Published online Jul 7, 2020. doi: 10.3748/wjg.v26.i25.3625
Peer-review started: March 11, 2020
First decision: April 25, 2020
Revised: May 26, 2020
Accepted: June 9, 2020
Article in press: June 9, 2020
Published online: July 7, 2020
Acute mesenteric venous thrombosis (AMVT) can cause a poor prognosis. Prompt transcatheter thrombolysis (TT) can achieve early mesenteric revascularization. However, irreversible intestinal ischemia still occurs and the mechanism is still unclear.
To evaluate the clinical outcomes of and to identify predictive factors for irreversible intestinal ischemia requiring surgical resection in AMVT patients treated by TT.
The records of consecutive patients with AMVT treated by TT from January 2010 to October 2017 were retrospectively analyzed. We compared patients who required resection of irreversible intestinal ischemia to patients who did not require.
Among 58 patients, prompt TT was carried out 28.5 h after admission. A total of 42 (72.4%) patients underwent arteriovenous combined thrombolysis, and 16 (27.6%) underwent arterial thrombolysis alone. The overall 30-d mortality rate was 8.6%. Irreversible intestinal ischemia was indicated in 32 (55.2%) patients, who had a higher 30-d mortality and a longer in-hospital stay than patients without resection. The significant independent predictors of irreversible intestinal ischemia were Acute Physiology and Chronic Health Evaluation (APACHE) II score (odds ratio = 2.368, 95% confidence interval: 1.047-5.357, P = 0.038) and leukocytosis (odds ratio = 2.058, 95% confidence interval: 1.085-3.903, P = 0.027). Using the receiver operating characteristic curve, the cutoff values of the APACHE II score and leukocytosis for predicting the onset of irreversible intestinal ischemia were calculated to be 8.5 and 12 × 109/L, respectively.
Prompt TT could achieve a favorable outcome in AMVT patients. High APACHE II score and leukocytosis can significantly predict the occurrence of irreversible intestinal ischemia. Therefore, close monitoring of these factors may help with the early identification of patients with irreversible intestinal ischemia, in whom ultimately surgical resection is required, before the initiation of TT.
Core tip: Prompt transcatheter thrombolysis (TT) can achieve early mesenteric revascularization in acute mesenteric venous thrombosis (AMVT) patients. However, irreversible intestinal ischemia still occurs in many cases. We compared AMVT patients with irreversible intestinal ischemia who underwent TT to patients with reversible intestinal ischemia. We demonstrated that the independent predictors of irreversible intestinal ischemia were Acute Physiology and Chronic Health Evaluation II score and leukocytosis and the cutoff values were 8.5 and 12 × 109/L, respectively. Close monitoring of these factors may help with early identification of irreversible intestinal ischemia, which requires surgical resection, before initiation of TT in AMVT patients.