Endovascular therapy combined with laparoscopic surgery for acute mesentery artery occlusion
10.3760/cma.j.cn113855-20230607-00291
- VernacularTitle:血管腔内介入联合腹腔镜外科治疗急性肠系膜动脉缺血
- Author:
Keqiang ZHAO
1
;
Peng ZHANG
;
Junlai ZHAO
;
Tong ZHANG
;
Zhanjiang CAO
;
Yu YANG
;
Chao JIANG
;
Rongrong ZHU
;
Weiwei WU
Author Information
1. 清华大学附属北京清华长庚医院血管外科，北京 102216
- Keywords:
Mesenteric ischemia;
Laparoscopy;
Endovascular procedures;
Multidisciplinary team
- From:
Chinese Journal of General Surgery
2024;39(3):192-196
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the efficacy and safety of endovascular intervention combined with preoperative laparoscopic exploration in the treatment of patients with acute mesenteric artery ischemia.Methods:This was a prospective cohort study (NCT04686981). The study enrolled 31 patients with acute mesenteric artery ischemia from Oct 1, 2020 to Oct 1, 2022. Among them, 26 patients (84%) were male, with a mean age of (67±13) years and a mean time to onset of (21±8) hours. All patients underwent laparoscopic exploration in the hybrid operating room. If the presence of intestinal necrosis or suspected necrosis was clearly determined, the patient would undergo open surgery (mesenteric artery embolization, intestinal resection and intestinal double stoma) as the treatment by gastrointestinal surgeon. If intestinal necrosis or suspected necrosis was not found by laparoscopy, the patient would undergo endovascular intervention by vascular surgeon. The primary observational endpoints of this study were the proportion of patients who were not dependent on total parenteral nutrition and all-cause mortality within 30 days after operation. The secondary observational endpoints were the rate of mesenteric vascular patency within 30 days and the proportion of interventions that were converted to open surgery.Results:Six patients underwent open surgery and 25 patients underwent endovascular intervention, including 13 cases of thrombus reduction alone, 3 cases of stent implantation during the same period after reduction, and 9 cases of stent implantation alone. Twenty-four patients (77%) were completely weaned from the TPN within 30 days after the procedure, and all-cause mortality was observed in 3 cases (9.7%). The patency rate of the mesenteric artery within 30 days after the procedure was 82.1%. The rate of conversion to open surgery after intervention was 16%.Conclusions:Endovascular intervention combined with preoperative laparoscopic exploration can clarify intestinal ischemia in acute mesenteric patients as early as possible, and individualized treatment strategies for each patient by multidisciplinary care team can potentially improve the prognosis of such patients.
