| Objective:Acute mesenteric ischemia (AMI) is a life-threatening acuteabdomen. Although the annual incidence of AMI was only 0.09% to 0.2%, the mortality rate is 60% to 80%. In recent years, with the development of intervention technology, the application of endovascular therapy for the treatment of AMI becomes more widely. There are a few studies with small sample size reported that endovascular therapy may reduce the mortality of patients with AMI. However, because of the low incidence of AMI, endovascular treatment effect on the prognosis of patients is still unclear. Therefore, the aim of this study is to compare endovascular therapy and traditional operative therapy and to evaluate the effect of endovascular treatment on outcomes of patients with AMI.Method:Clinical information of patients with AMI from Tianjin people's from June 2007 to December 2015 were identified. Patients with a diagnosis of AMI but with no endovascular or surgical treatment were excluded. According to the different treatment methods, the patients were divided into endovascular treatment group and open surgery group. The clinical characteristics, etiology, comorbidity, laboratory tests, image examination, treatment, complications and mortality of the two groups were compared. Finally, the logistics regression model was applied to identify the potential factors which can affect mortality of patients with AMI.Result:73 AMI patients who received treatment were identified.43 patients underwent endovascular therapy; 30 patients underwent open surgery. Because peritonitis is an important risk factor for the prognosis of AMI patients, open surgery group were divided into two subgroups according to whether patients had peritonitis or not. Then, the endovascular treatment group (n= 43) and open surgery patients without peritonitis (n= 14) were compared. Forthe gender, mean age, and clinical manifestation did not differ significantly between the treatment groups. The level of white blood cell count, lactic acid and D-dimer of both group were significantly increased.The overall mortality of endovascular treatment group was 30.2%, which was lower than the laparotomy without peritonitis subgroup (46.7%). Endovascular treatment failure required laparotomy in 12 cases (27.9%). The mortality endovascular failure subgroup still lower than mortality rate of laparotomy group (41.7% vs 46.7%). Endovascular therapy resulted in lower rates of acute renal failure (27.9% vs 57.1%, P= 0.046). No significant difference of the incidence of hemorrhage, acute renal failure, short bowel syndrome, acute myocardial infarction patients were observed in the two groups. By using logistic regression model,4 factors associated with mortality of patients with AMI were identified:A w finally, through logistic regression model on the prognosis of patients with AMI related factors were analyzed by univariate analysis, history of coronary artery disease [OR=5.303 (95%CI=1.979-14.207), p=0.001], interval time of presentation onset to treatment [OR=2.619. (95%CI=1.017-6.747), p=0.046], lactic acid level [OR=2.375, p<0.001] were associated with increased risk of death. In the postoperative period, acute pulmonary failure [OR=7.848 (95%CI=2.799-22.000), p<0.001] and acute renal failure [OR=3.643 95%CI=1395-9.511 p=0.008] were significantly associated with death.Conclusion:Theresultsshowedthatthe pulication of endovascular therapy for AMI reduced complications and improved outcomes of patients with AMI. |
PDF Full Text Request