Prognosis

Acute mesenteric ischemia

Despite advances in knowledge in diagnosis, pathophysiology and treatment, the outlook for patients with acute mesenteric ischemia remains poor.[30][37] Acute mesenteric ischemia results in mortality rates of around 50% to 60%, according to several large series.[17][30][84][85] Pooled mortality estimates for different treatment modalities confirm this high mortality rate, with one meta-analysis of observational studies and case series over the last 20 years showing a relatively static mortality rate of 40% for open surgery, 26% for endovascular surgery, and 32% for open retrograde mesenteric stenting.[86]

Mortality is correlated with the mechanism of ischemia; arterial mesenteric infarction and nonocclusive mesenteric ischemia are three times more likely to result in death than venous infarction.[37] 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.[87] Nonocclusive mesenteric ischemia results in mortality of up to 70% to 80%.[17][85][88]

Diagnosis before the occurrence of intestinal infarction is the most important factor in improving survival for patients with acute mesenteric ischemia. 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.[89]

Chronic mesenteric ischemia

The 30-day mortality rate for patients with chronic mesenteric ischemia is relatively similar regardless of whether it is treated endovascularly or surgically.[17][48][90][91] However, mortality after 5 years has shown to be lower in patients undergoing open surgical revascularization compared with those undergoing endovascular revascularization.[17][90]

Mortality rates for surgical revascularization tend toward the lower end of a range from 0% to 16%, with success rates of >90%, and recurrence rates generally <10%.[7]

However, endovascular revascularization is the preferred option for chronic mesenteric ischemia due to lower perioperative risks compared with surgical revascularization.[12][17][64]

Colonic ischemia

Colonic ischemia carries the most favorable prognosis of the varying forms of bowel ischemia; nevertheless, 20% will develop chronic ulcerating ischemic colitis.[25] Poor prognosis is associated with male sex, right-sided ischemia, and lack of rectal bleeding at presentation.[34][41]

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