Is open surgery or endovascular therapy best to treat acute mesenteric occlusive disease?

INTERNATIONAL JOURNAL OF SURGERY

卷:11

Review

Smith, S. F.¹  Gollop, N. D.²  Klimach, S. G.³  Murray, P. J.² 

[1] Univ Cambridge, Sch Clin Med, Cambridge CB2 1TN, England

[2] Norfolk & Norwich Univ Hosp, Norwich NR4 7UY, Norfolk, England

[3] Univ Sussex, Brighton & Sussex Med Sch, Brighton, E Sussex, England

关键词: Open surgery;    Endovascular surgery;    Acute mesenteric occlusive disease;    Acute mesenteric ischaemia;   

DOI  :  10.1016/j.ijsu.2013.10.003

来源: Elsevier

【 摘 要 】

A best evidence topic in vascular surgery was written according to a structured protocol. The question addressed whether endovascular treatment improved peri-operative outcomes when compared to an open approach to restore arterial perfusion in acute mesenteric occlusive disease. Four hundred and ninety seven papers were identified using the reported search; of which 4 represented the best evidence to answer the question and are discussed. The evidence on this subject is limited, comprising largely of non-randomised retrospective cohort studies. The evidence suggests that endovascular treatment is associated with reduced mortality and has better short-term peri-operative outcomes, as well as longer-term survival - however many endovascular cases require subsequent open surgery. There is also conflicting evidence to suggest endovascular therapy is associated with longer ICU stays. Aside from procedural complications, factors such as patient status, time delay to diagnosis and treatment may play a greater role in determining mortality rates. In summary, endovascular therapy appears to be a feasible treatment option with post-operative complications and inpatient mortality rates lower than those seen in open surgery. (C) 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

【 授权许可】

Free