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Comparison between endovascular and surgical treatment of acute arterial occlusive mesenteric ischemia

Kase, Karri ; Blaser, Annika Reintam ; Koitmäe, Merli ; Talving, Peep ; Tamme, Kadri ; Acosta, Stefan LU orcid ; Björck, Martin ; Bala, Miklosh ; Bodnar, Zsolt and Cahenzli, Martin , et al. (2025) In World Journal of Emergency Surgery 20(1).
Abstract

Background The optimal strategy for initial treatment of acute occlusion of superior mesenteric artery (SMA) is debated. The aim of the study was to compare the effectiveness, timelines and outcomes of endovascular versus open surgical treatment in patients with acute SMA occlusion. This was a preplanned substudy of the prospective observational multicenter AMESI (Acute MESenteric Ischaemia) study. Methods Patients with SMA occlusion were divided into surgical and endovascular treatment groups. The surgical group included patients initially subjected to open surgical treatment with surgical or hybrid revascularization or intestinal resection only. The endovascular group included patients initially revascularized endovascularly and was... (More)

Background The optimal strategy for initial treatment of acute occlusion of superior mesenteric artery (SMA) is debated. The aim of the study was to compare the effectiveness, timelines and outcomes of endovascular versus open surgical treatment in patients with acute SMA occlusion. This was a preplanned substudy of the prospective observational multicenter AMESI (Acute MESenteric Ischaemia) study. Methods Patients with SMA occlusion were divided into surgical and endovascular treatment groups. The surgical group included patients initially subjected to open surgical treatment with surgical or hybrid revascularization or intestinal resection only. The endovascular group included patients initially revascularized endovascularly and was further divided according to treatment effectiveness. Patients were also categorized according to revascularization or no revascularization, and subanalysis performed for different revascularization methods. Baseline and outcome comparisons were made using Fisher and Mann–Whitney U tests. Risk-factors for in-hospital mortality were analysed using a logistic regression model. Results Of 158 patients 107 had surgical and 51 endovascular treatment. The surgical group had higher baseline illness severity scores, higher C-reactive protein and lactate values. The mortality in the endovascular effective, endovascular insufficient as monotherapy and surgical groups was 2.9%, 41.2% and 45.8%, respectively. In multivariable analysis surgery was not an independent risk factor for in-hospital mortality. The rate of arterial embolism was higher in the endovascular revascularization as monotherapy insufficient treatment group (10/17) compared to the endovascular revascularization as monotherapy effective (5/34) and surgical (27/107) groups. We could not identify useful best thresholds for discriminating between effective and insufficient endovascular treatment. Analysis comparing the effect of any revascularization versus no revascularization on in-hospital mortality did not show a clear benefit of revascularization and the method of revascularization did not independently influence mortality. Conclusion The beneficial effect of endovascular compared to surgical treatment in unadjusted analyses is largely explained by selection of patients. None of the compared management approaches had an independent effect on mortality. The choice between endovascular and surgical treatment should not be based solely on the time elapsed from symptom onset but rather on the patient’s general condition and possibly on the cause of SMA occlusion.

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Contribution to journal
publication status
published
subject
keywords
Acute mesenteric ischemia, Endovascular revascularization, Occlusion of superior mesenteric artery, Surgical revascularization
in
World Journal of Emergency Surgery
volume
20
issue
1
article number
46
publisher
BioMed Central (BMC)
external identifiers
  • scopus:105008253950
  • pmid:40452055
ISSN
1749-7922
DOI
10.1186/S13017-025-00616-4
language
English
LU publication?
yes
additional info
Publisher Copyright: © The Author(s) 2025.
id
0f2a1f86-e21c-47ca-bf23-6f3727aafc12
date added to LUP
2025-12-16 09:32:35
date last changed
2025-12-17 03:00:02
@article{0f2a1f86-e21c-47ca-bf23-6f3727aafc12,
  abstract     = {{<p>Background The optimal strategy for initial treatment of acute occlusion of superior mesenteric artery (SMA) is debated. The aim of the study was to compare the effectiveness, timelines and outcomes of endovascular versus open surgical treatment in patients with acute SMA occlusion. This was a preplanned substudy of the prospective observational multicenter AMESI (Acute MESenteric Ischaemia) study. Methods Patients with SMA occlusion were divided into surgical and endovascular treatment groups. The surgical group included patients initially subjected to open surgical treatment with surgical or hybrid revascularization or intestinal resection only. The endovascular group included patients initially revascularized endovascularly and was further divided according to treatment effectiveness. Patients were also categorized according to revascularization or no revascularization, and subanalysis performed for different revascularization methods. Baseline and outcome comparisons were made using Fisher and Mann–Whitney U tests. Risk-factors for in-hospital mortality were analysed using a logistic regression model. Results Of 158 patients 107 had surgical and 51 endovascular treatment. The surgical group had higher baseline illness severity scores, higher C-reactive protein and lactate values. The mortality in the endovascular effective, endovascular insufficient as monotherapy and surgical groups was 2.9%, 41.2% and 45.8%, respectively. In multivariable analysis surgery was not an independent risk factor for in-hospital mortality. The rate of arterial embolism was higher in the endovascular revascularization as monotherapy insufficient treatment group (10/17) compared to the endovascular revascularization as monotherapy effective (5/34) and surgical (27/107) groups. We could not identify useful best thresholds for discriminating between effective and insufficient endovascular treatment. Analysis comparing the effect of any revascularization versus no revascularization on in-hospital mortality did not show a clear benefit of revascularization and the method of revascularization did not independently influence mortality. Conclusion The beneficial effect of endovascular compared to surgical treatment in unadjusted analyses is largely explained by selection of patients. None of the compared management approaches had an independent effect on mortality. The choice between endovascular and surgical treatment should not be based solely on the time elapsed from symptom onset but rather on the patient’s general condition and possibly on the cause of SMA occlusion.</p>}},
  author       = {{Kase, Karri and Blaser, Annika Reintam and Koitmäe, Merli and Talving, Peep and Tamme, Kadri and Acosta, Stefan and Björck, Martin and Bala, Miklosh and Bodnar, Zsolt and Cahenzli, Martin and Casian, Dumitru and Demetrashvili, Zaza and D’oria, Mario and Muñoz-Cruzado, Virginia Durán and Forbes, Alastair and Vetrhus, Morten and Itzhaki, Moran Hellerman and Lein, Kristoffer and Lindner, Matthias and Loudet, Cecilia I. and Damaskos, Dimitrios and Nuzzo, Alexandre and Saar, Sten and Scheiterle, Maximilian and Starkopf, Joel and Voomets, Anna Liisa and Voon, Kenneth and Yunus, Mohammad Alif and Murruste, Marko and Castier, Yves and Ronot, Maxime and Biloslavo, Alan and Paiano, Lucia and Elke, Gunnar and Nagel, Denise and Radke, David I. and Becerra, Jacqueline Vilca and Abeleyra, María Elina and Hess, Benjamin and Kirov, Mikhail and Semenkova, Tatjana and Nikonov, Anton and Smetkin, Alexey and Nedredal, Geir Ivar and Irtun, Øivind and Cohen-Arazi, Oded and Keda, Asaf and Rojnoveanu, Gheorghe and Malcova, Tatiana and Ciuró, Felipe Pareja}},
  issn         = {{1749-7922}},
  keywords     = {{Acute mesenteric ischemia; Endovascular revascularization; Occlusion of superior mesenteric artery; Surgical revascularization}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{World Journal of Emergency Surgery}},
  title        = {{Comparison between endovascular and surgical treatment of acute arterial occlusive mesenteric ischemia}},
  url          = {{http://dx.doi.org/10.1186/S13017-025-00616-4}},
  doi          = {{10.1186/S13017-025-00616-4}},
  volume       = {{20}},
  year         = {{2025}},
}