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Causes and consequences of mesenteric embolization after endovascular aorto-iliac intervention - a nested case control study

Acosta, Stefan LU and Kärkkäinen, Jussi M. (2017) In Anaesthesiology Intensive Therapy 49(2). p.122-129
Abstract

Background: Causes and consequences of mesenteric embolization after endovascular aorto-iliac procedures have not been studied adequately. Methods: Consecutive patients with mesenteric embolization after endovascular aorto-iliac intervention between 2011 and 2015 (case-group, n = 9) were investigated and compared with age, gender and procedure-matched random controls (n = 36). Results: Compared to the control group, a higher proportion of patients with mesenteric embolization were current smokers (89% vs. 53%; P = 0.048) and had renal insufficiency at admission (44% vs. 11%; P = 0.019). In patients treated for aorto-iliac occlusive disease, aortic irregularity (shagginess) was more severe (P = 0.015), visceral thrombus volume was larger... (More)

Background: Causes and consequences of mesenteric embolization after endovascular aorto-iliac procedures have not been studied adequately. Methods: Consecutive patients with mesenteric embolization after endovascular aorto-iliac intervention between 2011 and 2015 (case-group, n = 9) were investigated and compared with age, gender and procedure-matched random controls (n = 36). Results: Compared to the control group, a higher proportion of patients with mesenteric embolization were current smokers (89% vs. 53%; P = 0.048) and had renal insufficiency at admission (44% vs. 11%; P = 0.019). In patients treated for aorto-iliac occlusive disease, aortic irregularity (shagginess) was more severe (P = 0.015), visceral thrombus volume was larger (P = 0.004) and operation-Time was longer (P = 0.009) among the case-group. However, no differences were found between cases with mesenteric embolization caused by endovascular aortic aneurysm repair versus controls. Myoglobin, arterial blood lactate, aspartate aminotransferase, alanine aminotransferase and pancreatic amylase levels were elevated in 100%, 67%, 89%, 89%, 89% and 56% of patients with mesenteric embolization, respectively. Overall in-hospital mortality among cases was 33% (3/9). The in-hospital mortality was 17% (1/6) in patients treated with open abdomen therapy, of whom five were managed with stomas. Conclusion: Smoking cessation, careful patient selection and procedure planning with identification of severe shaggy aortas might prevent mesenteric embolization during aorto-iliac procedures. In suspected cases of mesenteric embolization, elevated myoglobin and arterial blood lactate may be indicative of this complication. Aspartate and alanine aminotranferases, as well as pancreatic amylase, are also relevant tests to assess the extent of organ ischaemia. Damage control with open abdomen therapy and the creation of stomas seem justifiable in order to improve survival in this complex situation.

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author
organization
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type
Contribution to journal
publication status
published
subject
keywords
Aortic Aneurysm, Endovascular Aneurysm Repair, Endovascular Therapy, Iliac Occlusion, Mesenteric Embolization, Shaggy Aorta
in
Anaesthesiology Intensive Therapy
volume
49
issue
2
pages
8 pages
external identifiers
  • scopus:85021243261
  • wos:000404441500007
ISSN
1642-5758
DOI
10.5603/AIT.a2017.0022
language
English
LU publication?
yes
id
f7aab2ab-89d0-4f51-ad37-6357a3b75a70
date added to LUP
2017-08-10 16:18:11
date last changed
2017-09-18 11:41:21
@article{f7aab2ab-89d0-4f51-ad37-6357a3b75a70,
  abstract     = {<p>Background: Causes and consequences of mesenteric embolization after endovascular aorto-iliac procedures have not been studied adequately. Methods: Consecutive patients with mesenteric embolization after endovascular aorto-iliac intervention between 2011 and 2015 (case-group, n = 9) were investigated and compared with age, gender and procedure-matched random controls (n = 36). Results: Compared to the control group, a higher proportion of patients with mesenteric embolization were current smokers (89% vs. 53%; P = 0.048) and had renal insufficiency at admission (44% vs. 11%; P = 0.019). In patients treated for aorto-iliac occlusive disease, aortic irregularity (shagginess) was more severe (P = 0.015), visceral thrombus volume was larger (P = 0.004) and operation-Time was longer (P = 0.009) among the case-group. However, no differences were found between cases with mesenteric embolization caused by endovascular aortic aneurysm repair versus controls. Myoglobin, arterial blood lactate, aspartate aminotransferase, alanine aminotransferase and pancreatic amylase levels were elevated in 100%, 67%, 89%, 89%, 89% and 56% of patients with mesenteric embolization, respectively. Overall in-hospital mortality among cases was 33% (3/9). The in-hospital mortality was 17% (1/6) in patients treated with open abdomen therapy, of whom five were managed with stomas. Conclusion: Smoking cessation, careful patient selection and procedure planning with identification of severe shaggy aortas might prevent mesenteric embolization during aorto-iliac procedures. In suspected cases of mesenteric embolization, elevated myoglobin and arterial blood lactate may be indicative of this complication. Aspartate and alanine aminotranferases, as well as pancreatic amylase, are also relevant tests to assess the extent of organ ischaemia. Damage control with open abdomen therapy and the creation of stomas seem justifiable in order to improve survival in this complex situation.</p>},
  author       = {Acosta, Stefan and Kärkkäinen, Jussi M.},
  issn         = {1642-5758},
  keyword      = {Aortic Aneurysm,Endovascular Aneurysm Repair,Endovascular Therapy,Iliac Occlusion,Mesenteric Embolization,Shaggy Aorta},
  language     = {eng},
  month        = {06},
  number       = {2},
  pages        = {122--129},
  series       = {Anaesthesiology Intensive Therapy},
  title        = {Causes and consequences of mesenteric embolization after endovascular aorto-iliac intervention - a nested case control study},
  url          = {http://dx.doi.org/10.5603/AIT.a2017.0022},
  volume       = {49},
  year         = {2017},
}