Treatment Outcome of Acute Mesenteric Ischemia 10 Years Ago and Today

Introduction. Acute mesenteric ischemia (AMI) is a life threatening condition (11). Patients with AMI are predominantly elderly people with significant cardiovascular disorders and other risk factors, hence there are particular difficulties in management of treatment (16). AMI accounts for 0.1% of all hospital admissions, but the rate of mortality is high - 60-90% (1,11,15). Usual standard conservative and surgical treatment doesn’t enhance survival rate, therefore endovascular thrombectomy is being used more frequently in order to improve treatment outcomes (11). Aim of the study. To analyze AMI treatment options and survival rate 10 years ago and now, when endovascular thrombectomy has become available. Materials and methods. During 2003 - 2004 and 2012 - 2013, 120 cases of thrombosis in superior mesenteric artery were analyzed (60 cases in each period). The mean age of the patients treated in Pauls Stradiņš Clinical University Hospital was 79.1 ± 1.5; 95% CI (77.6 - 80.6), (p=0.001). Depending on indications conservative treatment or bowel resection were performed. In 2012 - 2013 in addition to conservative therapy and surgical intervention, endovascular thrombectomy was performed. Bowel resection was implemented in 12 cases during 2003 - 2004 and in 10 cases during 2012 - 2013. 15 patients underwent endovascular thrombectomy in 2012 - 2013. Results. In 2003 - 2004 there were 47 fatal cases out of 60. 13 patients had recovered - 7 male and 6 female (p=0.340). In 2012 - 2013 there were 46 fatal cases out of 60. 14 patients had recovered - 8 male and 6 female (p=0.381). In 2003-2004, 48 (80%) patients received conservative treatment. The number of fatal cases was 43 (89.6%, p=0.001). In 2012 - 2013 35 (58.3%) patients were treated conservatively, 33 (94.3%) patients did not survive (p=0.001). In 2003 - 2004 bowel resection was implemented in 12 (20%) cases, 4 (33.3%) patients didn’t recover (p=0.001). In 2012 - 2013 bowel resection was performed on 10 patients (16.7%) with a mortality rate of 50% (p=0.044). In 2012 - 2013 15 patients received endovascular thrombectomy. 7 (46.7%) patients that had recovered from the procedure, received endovascular thrombectomy within 5.1 ± 1.5 hours; 95% CI (3.6-6.6), p=0.002 from the onset of symptoms. Conclusions. Traditional conservative therapy and open surgery are still being used. The age of patients should not be viewed as a contraindication for surgical intervention, since there is no statistically significant dif