Use of endovascular methods in the treatment of acute mesenteric ischemia

Gastrointestinal complications are relatively rare complications of cardiac surgery but are nevertheless associated with high mortality. The absolute number of gastrointestinal complications (GI) varies from 0.21 % to 2.9 %. However, the overall mortality in available analyses ranges from 4 % to 100 %, mainly related to mesenteric ischemia. Over the past decade, the greatest attention among GI complications has been paid to ischemic intestinal injury. The frequency of this complication is quite low – from 0.06 to 1.15 %, but the mortality reaches 50–70 %, and according to some authors, even 100 %. Usually, acute intestinal ischemia is caused by embolism caused by thrombi of various origins. However, hypoperfusion as a result of various factors can lead to non-occlusive ischemia.Thus, the morbidity and mortality because of mesenteric ischemia remain high even in the era of modern advances in diagnostic and therapeutic modalities, and the best treatment method is still debated among surgeons and interventionists. Recently, interventionists have increasingly preferred endovascular approaches to open surgery, probably due to the apparent reduction in mortality and perioperative complications. However, despite the high technical success rates, further exploratory laparotomy for resection of necrotic bowel is necessary in a significant proportion of patients. Most evidence suggests that hybrid approaches involving primary endovascular interventions followed by open laparotomies for bowel resection may be superior to either approach alone. An exceptional factor dramatically affecting outcome and mortality is early diagnosis. Given the relative rarity of mesenteric ischemia in intensive care practice, awareness and vigilance regarding this complication, as well as early multispiral computed tomography with subsequent referral to cathlab may be a key.