Authors
Darvin V.V., Mazajshvili K.V., Klimova N.V., Vasilev V.V., Gustelyov Yu.A.
Surgut state university, Surgut
Abstract
The aging population in developed countries and Russia affects the structure of emergency surgical pathology and is accompanied by an increase of patients with acute mesenteric ischemia. In half of the patients, it is caused by cardiac thromboembolic events, in a quarter of the target population mesenteric thrombosis occurs by an atherosclerotic process in the intestinal arteries, and in 5-10% of cases, venous thrombosis is observed. The lack of evidence for the lab detection and the wide range of instrumental examinations, such as CT angiography, MRI angiography, duplex ultrasound, and X-ray contrast angiography demonstrates the absence of a routine diagnostic test. The limitations of the traditional surgery indicate the need for revascularization by embolectomy and/or by-pass surgery that require appropriate equipment and trained staff. X-ray endovascular interventions change the treatment patterns of acute mesenteric thrombosis and include selective catheter-directed thrombolysis, percutaneous rheolytic thrombectomy, balloon angioplasty, and stenting. The hybrid technique with a simultaneous combination of open surgery and X-ray endovascular interventions is very promising and requires long-term study results. Anticoagulant therapy is the treatment of choice for acute mesenteric ischemia caused by thrombosis of the superior mesenteric, inferior mesenteric, splenic and/or portal veins. However, in some ineffectiveness cases of nonsurgical treatment X-ray endovascular interventions are also successfully applied, e.g., direct percutaneous catheter installation into the portal vein system and transjugular intrahepatic portosystemic shunt followed by retrograde catheter insertion into mesenteric veins and mechanical fragmentation with thromboaspiration and/or selective catheter-directed thrombolysis. Thus, including a vascular surgical team in the hospital structure can significantly change the survival rate and quality of life of patients with acute mesenteric ischemia. Good organization of diagnostics, treatment, and prevention of this disease, by analogy with an acute coronary syndrome, will achieve rational improvement of the current situation in Russian healthcare.
Keywords: acute mesenteric ischemia, acute mesenteric thrombosis, selective catheter-directed thrombolysis, percutaneous rheolytic thrombectomy, mesenteric balloon angioplasty and stenting.
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