SURGERY FOR ACUTE MESENTERIC ISCHEMIA

Between 1972 and 1993 a total of 90 patients were operated on for acut e mesenteric ischemia at Hanover Medical School, Department of Abdomin al- and Transplantation Surgery. As causes of mesenteric ischemia, art erial embolism (23%), arterial thrombosis (30%), venous thrombosis (33 %), and non-occlusive disease (14%) were differentiated. The overall h ospital mortality was 66%. The hospital mortality after venous thrombo sis was 37%, significantly lower than after arterial (79%) and functio nal(83%) types of mesenteric ischemia. Besides the pathogenesis of mes enteric infarction, a multivariate analysis revealed age and presence of peritonitis and intestinal perforation to be independent prognostic factors of hospital lethality. Patients with venous thrombosis had a mean age of 48 years and were significantly younger than the remaining patients who had an average age of over 60 years. Surgical procedures comprised solitary bowel resection (60%), isolated embolectomy and/or thrombectomy (10%), a combination of embolectomy/thrombectomy and bow el resection (4%), and exploratory laparotomy only (21%). Vascular rec onstruction was associated with a significantly better survival rate t han bowel resection only. While hospital mortality was dependent on th e type of mesenteric ischemia, long-term survival after exclusion of h ospital deaths proved independent of the original pathogenesis. Of the patients who survived the acute attack of mesenteric ischemia, 70% we re alive 2 years later and 50% 5 years later. The survival probability of these patients was not determined by recurrence of mesenteric isch emia, but was mainly related to their cardiovascular comorbidity and a high incidence and prevalence of malignancies.