Acute mesenteric ischemia: Utility of endovascular techniques.
INTRODUCTION
Acute mesenteric ischemia (AMI) has a high mortality. Early diagnosis and treatment are very important. In our institution there is a therapeutic protocol that includes endovascular techniques (ET) in patients with AMI without peritoneal irritation at diagnosis. The aim of this study was to evaluate the use of ET in conjunction with conventional surgery in the management of potentially reversible IMA diagnosed by computed tomography (CT-angiography).


METHODS
Observational, descriptive and retrospective study that evaluated the use of ET in patients with AMI (arterial origin) in 2 periods (before and after the application of a protocol that includes ET), between 2009-2013. All patients were diagnosed by a CT-angiography, as the diagnostic technique of choice, because of the clinical and analytical suspicion.


RESULTS
Our series included 73 patients with IMA diagnosed by CT-angiography (45: 2009-2011; 28: 2012-2013). Leukocytosis was common (82%), high lactate levels are less frequent (47% vs. 53%). There were 49 patients with IMA without peritoneal irritation. In 51% bowel resection surgery was performed (44% survival); 18%: revascularization by ET (survival 67%); 31%: palliative treatment (0% survival). 33% of patients undergoing first-line RVI needed a surgical rescue (bowel resection). The overall mortality was 67% (2009-2011) vs. 62% (2012-2013).


CONCLUSIONS
Since the protocol application, there is a higher indication of ET in patients with AMI without peritoneal irritation, showing a decreased mortality. With ET application, there is a higher survival in these patients. In our experience, the use of ET in cases of AMI without peritoneal irritation at diagnosis, may increase survival.
['Serracant Barrera|Anna|A|', 'Luna Aufroy|Alexis|A|', 'Hidalgo Rosas|José Manuel|JM|', 'Cánovas Moreno|Gabriel|G|', 'Fortuño Andres|José Ramón|JR|', 'Falcó Fages|Joan|J|', 'Navarro Soto|Salvador|S|']
D057510:Endovascular Procedures D006801:Humans D007511:Ischemia D065666:Mesenteric Ischemia D012189:Retrospective Studies D014057:Tomography, X-Ray Computed
Acute mesenteric ischemia Endovascular techniques Endovascular revascularization Isquemia mesentérica aguda Radiología vascular intervencionista Revascularización endovascular