RS28 - Mortality Following Intervention for Acute Arterial Mesenteric Ischemia Remains Unchanged In-spite of Escalating Use of Endovascular Revascularization

Saturday, June 22, 2024

12:21 PM – 12:28 PM CT

Location: West Building, Level 3, Skyline Ballroom W375ab

Submitting & Presenting Author(s)

VV

Venkata Vineeth Vaddavalli

Research Fellow
Division of Vascular and Endovascular Surgery, Mayo Clinic
Rochester, Minnesota

Co-Author(s)

UB

Umer H. Bhatti

Research Fellow
Mayo Clinic
Rochester, Minnesota
Randall R. DeMartino, MD

Associate Professor of Surgery
Division of Vascular and Endovascular Surgery, Mayo Clinic
Rochester, Minnesota
Bernardo C. Mendes, MD

Associate Professor of Surgery
Division of Vascular and Endovascular Surgery, Mayo Clinic
Rochester, Minnesota
Jill J. Colglazier, MD

Assistant Professor of Vascular Surgery
Mayo Clinic
Rochester, Minnesota
Fahad Shuja, MBBS

Assistant Professor of Vascular and Endovascular Surgery
Division of Vascular and Endovascular Surgery, Mayo Clinic
Rochester, Minnesota
Todd E. Rasmussen, MD

Professor of Surgery
Division of Vascular and Endovascular Surgery, Mayo Clinic
Rochester, Minnesota
MS

Melinda S. Schaller

Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MInnesota
Rochester, Minnesota
WH

William S. Harmsen, MS

Biostatistician
Mayo clinic
Rochester, Minnesota

Senior Author(s)

Manju Kalra, MBBS

Professor of Surgery
Division of Vascular and Endovascular Surgery, Mayo Clinic
Rochester, Minnesota

Objectives: Acute mesenteric ischemia (AMI), has been associated with significant morbidity and mortality. Increased awareness and rapid imaging techniques have improved early diagnosis. The aim of this study was to evaluate the impact of endovascular revascularization techniques on outcomes following intervention for arterial AMI.

Methods: Data from consecutive patients who underwent arterial revascularization for AMI over a 33-year period (January 1990-July 2023) were retrospectively reviewed. Patient demographics, treatment modalities, and outcomes were analyzed and compared over two time periods, Group 1: 1990-2006 and Group 2: 2007-2023.

Results: There were 180 patients with AMI (median age 71years, IQR 62 to 80, Group 1 -75 and Group 2 -105). Patient demographics and risk factors were similar between Groups with the exception that patients in Group 2 were significantly older (71.2 ± 11.8 vs 66.8 ± 15.2, p=0.03) with a greater proportion on statin therapy (Table I). Etiology remained constant between groups with arterial thrombosis more common than arterial embolus. The number of patients treated with open revascularization (OSR) significantly decreased from Group 1 (91%) to Group 2 (56%) with increase in endovascular (ENDO) (7% vs 25%) and hybrid (HYB) procedures (3% vs 19%, p < 0.0001). Laparotomy for evaluation of bowel following ENDO was performed more liberally in Group 1 (80% vs 28%, p=0.04). The incidence of second look laparotomy was equivalent between groups. The rate of bowel resection at initial laparotomy was higher in Group 1 (49% vs 32%, p=0.02). Thirty-day mortality, (20% vs 27%, p=0.24), and major adverse events (MAE, 50% vs 45%, p=0.51) were similar between groups; remaining similar after adjustment for age. Median length of ICU (8.5 vs 3 days) and hospital stay (28.5 vs 10 days) were significantly lower in Group 2 (p < 0.0001). Primary patency at 30 days for OSR, ENDO and HYB was 92%, 93% and 81% (p=0.32) respectively. Thirty-day mortality was highest in the HYB group (p=0.05) and respiratory complications (p=0.03) were lowest in the ENDO group (Table II). On univariate analysis, higher SVS comorbidity score and elevated lactate at presentation significantly predicted 30-day morbidity and mortality(p < 0.001).

Conclusions: Greater use of endovascular and hybrid techniques for emergent mesenteric revascularization in the last 2 decades has not resulted in lower early mortality or MAE’s from AMI but was associated with shorter hospital stay and respiratory complications in the ENDO group. Outcome is dependent upon the severity of ischemia and patient comorbidities rather than mode of revascularization.