Prognosis

Acute mesenteric ischaemia

Despite advances in knowledge in diagnosis, pathophysiology and treatment, the outlook for patients with acute mesenteric ischaemia remains poor.[29][38] Acute mesenteric ischaemia results in mortality rates of approximately 50% to 60% according to several large series.[8][29][90][91] Pooled mortality estimates for different treatment modalities confirm this high mortality rate, with a meta-analysis of observational studies and case series from 2000 to 2001 showing a relatively static mortality rate of 40% for open surgery, 26% for endovascular surgery, and 32% for open retrograde mesenteric stenting.[92]

Mortality is correlated with the mechanism of ischaemia; arterial mesenteric infarction and non-occlusive mesenteric ischaemia (NOMI) are three times more likely to result in death than venous infarction.[38] In general, the relatively slow process of mesenteric venous thrombosis is much less lethal than the very sudden interruption to blood supply caused by superior mesenteric artery embolus. Predictors of poor outcome include advanced age, chronic kidney disease, diabetes, large bowel involvement, evidence of organ hypoperfusion (e.g., creatinine and/or lactate rise), and delayed surgery.[93] Historically, NOMI has resulted in 70% to 80% mortality; however, more recent data suggest mortality rates from NOMI are more like 30% to 55%.[91][94][95][96]

Diagnosis before the occurrence of intestinal infarction is the most important factor in improving survival for patients with acute mesenteric ischaemia. This is supported by several retrospective studies in which diagnosis within 24 hours of presentation to a physician, or before any significant bowel infarction occurred, resulted in markedly improved survival. In a report of 21 patients with superior mesenteric artery embolus, intestinal viability was achieved in 100% of patients if the duration of symptoms was <12 hours, in 56% if it was between 12 and 24 hours, and in only 18% if symptoms were >24 hours in duration before diagnosis.[97]

Chronic mesenteric ischaemia

Mortality rates for surgical revascularisation tend towards the lower end of a range from 0% to 16%, with success rates of >90%, and recurrence rates generally <10%.[65]

Several long-term studies have shown that patients who survive surgical revascularisation have cumulative 5-year survival rates of 81% to 86%.[65]

Colonic ischaemia

Colonic ischaemia carries the most favourable prognosis of the varying forms of bowel ischaemia; nevertheless, 20% will develop chronic ulcerating ischaemic colitis.[21] Poor prognosis is associated with male sex, right-sided ischaemia, and lack of rectal bleeding at presentation.[33]

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