30 Contemporary Management of Acute Mesenteric Ischemia Factors Associated with Survival скачать в хорошем качестве

30 Contemporary Management of Acute Mesenteric Ischemia Factors Associated with Survival

#AcuteMesentericIschemia #AMI #VascularSurgery #ParkStudy #Mortality #Survival #BowelIschemia #Revascularization #IntestinalStrokeCenter This video focuses on Acute Mesenteric Ischemia (AMI), a severe condition involving sudden loss of blood flow to the intestines with a high mortality rate. It examines a 2002 study by Park and colleagues in the Journal of Vascular Surgery, analysing cases from their institution between 1990 and 1999. The study involved 58 patients who underwent surgery for AMI, ranging in age from 35 to 96, with an average of 67. A key symptom was severe abdominal pain, reported by 95% of patients. Interestingly, 33% had a history suggestive of chronic mesenteric ischemia, highlighting potential warning signs. The main causes of AMI in the study were thrombosis (64%), embolism (28%), and non-occlusive mesenteric ischemia (NMI) (8.6%). Diagnosis primarily used arteriography (81% of patients). Treatment for surgical candidates was open exploration. Common open techniques included bypass grafting (22 patients) and thrombectomy (19 patients), along with patch angioplasty or endarterectomy. A significant number, 53%, required bowel resection during the initial surgery. Second look procedures, often within 24-48 hours, were planned in 23 patients to re-evaluate bowel viability; 11 of these required further resection. Early experience with endovascular treatment was noted in eight patients. Outcomes were challenging. The overall 30-day mortality rate was 32%. Mortality was particularly high for NMI at 80%, compared to 31% for embolism and 32% for thrombosis. Multi-organ failure was the leading cause of death (18 patients). Longer-term survival was low: 43% at one year and 32% at three years. Factors associated with better survival included being younger than 60 and, paradoxically, needing bowel resection. The authors proposed that resection might indicate more treatable, localised disease. The study supported the era's aggressive surgical approach. Subsequent research since 2002, by groups like Reyer and Roussel, has explored endovascular and hybrid techniques like ROMS, but overall mortality has remained persistently high in many reports. Crucially, more recent work, including studies on specialised 'intestinal stroke centers', strongly suggests that the timeliness of diagnosis and intervention is perhaps the most critical factor for improving outcomes. Despite advances in treatment techniques, high mortality underscores the need for earlier identification and management strategies.