Abstract
PurposeTo investigate the outcome of local intra-arterial papaverine infusion therapy in patients with non-occlusive mesenteric ischemia (NOMI), and factors influencing survival, in comparison with a conservative approach.MethodsFrom 2013 to 2019, patients with NOMI confirmed by imaging were included in a retrospective two-center study. According to different in-house standard procedures, patients were treated in each center either conservatively or interventionally by a standardized local infusion of intra-arterial papaverine into the splanchnic arteries. Thirty-day mortality and factors influencing the outcome, such as different demographics and laboratories, were compared between groups using Kaplan–Meier survival analysis and Cox regression, respectively.ResultsA total of 66 patients with NOMI were included, with n = 35 treated interventionally (21 males, mean age 67.7 ± 12.3 years) and n = 31 treated conservatively (18 females, mean age 71.6 ± 9.6 years). There was a significant difference in 30-day mortality between the interventional (65.7%; 12/35 survived) and the conservative group (96.8%; 1/31 survived) (hazard ratio 2.44; P = 0.005). Thresholds associated with a worse outcome of interventional therapy are > 7.68 mmol/l for lactate, < 7.31 for pH and < − 4.55 for base excess.ConclusionLocal intra-arterial papaverine infusion therapy in patients with NOMI significantly increases survival rate in comparison with conservative treatment. High lactate levels, low pH and high base excess, and high demand for catecholamines are associated with a poor outcome.Level of EvidenceLevel III.
Highlights
Despite the progress in intensive care medicine, acute mesenteric ischemia is still a potentially lethal event due to insufficient blood supply of intestinal tissue over a criticalR
Purpose To investigate the outcome of local intra-arterial papaverine infusion therapy in patients with non-occlusive mesenteric ischemia (NOMI), and factors influencing survival, in comparison with a conservative approach
We assessed the impact of acute treatment of NOMI by local infusion of papaverine hydrochloride into splanchnic arteries in comparison with conservative noninterventional treatment
Summary
Despite the progress in intensive care medicine, acute mesenteric ischemia is still a potentially lethal event due to insufficient blood supply of intestinal tissue over a criticalR. Despite the progress in intensive care medicine, acute mesenteric ischemia is still a potentially lethal event due to insufficient blood supply of intestinal tissue over a critical. Mesenteric ischemia can either result from arterial occlusion or be non-occlusive and result from severe lasting vasoconstriction (NOMI). For the latter form, a profound drop of systemic blood pressure is seen as causative for reflexive mesenteric arterial vasoconstriction and consecutive ischemia [2, 3]. The aforementioned mismatch is amplified by the vasoconstrictive effect of catecholamines, starting a vicious circle. Left untreated, this can lead to gangrene of the intestinal wall, sepsis and multiple organ failure within a short time.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
