Acute Mesenteric Ischemia: Does Etiology Influence Mortality and Recurrence?
Recommended Citation
Chamseddine H, Hamdan H, Halabi M, Shepard A, Nypaver T, Weaver M, Peshkepija A, Kavousi Y, Onofrey K, Kabbani L. Acute Mesenteric Ischemia: Does Etiology Influence Mortality and Recurrence?. J Vasc Surg 2025; 81(6):e12-e13.
Document Type
Conference Proceeding
Publication Date
6-1-2025
Publication Title
J Vasc Surg
Abstract
Objectives: Acute mesenteric ischemia (AMI) is a morbid condition associated with significant rates of operative mortality. This study investigates the impact of the underlying cause of AMI on outcomes and aims to identify key predictors of mortality. Methods: A retrospective review of all patients who underwent revascularization for AMI at a quaternary medical center between 2014 and 2024 was performed. AMI was defined as acute symptom onset of ≤2 weeks duration. Patients with AMI secondary to aortic dissection were excluded. Patients were categorized by AMI etiology into embolism and acute thrombosis. Kaplan-Meier and Cox regression analysis were used to evaluate the long-term outcomes of survival, primary patency, reintervention, and AMI recurrence. Multivariate logistic regression identified significant predictors of 30-day mortality. Results: Ninety-two patients (35 males, 57 females) with a mean age of 67 years were included. AMI etiologies were embolism (30%) and acute thrombosis (70%). Patients with acute thrombosis were more likely to have a history of smoking (91% vs 68%; P = .033), chronic obstructive pulmonary disease (34% vs 11%; P = .019), and chronic mesenteric ischemia (63% vs 4%; P < .001). They also more commonly presented with two-vessel disease compared to one-vessel disease (16% vs 0%; P = .013) and were more frequently treated with endovascular revascularization (80% vs 14%; P < .001). Mortality rates at 30 days (thrombosis 25% vs embolism 22%; P = .748) and mean bowel resection lengths (thrombosis 42 cm vs embolism 44 cm; P = .893) were similar between the two groups. At 1-year follow-up, thrombosis patients had lower primary patency (80% vs 94%; P = .008), higher rates of AMI recurrence (12% vs 6%; P = .05), and higher reintervention (21% vs 6%; P = .02) (Fig 1). Nonetheless, no difference in mortality was observed between the two groups (32% vs 34% P = .873) (Fig 2). Significant predictors of 30-day mortality were age, time from symptom onset to intervention, and lactate level at presentation (area under the receiver operating characteristic curve, 88%). Every 1-year increase in age increased mortality by 6% (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.01-1.12; P = .049); every 1-day delay in intervention by 15% (OR 1.15; 95% CI, 1.03-1.44; P = .021); and every 1-unit increase in lactate by 27% (OR 1.27; 95% CI, 1.03-1.56; P = .029). Conclusions: In our institution, AMI etiology did not affect outcomes in terms mortality, morbidity, or extent of bowel resection. However, thrombotic AMI was associated with higher rates of AMI recurrence and reinterventions. Predictors of mortality included advancing age, time from symptom onset to intervention, and lactate levels on presentation. Prompt diagnosis and intervention remain key to survival in AMI. [Formula presented] [Formula presented]
Volume
81
Issue
6
First Page
e12
Last Page
e13
