From the Departments of Radiology (L.G., R.D., A.T., V.V., M.R.), Pathology (D.C.H.), and Gastroenterology, IBD, and Intestinal Insufficiency (O.C., A.N.), Hôpital Beaujon, AP-HP Nord, 100 Blvd du Général Leclerc, 92110 Clichy, France; Department of Vascular Surgery, Hôpital Bichat, AP-HP Nord, Paris, France (I.B.A.); Université Paris-Cité, Paris, UMR 1149 CRI, Paris, France (V.V., M.R.); Université des Antilles, Cayenne, French West Indies (L.G.).
Radiology. 2024 Jun;311(3):e230830. doi: 10.1148/radiol.230830.
Background Acute arterial mesenteric ischemia requires emergency treatment and is associated with high mortality rate and poor quality of life. Identifying factors associated with survival without intestinal resection (hereafter, intestinal resection-free [IRF] survival) could help in treatment decision-making after first-line endovascular revascularization. Purpose To identify factors associated with 30-day IRF survival in patients with acute arterial mesenteric ischemia whose first-line treatment was endovascular revascularization. Materials and Methods Patients with acute arterial mesenteric ischemia whose first-line treatment was endovascular revascularization because of a low probability of bowel necrosis were included in this single-center retrospective cohort (May 2014 to August 2022). Patient demographics, laboratory values, clinical characteristics at admission, CT scans, angiograms, and endovascular revascularization-related variables were included. The primary end point was 30-day IRF survival, and secondary end points were 3-month, 1-year, and 3-year overall survival. Factors independently associated with 30-day IRF survival were identified with binary logistic regression. Results A total of 117 patients (median age, 70 years [IQR, 60-77]; 53 female, 64 male) were included. Within 30 days after revascularization, 73 of 117 patients (62%) survived without resection, 28 of 117 (24%) survived after resection, 14 of 117 (12%) died without resection, and two of 117 (2%) underwent resection but died. The 30-day IRF survival was 63% (74 of 117). The 3-month, 1-year, and 3-year mortality rate was 18% (21 of 117), 21% (25 of 117), and 27% (32 of 117), respectively. Independent predictors of 30-day IRF survival were persistent bowel enhancement at initial CT (odds ratio [OR], 0.3; 95% CI: 0.2, 0.8; = .013) and C-reactive protein (CRP) level less than 100 mg/L (OR, 0.3; 95% CI: 0.1, 0.8; = .002). The 30-day IRF survival was 86%, 61%, 47%, and 23% in patients with both favorable features, persistent bowel enhancement but CRP level greater than 100 mg/L, no bowel enhancement but CRP level less than 100 mg/L, and both unfavorable features, respectively. Conclusion Independent predictors associated with 30-day IRF survival in patients with acute arterial mesenteric ischemia whose first-line treatment was endovascular revascularization were persistent bowel wall enhancement at initial CT and CRP level less than 100 mg/L. © RSNA, 2024
背景 急性肠系膜动脉缺血需要紧急治疗，其死亡率和生活质量均较差。识别与免于肠切除术（以下简称无肠切除术[IRF]生存）相关的因素有助于在一线血管内再血管化后做出治疗决策。
目的 确定在一线血管内再血管化治疗的急性肠系膜动脉缺血患者中与 30 天 IRF 生存相关的因素，这些患者的一线治疗是由于肠坏死可能性较低而行血管内再血管化治疗。
材料与方法 本单中心回顾性队列研究纳入了 2014 年 5 月至 2022 年 8 月期间因肠坏死可能性较低而行一线血管内再血管化治疗的急性肠系膜动脉缺血患者（n=117）。患者的人口统计学数据、实验室值、入院时的临床特征、CT 扫描、血管造影和血管内再血管化相关变量均被纳入分析。主要终点是 30 天 IRF 生存，次要终点是 3 个月、1 年和 3 年的总体生存。采用二项逻辑回归识别与 30 天 IRF 生存独立相关的因素。
结果 共纳入 117 例患者（中位年龄，70 岁[IQR，60-77]；53 例女性，64 例男性）。血管再通后 30 天内，117 例患者中有 73 例（62%）无切除术存活，28 例（24%）在切除术后存活，14 例（12%）无切除术死亡，2 例（2%）接受切除术但死亡。30 天 IRF 生存率为 63%（74/117）。3 个月、1 年和 3 年的死亡率分别为 18%（21/117）、21%（25/117）和 27%（32/117）。30 天 IRF 生存的独立预测因素为初始 CT 上持续的肠壁增强（比值比[OR]，0.3；95%CI：0.2，0.8；P=.013）和 C 反应蛋白（CRP）水平＜100 mg/L（OR，0.3；95%CI：0.1，0.8；P=.002）。具有以下有利特征的患者 30 天 IRF 生存率分别为 86%、61%、47%和 23%：初始 CT 上持续的肠壁增强且 CRP 水平＜100 mg/L、初始 CT 上持续的肠壁增强但 CRP 水平＞100 mg/L、无肠壁增强但 CRP 水平＜100 mg/L以及均为不利特征。
结论 急性肠系膜动脉缺血患者行一线血管内再血管化治疗后，与 30 天 IRF 生存相关的独立预测因素为初始 CT 上持续的肠壁增强和 CRP 水平＜100 mg/L。
