Isquemia mesentérica aguda: utilidad de las técnicas de revascularización endovascular / Acute mesenteric ischemia: Utility of endovascular techniques

INTRODUCCIÓN: La isquemia mesentérica aguda (IMA) presenta una elevada mortalidad. El diagnóstico y el tratamiento precoces son claves. En nuestro centro aplicamos un protocolo terapéutico que incluye la radiología vascular intervencionista (RVI) en pacientes con IMA sin irritación peritoneal. El objetivo de este estudio fue evaluar el uso de la RVI conjuntamente con la cirugía convencional en el manejo de la IMA de intestino delgado potencialmente reversible diagnosticada mediante tomografía computarizada vascular (angio-TC). MÉTODOS: Estudio observacional, retrospectivo y descriptivo, donde se valora el manejo diagnóstico y terapéutico de la IMA en 2 períodos (antes y después de la aplicación de un protocolo que incluye la RVI) entre 2009 y 2013. El diagnóstico de elección es mediante angio-TC, ante la sospecha clínico-analítica. RESULTADOS: Nuestra serie incluye a 73 pacientes diagnosticados de IMA mediante angio-TC (45: 2009-2011; 28: 2012-2013). La leucocitosis es frecuente (82%), siendo menos frecuente la lactacidemia (47% vs. 53%). Hay 49 pacientes con IMA y exploración abdominal normal. En el 51% se realizó cirugía de resección intestinal (supervivencia 44%); 18%: revascularización mediante RVI (supervivencia 67%); 31%: tratamiento paliativo (supervivencia 0%). El 33% de los pacientes sometidos a RVI como primera línea precisaron de cirugía de rescate (resección intestinal). La mortalidad global es del 67% (2009-2011) vs. 62% (2012-2013). CONCLUSIONES: Desde la aplicación del protocolo ha aumentado la indicación de RVI para tratar a pacientes sin irritación peritoneal, objetivando una disminución de la mortalidad global. En nuestra experiencia, la aplicación de RVI en casos de IMA sin irritación peritoneal al diagnóstico puede incrementar la supervivencia

INTRODUCTION: Acute mesenteric ischemia (AMI) has a high mortality. Early diagnosis and treatment are very important. In our institution there is a therapeutic protocol that includes endovascular techniques (ET) in patients with AMI without peritoneal irritation at diagnosis. The aim of this study was to evaluate the use of ET in conjunction with conventional surgery in the management of potentially reversible IMA diagnosed by computed tomography (CT-angiography). METHODS: Observational, descriptive and retrospective study that evaluated the use of ET in patients with AMI (arterial origin) in 2 periods (before and after the application of a protocol that includes ET), between 2009-2013. All patients were diagnosed by a CT-angiography, as the diagnostic technique of choice, because of the clinical and analytical suspicion. RESULTS: Our series included 73 patients with IMA diagnosed by CT-angiography (45: 2009-2011; 28: 2012-2013). Leukocytosis was common (82%), high lactate levels are less frequent (47% vs. 53%). There were 49 patients with IMA without peritoneal irritation. In 51% bowel resection surgery was performed (44% survival); 18%: revascularization by ET (survival 67%); 31%: palliative treatment (0% survival). 33% of patients undergoing first-line RVI needed a surgical rescue (bowel resection). The overall mortality was 67% (2009-2011) vs. 62% (2012-2013). CONCLUSIONS: Since the protocol application, there is a higher indication of ET in patients with AMI without peritoneal irritation, showing a decreased mortality. With ET application, there is a higher survival in these patients. In our experience, the use of ET in cases of AMI without peritoneal irritation at diagnosis, may increase survival

Acute mesenteric ischemia: Utility of endovascular techniques.

INTRODUCTION: Acute mesenteric ischemia (AMI) has a high mortality. Early diagnosis and treatment are very important. In our institution there is a therapeutic protocol that includes endovascular techniques (ET) in patients with AMI without peritoneal irritation at diagnosis. The aim of this study was to evaluate the use of ET in conjunction with conventional surgery in the management of potentially reversible IMA diagnosed by computed tomography (CT-angiography). METHODS: Observational, descriptive and retrospective study that evaluated the use of ET in patients with AMI (arterial origin) in 2 periods (before and after the application of a protocol that includes ET), between 2009-2013. All patients were diagnosed by a CT-angiography, as the diagnostic technique of choice, because of the clinical and analytical suspicion. RESULTS: Our series included 73 patients with IMA diagnosed by CT-angiography (45: 2009-2011; 28: 2012-2013). Leukocytosis was common (82%), high lactate levels are less frequent (47% vs. 53%). There were 49 patients with IMA without peritoneal irritation. In 51% bowel resection surgery was performed (44% survival); 18%: revascularization by ET (survival 67%); 31%: palliative treatment (0% survival). 33% of patients undergoing first-line RVI needed a surgical rescue (bowel resection). The overall mortality was 67% (2009-2011) vs. 62% (2012-2013). CONCLUSIONS: Since the protocol application, there is a higher indication of ET in patients with AMI without peritoneal irritation, showing a decreased mortality. With ET application, there is a higher survival in these patients. In our experience, the use of ET in cases of AMI without peritoneal irritation at diagnosis, may increase survival.