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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Acute mesenteric ischemia (AMI) is still associated with a high mortality rate. Early diagnosis and treatment are mandatory since irreversible bowel damage occurs within a few hours of total ischemia. Reactive vasoconstriction, high postoperative vascular reocclusion rate and the release of toxic substances from the damaged bowel followed by bacterial translocation are all part of the disease process. A combined treatment plan for AMI devides to combat the unrelenting disease process on different levels involving early operation, perioperative intraarterial fibrinolytic and vasodilative treatment and anticoagulation, selective small bowel decontamination and mandatory second look operation is presented. The rationale of this concept and its successful outcome in a highly complex case are discussed.
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PMID:A case of acute mesenteric ischemia that responded to a combined treatment concept. 868 Nov 22

Between 1979 and 1995 we operated 141 (80 female/61 male) patients with acute mesenteric ischemia (AMI) in our department with a median age of 71.5 years. We found 107 arterial occlusions of the intestinal arteries, 16 patients with splanchnic vein thrombosis and 18 non-occlusive-AMI. We performed 46 bowel resections, 24 vascular interventions, 11 combinations of both and in 60 cases laparotomy alone. The mortality rate was 70.9% (75% in over 70 years old patients and 65% in under 70 years old patients). Acute mesenteric ischemia remains a disease with a high mortality between 60 and 80%. Prognostic factors include the time interval until surgical intervention, elevated WBC and serum-lactate level. The mortality rate is higher in elderly patients than in younger patients which is mainly due to delayed surgery in the elderly group. If surgery is performed early the survival rate increases independent of age. The most important prognostic factor and the only factor that can be influenced by the surgeon is the time interval between onset of symptoms and surgery. Therefore angiography or laparotomy should be performed as early as possible in cases of suspected AMI.
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PMID:[Prognostic factors in mesenteric infarct]. 933 93

Acute mesenteric ischemia is a rare but severe complication after open heart surgery. Its incidence (0.2-0.4%) is quite low, but mortality rates are ranging between 70% and 100%. From October 1992 to December 1996, 4,640 patients underwent open heart surgery with cardiopulmonary bypass: 74.6% coronary artery bypass graft (CABG) operations, 23.2% valve replacement including aortic repairs, and 2.2% corrections of congenital heart diseases or tumors of the heart. The overall mortality rate (30 days) was 3.4%, and after CABG, 2.9%. Twelve patients (0.26%), following CABG (one combined with aortic valve replacement, one with mitral reconstruction, and one with carotid disobliteration) developed signs of acute mesenteric ischemia in the early postoperative period (day 1 to 5). In all patients various abdominal symptoms, leukocytosis, acidosis, hyperlactatemia, hyperosmolality, renal failure, and, finally, hemodynamic instability were observed. Eleven patients underwent emergency laparotomy. Mesenteric angiography was done if possible in still stable patients (n=7); it showed severe stenosis or occlusion prior to the operation in each case. Other diagnostic methods were not reliable. In six patients (55%) during the first look, extensive bowel necrosis was found and in five patients an ischemic intestine but no necrosis was detected. Of these, three patients were affected by extensive bowel gangrene at the second look. In the fourth patient a disseminated peripheral ischemia of the entire small intestine was found intraoperatively. After mechanical release and stimulation normal bowel function could be reestablished. One patient underwent percutaneous transluminal angioplasty prior to the laparotomy. Bowel perfusion was still deteriorated but no necrosis was found intraoperatively. These patients were the only survivors in the investigated group; 10 of 12 patients (83.3%) died in the early postoperative period (day 1 to day 6). Predisposing factors for mesenteric ischemia are: arteriosclerotic patients after CABG (100%), age >70 years (91.7%), hyperosmotic dehydration (100%), and cardiac ischemia in 25%. Mesenteric ischemia is a fatal complication with high mortality rates after open heart surgery, especially in older, dehydrated patients with generalized atherosclerotic vessel disease. As the acute mesenteric ischemia usually starts during anesthesia or in the early postoperative period, setting of immediate diagnosis is very difficult. With the occurrence of typical symptoms diagnostic and therapeutic procedures (angiography and laparotomy) must be done very urgently owing to the life-threatening mesenteric process. When mesenteric gangrene already has taken place, the prognosis is very poor, despite extensive resection. Prevention can be exercised by avoiding perioperative hyperosmotic dehydration of patients at high risk.
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PMID:Acute mesenteric ischemia after open heart surgery. 955 29

1. The effects of acute diminution in superior mesenteric arterial flow on gastric blood flow and acidity were studied in 17 anesthetized dogs. 2. Acute mesenteric ischemia produced a rise in celiac and gastric blood flow, higher total acid concentrations, and increased total acid secretion. Ischemia of 12 hours' duration was associated with gross gastric bleeding and in one animal acute superficial gastric ulcerations. 3. The rise in celiac and gastric blood flow appeared to be a hemodynamic response to the fall in mesenteric arterial pressure and was minimized by ligation of the major artery connecting the mesenteric and celiac vascular beds. 4. The increased acid concentration and secretion appeared to be directly related to, and a result of, the augmented gastric blood flow. 5. A direct causal relationship between mesenteric vascular occlusions and subsequent upper gastrointestinal bleeding is suggested.
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PMID:Mesenteric ischemia: a cause of increased gastric blood flow, hyperacidity, and acute gastric ulceration. 1048 73

Acute mesenteric ischemia (AMI) remains a complex and difficult clinical problem. Such acute ischemia is usually either embolic or thrombotic in nature, but other etiologies exist. The diagnosis of AMI is difficult to establish and often delayed, resulting in irreversible bowel injury that requires intestinal resection. Mortality for AMI remains high, and patients requiring extensive gut resection are unlikely to survive. Patients surviving intestinal resection may develop short gut syndrome. The prognosis dramatically improves if revascularization can be achieved prior to intestinal infarction.
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PMID:Acute mesenteric ischemia. 1050 Sep 10

Acute mesenteric ischemia is an infrequent abdominal emergency. The 90% mortality of this affection is related to a delayed diagnosis. The mesenteric ischemia and the mesenteric infarction are two different pathologic stages characterized by two different treatment and prognosis. Superior mesenteric artery embolism is the most frequent cause of mesenteric ischemia. According a difficult clinical diagnosis and the necessity of an early diagnosis we suggest an aggressive attitude. All the patients presenting risk factors and an abdominal pain must have a mesenteric angiography. The purpose of the angiography is diagnostic and therapeutic. The aim of surgery in case of mesenteric ischemia is to restore a normal vascularisation. In spite of this attitude the prognosis of this affection remain poor.
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PMID:[Management of acute intestinal arterial ischemia]. 1054 9

The ischemic bowel diseases are a heterogeneous group of disorders usually seen in elderly individuals. They represent ischemic damage to different portions [figure: see text] of the bowel and produce a variety of clinical syndromes and outcomes. Colonic ischemia is the commonest of these disorders and has a favorable prognosis in most cases. In contrast, acute mesenteric ischemia, most commonly caused by a superior mesenteric artery embolus, is a disease with a poor prognosis. Acute mesenteric ischemia secondary to nonocclusive mesenteric ischemia usually is a [figure: see text] catastrophic complication of other severe medical illnesses, most notably atherosclerosis. Proper diagnosis and management of patients with ischemic bowel disease requires vigilance on the part of the physician and a willingness to embark on an aggressive plan of diagnosis and management in the appropriate setting.
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PMID:Ischemic bowel disease in the elderly. 1143

Acute mesenteric ischemia is an abdominal emergency due to inadequate tissue perfusion with a mortality rate between 60 and 100%. Intestinal damage by ischemia depends on general circulation, collateral blood flow, response of the mesenteric vasculature to autonomic stimuli, circulating vasoactive substances, local humoral factors, and the normal and abnormal products of cellular metabolism before and after reperfusion of the ischemic segment. Four physiopathologic phenomenon are present: superior mesenteric artery embolism; superior mesenteric artery thrombosis; non-occlusive acute mesenteric ischemia, and superior mesenteric venous thrombosis; embolism event is the most frequent. The injury observed after 3 of ischemia (blood flow reduced to 20% of normal) and 1 of reperfusion is more severe than 4 of ischemia. Clinical diagnosis of mesenteric ischemia required a high suspect index, specially in elderly patients with cardiovascular problems. Abdominal pain and hemodynamic and/or metabolic changes are the most frequent symptoms. Although some authors have questioned the need for angiography, this study is the key not only to making a diagnosis of acute mesenteric ischemia before bowel infarction and prior to laparotomy, but also to initiate intra-arterial mesenteric angiography therapy with vasodilators. Patients who persist with acute abdomen will require exploratory celiotomy and vascular exploration. The outcome depends on early diagnosis and therapy to avoid ischemia progression and reperfusion injury.
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PMID:[Acute mesenteric ischemia. Profile of an aggressive disease]. 1146 7

Magnetic resonance angiography (MRA) has been used to image abdominal vessels less frequently than renal arteries. Until the use of fast contrast-enhanced (CE) techniques, an important limitation was the acquisition time of phase-contrast or time-of-flight imaging and, consequently, the creation of motion artifacts. Recent advances in MRA technology have shortened acquisition times, so it is now possible to obtain successive images in the arterial and then the portal phase. MRA can be used as an adjunct to any MR examination to assess, e.g., the arterial feeding of hepatocellular carcinoma, the encasement of arteries, and segmental portal thrombosis in pancreatic carcinoma. However, MRA has been used mainly to study chronic mesenteric ischemia, portal vein diseases, and complications from liver transplantation. The portal venous system is exquisitely portrayed with this method; MRA is as accurate as digital subtraction angiography (DSA) in the diagnosis of portal vein diseases. Acute mesenteric ischemia is an emergency in which computed tomography is the most appropriate imaging modality. Conversely, chronic mesenteric ischemia is best examined with CE-MRA, which is almost as accurate as DSA. CE-MRA is superior to DSA for the simultaneous exploration of the aorta, renal arteries, and iliac arteries, thereby providing a panoramic view of abdominal vascular involvement. MRA can be coupled with measurements of flow. With this functional approach, MRA is the only modality that can completely assess vascular diseases of the abdomen.
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PMID:MR angiography: noninvasive vascular imaging of the abdomen. 1217 87

Acute mesenteric ischemia secondary to arterial occlusion (AMI) remains a highly lethal condition. To examine recent trends in management and associated outcomes, we examined our institutional experience over a recent 10-year period. All patients treated for AMI between January 1990 and January 2000 were identified (76 patients, 77 cases) and their medical records examined. At presentation, 64% demonstrated peritonitis and 30% exhibited hypotension. The interval from symptom onset to treatment exceeded 24 h in 63% of cases. Etiology was mesenteric thrombosis in 44 patients (58%) and embolism in 32 patients (42%). Thirty-five patients (46%) had prior conditions placing them at high risk for the development of AMI including chronic mesenteric ischemia (n = 26) and inadequately anticoagulated chronic atrial fibrillation (n = 9). Surgical management consisted of exploration alone in 16 patients, bowel resection alone in 18 patients, and revascularization in 43 patients, including 28 who required concomitant bowel resection. Overall, intestinal necrosis was present in 81% of cases. Perioperative mortality was 62% and long-term parenteral nutrition (TPN) was required in 31% of survivors. Peritonitis (odds ratio [OR] 9.4, 95% confidence interval [CI] 1.6, 54.0; p = 0.012 and bowel necrosis (OR 10.4, CI 1.9, 56.3; p = 0.007) at presentation were independent predictors of death or survival dependent upon TPN. We conclude that AMI remains a highly lethal condition due in large part to advanced presentation and inadequate recognition and treatment of patients at high risk.
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PMID:Acute occlusive mesenteric ischemia: surgical management and outcomes. 1252 95


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