Hybrid treatment tactics in acute mesenteric ishemia

A.A. Atayan^1,2, A.N. Kosenkov¹, M.R. Kuznetsov^2,3, A.I. Chernookov⁴, M.I. Ivanova², E.O. Khachatryan¹

¹Sechenov University, Moscow

²State Clinical Hospital № 29 named after N.E. Bauman, Moscow

³Pirogov Russian National Research Medical University, Moscow

⁴CJSC “Phlebology Center”, Moscow

Background: nowadays, acute mesenteric ischemia (AMI) is not a rare disease. Depending on the treatment tactics, mortality varies between 60–97%.

Aim: to study the possibility of using hybrid treatment tactics using endovascular revascularization of the superior mesenteric artery (SMA) and conventional surgical intervention in AMI.

Patients and Methods: AMI was treated in 52 patients. Average age of patients — 70.21±6.43 years. Patients underwent a hybrid treatment tactics using endovascular revascularization of SMA and conventional surgical intervention in AMI. After the endovascular intervention, all patients underwent a bowel resection with the necrotic area excision.

Results: there was an attempt to restore blood flow in SMA and its branches at all lesion levels using X-ray surgical methods, followed by bowel resection. It was noted that the higher the lesion of SMA, the larger the bowel area was involved and excised. Thus, the 1st SMA segment lesion was revealed in 5 patients with total necrosis; the 1st SMA segment lesion was revealed in 7 patients with a resection volume of more than 3 m, the 2nd segment — in 2. With resection of 2–3 m, the 1st segment lesion was revealed in 6 patients, in 9 patients — the 2nd SMA segment, in 3 patients — the 3rd SMA segment and/or branches. In the group with a resection volume of up to 2 m, the 1st SMA segment lesion in 4 patients, in 10 — the 2nd SMA segment, in 5 — the 3rd SMA segment and/or branches. Since intestinal necrosis begins with distal sites, it was possible to perform more limited resections that are not characteristic of proximal levels of SMA lesion.

Conclusion: the use of X-ray endovascular repair techniques made it possible to solve the mesenteric ischemia problem both in case of occlusion and SMA stenosis at the level of almost any segment and branch, unlike SMA revascularization conventional methods.

Keywords: acute mesenteric ischemia, superior mesenteric artery, diagnosis, treatment, hybrid surgery, resection.

For citation: Atayan A.A., Kosenkov A.N., Kuznetsov M.R. et al. Hybrid treatment tactics in acute mesenteric ishemia. RMJ. 2019;8(II):83–88.