Results after intraoperative open and endovascular revascularization of acute mesenteric ischemia

Abstract Background: Acute mesenteric ischemia (AMI) is a dreaded condition with a difficult diagnosis and high mortality. Due to different baseline situations, the frequently performed comparison between endovascular and open surgical treatment is interfered by selection bias. The purpose of this study was to review outcomes in AMI treatment with an open or endovascular approach in association with laparotomy to analyze risk factors of mortality for proper risk stratification. Methods: The clinical data of 74 patients treated for AMI from 2007 to 2021 were retrospectively reviewed and compared. In-hospital mortality was appointed as the primary study endpoint. Risk factors for mortality were identified by using univariate and multivariate analysis. Results: In total, 61 patients (82%) were treated open surgically (OT) and, 13 patients (18%) with an endovascular approach (ET) in combination with laparatomy. The etiology of AMI was 53% thrombotic and 47% embolic occlusion. The total in-hospital mortality manifested at 43% (n=32) (OT 41% vs. ET 53.8%; P=0.54). As independent risk factors for in-hospital mortality pneumatosis intestinalis (P=0.01), increased lactate concentration (P=0.04) and ischemic intestinal sections (P=0.01) were identified. Additionally, on univariate analysis patient age, congestive heart failure (> NYHA II) and atrial fibrillation were related with higher mortality. Conclusions: Morbidity and mortality of AMI remainsat a high level. Conventional open or intraoperative endovascular therapy achieved similar results in patients with indication for laparotomy. Advanced disease stage with ischemic intestinal sections at presentation and cardiovascular comorbidities were associated with adverse outcome.