Lim Sungho, Halandras Pegge M, Bechara Carlos, Aulivola Bernadette, Crisostomo Paul
1 Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA.
Vasc Endovascular Surg. 2019 Jan;53(1):42-50. doi: 10.1177/1538574418805228. Epub 2018 Oct 25.
: Acute mesenteric ischemia is a rare disease entity associated with high morbidity and mortality. Disparate etiologies and nonspecific symptoms make the diagnosis challenging and often result in delayed diagnosis and intervention. Open laparotomy with mesenteric revascularization and resection of necrotic bowel has been considered the gold standard of care. With recent advances in percutaneous catheter-directed techniques, multiple retrospective studies have demonstrated the outcomes of endovascular therapy. Herein, we review the etiology, presentation, and diagnosis of acute mesenteric ischemia with contemporary outcomes associated with both open and endovascular treatments.
: The PubMed electronic database was queried in the English language using the search words mesenteric, acute ischemia, embolism, thromboembolism, thrombosis, revascularization, and endovascular in various combinations. Abstracts of the relevant titles were examined to confirm their relevance and the full articles then extracted. References from extracted articles were checked for any additional relevant articles. This systematic review encompassed literature for the past 5 years (between 2011 and 2016).
: Early diagnosis and intervention improves acute mesenteric ischemia outcomes. Early restoration of mesenteric flow minimizes morbidity and mortality. In comparison to open laparotomy with mesenteric revascularization and resection of necrotic bowel, several retrospective studies using administrative data and single-center chart reviews demonstrate noninferior outcomes of an endovascular first approach in acute arterial mesenteric occlusion.
: For acute mesenteric arterial occlusive disease, both endovascular and open revascularization techniques are viable options. Although there is lack of level 1 evidence, single-center retrospective studies and administrative database studies demonstrated that an endovascular first approach may have improved outcomes in the immediate postoperative period. However, selection and other bias in these studies necessitate the need for definitive randomized prospective studies between endovascular and open mesenteric intervention. In contrast, mesenteric venous thrombosis may be treated with systemic anticoagulation without surgical revascularization. Catheter-directed thrombectomy and thrombolysis can be considered at the discretion of the clinician.
急性肠系膜缺血是一种罕见的疾病，其发病率和死亡率都很高。病因各异且症状不具特异性，这使得诊断颇具挑战性，常常导致诊断和干预延迟。开放性剖腹手术联合肠系膜血管重建及坏死肠段切除一直被视为治疗的金标准。随着经皮导管技术的最新进展，多项回顾性研究已证实了血管内治疗的效果。在此，我们回顾急性肠系膜缺血的病因、临床表现、诊断，以及开放性手术和血管内治疗的当代疗效。
使用“肠系膜”“急性缺血”“栓塞”“血栓栓塞”“血栓形成”“血管重建”和“血管内”等关键词的各种组合，以英文检索PubMed电子数据库。检查相关标题的摘要以确认其相关性，然后提取全文。检查提取文章的参考文献，以查找任何其他相关文章。本系统评价涵盖了过去5年（2011年至2016年）的文献。
早期诊断和干预可改善急性肠系膜缺血的治疗效果。早期恢复肠系膜血流可将发病率和死亡率降至最低。与开放性剖腹手术联合肠系膜血管重建及坏死肠段切除相比，多项使用行政数据和单中心病历回顾的回顾性研究表明，急性动脉性肠系膜闭塞采用血管内优先治疗方法的效果并不逊色。
对于急性肠系膜动脉闭塞性疾病，血管内和开放性血管重建技术都是可行的选择。尽管缺乏一级证据，但单中心回顾性研究和行政数据库研究表明，血管内优先治疗方法可能在术后即刻具有更好的疗效。然而，这些研究中的选择偏倚及其他偏倚使得有必要进行血管内和开放性肠系膜干预之间的确定性随机前瞻性研究。相比之下，肠系膜静脉血栓形成可采用全身抗凝治疗，无需手术血管重建。临床医生可酌情考虑导管定向血栓切除术和溶栓治疗。
