Mesenteric ischemia surgery: Difference between revisions
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*After preliminary [[Cardiopulmonary resuscitation|resuscitation]], midline [[laparotomy]] should be done to observe the areas of gut with choices for resection of all the [[Necrosis|necrotic]] areas. In instances of uncertainty, intraoperative [[Doppler echocardiography|Doppler]] can be beneficial. | *After preliminary [[Cardiopulmonary resuscitation|resuscitation]], midline [[laparotomy]] should be done to observe the areas of gut with choices for resection of all the [[Necrosis|necrotic]] areas. In instances of uncertainty, intraoperative [[Doppler echocardiography|Doppler]] can be beneficial. | ||
===Approach to | ===Approach to treatment=== | ||
===Surgical versus endovascular intervention=== | ===Surgical versus endovascular intervention=== | ||
Revision as of 15:55, 15 January 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Feham Tariq, MD [2]
Overview
Surgery in mesenteric ischemia is done to resect the ischemic bowel in order to prevent the complications. However, in case of acute embolic type of mesenteric ischemia, early laparotomy and surgical resection is the mainstay of treatment.
Surgery
- The goals of surgical therapy are as follows:
- Intestinal viability is defined as the maximum vital element influencing outcome in patients with AMI.
- Non-viable bowel, if unrecognized, can cause multi-organ failure and lead to the death eventually.
- Laparotomy allows to determine the viability of the bowel.
- After preliminary resuscitation, midline laparotomy should be done to observe the areas of gut with choices for resection of all the necrotic areas. In instances of uncertainty, intraoperative Doppler can be beneficial.
Approach to treatment
Surgical versus endovascular intervention
Endovascular intervention
Pharmacomechanical thrombolysis
Mesenteric angioplasty/stenting
Retrograde open mesenteric stenting
Abdominal exploration and damage control
Revascularization
- Embolectomy
- Mesenteric bypass
Bowel and abdominal closure
Postprocedural care and follow up
Second-look lapratomy and abdominal wall closure
Surgical procedure options
- Balloon catheter embolectomy of the superior mesenteric artery
- For restoration of blood flow in acute mesenteric ischemia, antegrade aorto-mesenteric bypass from supraceliac aorta is the best choice.
- Percutaneous transluminal angioplasty is also considered for revascularization in some case reports.
- A new hybrid endovascular-surgical technique for managing mesenteric ischemia has been proposed.
- Laprotomy is done when transmural bowel infacrction has occured.
References
- ↑ Luo QZ, Lin L, Gong Z, Mei B, Xu YJ, Huo Z; et al. (2011). "Positive association of major histocompatibility complex class I chain-related gene A polymorphism with leukemia susceptibility in the people of Han nationality of Southern China". Tissue Antigens. 78 (3): 178–84. doi:10.1111/j.1399-0039.2011.01748.x. PMID 21810082.
- ↑ Lee RW, Bakken AM, Palchik E, Saad WE, Davies MG (2008). "Long-term outcomes of endoluminal therapy for chronic atherosclerotic occlusive mesenteric disease". Ann Vasc Surg. 22 (4): 541–6. doi:10.1016/j.avsg.2007.09.019. PMID 18620112.
- ↑ Sarac TP, Altinel O, Kashyap V, Bena J, Lyden S, Sruvastava S; et al. (2008). "Endovascular treatment of stenotic and occluded visceral arteries for chronic mesenteric ischemia". J Vasc Surg. 47 (3): 485–491. doi:10.1016/j.jvs.2007.11.046. PMID 18295100.