanalysis performed for different revascularization methods. Baseline and outcome comparisons were made using Fisher and Mann-Whitney U tests. Risk-factors for in-hospital mortality were analysed using a logistic regression model.

Results: Of 158 patients 107 had surgical and 51 endovascular treatment. The surgical group had higher baseline illness severity scores, higher C-reactive protein and lactate values. The mortality in the endovascular effective, endovascular insufficient as monotherapy and surgical groups was 2.9%, 41.2% and 45.8%, respectively. In multivariable analysis surgery was not an independent risk factor for in-hospital mortality. The rate of arterial embolism was higher in the endovascular revascularization as monotherapy insufficient treatment group (10/17) compared to the endovascular revascularization as monotherapy effective (5/34) and surgical (27/107) groups. We could not identify useful best thresholds for discriminating between effective and insufficient endovascular treatment. Analysis comparing the effect of any revascularization versus no revascularization on in-hospital mortality did not show a clear benefit of revascularization and the method of revascularization did not independently influence mortality.

Conclusion: The beneficial effect of endovascular compared to surgical treatment in unadjusted analyses is largely explained by selection of patients. None of the compared management approaches had an independent effect on mortality. The choice between endovascular and surgical treatment should not be based solely on the time elapsed from symptom onset but rather on the patient's general condition and possibly on the cause of SMA occlusion.

Keywords: Acute mesenteric ischemia; Endovascular revascularization; Occlusion of superior mesenteric artery; Surgical revascularization.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Approval for the AMESI study was obtained from the Research Ethics Committee of the University of Tartu (number 357 T-8 and 364 M-7-amendment). All participating sites obtained local Ethics Committee approval according to their local regulations. Consent for publication: Not applicable. Competing interests: A.R.B. received consultancy fee from VIPUN medical and is holding a grant from the Estonian Research Council (PRG1255). A.F. has received speaker fees from B Braun and Fresenius Kabi. A.N. has received speaker or consultancy fees from Abbvie and Janssen, research funding from MSD-Avenir, and PhD grants from Fondation de l’Avenir and SNFGE. K.K., M.K., P.T., K.T., S.A., M.Bj., M.Ba., Z.B., M.C., D.C., Z.D., M.D.O., V.D.M.C., M.V., M.H.I., K.L., M.L., C.I.L., D.D., S.S., M.S., J.S., A.L.V., K.V., M.A.Y., M.M. declare no conficts of interest. All authors completed the ICMJE uniform conflict of interest disclosure form.

Figures

Fig. 1
Fig. 1
Study flowchart
See this image and copyright information in PMC

References

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