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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Lim S, Halandras PM, Bechara C, Aulivola B, Crisostomo P. Contemporary Management of Acute Mesenteric Ischemia in the Endovascular Era. [Review]. Vasc Endovascular Surg. 53(1):42-50, 2019 Jan. Review/Other-Tx N/A To review the etiology, presentation, and diagnosis of acute mesenteric ischemia with contemporary outcomes associated with both open and endovascular treatments. Early diagnosis and intervention improves acute mesenteric ischemia outcomes. Early restoration of mesenteric flow minimizes morbidity and mortality. In comparison to open laparotomy with mesenteric revascularization and resection of necrotic bowel, several retrospective studies using administrative data and single-center chart reviews demonstrate noninferior outcomes of an endovascular first approach in acute arterial mesenteric occlusion. 4
2. Ginsburg M, Obara P, Lambert DL, et al. ACR Appropriateness Criteria® Imaging of Mesenteric Ischemia. J Am Coll Radiol 2018;15:S332-S40. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for imaging of mesenteric ischemia. No results stated in abstract. 4
3. Kanasaki S, Furukawa A, Fumoto K, et al. Acute Mesenteric Ischemia: Multidetector CT Findings and Endovascular Management. Radiographics 2018;38:945-61. Review/Other-Tx N/A To discuss current diagnostic approaches with use of multidetector CT and recent endovascular management strategies for AMI. No results provided. 4
4. Bjorck M, Koelemay M, Acosta S, et al. Editor's Choice - Management of the Diseases of Mesenteric Arteries and Veins: Clinical Practice Guidelines of the European Society of Vascular Surgery (ESVS). [Review]. Eur J Vasc Endovasc Surg. 53(4):460-510, 2017 04. Review/Other-Tx N/A No abstract available No abstract available 4
5. El Farargy M, Abdel Hadi A, Abou Eisha M, Bashaeb K, Antoniou GA. Systematic review and meta-analysis of endovascular treatment for acute mesenteric ischaemia. [Review]. Vascular. 25(4):430-438, 2017 Aug. Meta-analysis 19 observational studies To conduct a systematic review of the literature and perform a meta-analysis of reported outcomes. We identified 19 observational studies reporting on a total of 3362 patients undergoing endovascular treatmentfor acute mesenteric ischaemia. The pooled estimate of peri-interventional mortality was 0.245 (95% confidence interval0.197–0.299), that of the requirement for bowel resection 0.326 (95% confidence interval 0.229–0.439), and the pooledestimate for acute kidney injury was 0.132 (95% confidence interval 0.082–0.204). Eight studies reported comparativeoutcomes of endovascular versus surgical treatment for acute mesenteric ischaemia (endovascular group, 3187 patients;surgical group, 4998 patients). Endovascular therapy was associated with a significantly lower risk of 30-day mortality(odds ratio 0.45, 95% confidence interval 0.30–0.67, P=0.0001), bowel resection (odds ratio 0.45, 95% confidenceinterval 0.34–0.59, P<0.00001) and acute renal failure (odds ratio 0.58, 95% confidence interval 0.49–0.68, P<0.00001).No differences were identified in septic complications or the development of short bowel syndrome. Inadequate
6. Karkkainen JM, Lehtimaki TT, Saari P, et al. Endovascular Therapy as a Primary Revascularization Modality in Acute Mesenteric Ischemia. Cardiovasc Intervent Radiol. 38(5):1119-29, 2015 Oct. Observational-Tx 50 patients with AMI To evaluate endovascular therapy (EVT) as the primary revascularization method for acute mesenteric ischemia (AMI). Fifty patients, aged 79 ± 9 years (mean ± SD), out of 66 consecutive patients with AMI secondary to embolic or thrombotic obstruction of the superior mesenteric artery were referred for revascularization. The etiology of AMI was embolism in 18 (36 %) and thrombosis in 32 (64 %) patients. EVT was technically successful in 44 (88 %) patients. Mortality after successful or failed EVT was 32 %. The rates of emergency laparotomy, bowel resection, and EVT-related complication were 40, 34, and 10 %, respectively. Three out of six patients with failure of EVT were treated with surgical bypass. EVT failure did not significantly affect survival. 3
7. Freitas B, Bausback Y, Schuster J, et al. Thrombectomy Devices in the Treatment of Acute Mesenteric Ischemia: Initial Single-Center Experience. Ann Vasc Surg. 51:124-131, 2018 Aug. Observational-Tx 20 patients To report our preliminary experience with endovascular revascularization of patients with acute mesenteric ischemia (AMI), using thrombectomy devices. Twenty patients (mean age: 69.8 ± 11.3 years) underwent endovascular revascularization for AMI using thrombectomy devices, during the period of the study. Abdominal pain was the most common complain on admission (65%), with ileus (35%), sepsis (25%), and myocardial infarction as the main clinical referral presentation at admission. Fifteen patients (75%) had suggestive computer tomography (CT) signs of AMI on admission. Endovascular revascularization was successfully performed in all patients through the left brachial artery with a mean procedural time of 28 ± 17 min. Superior mesenteric artery (SMA) was the main vessel involved in 75% on a solely basis. The majority of the SMA occlusions were in the periosteal (30%) and proximal to middle colic artery offspring (35%). Primary use of thrombectomy devices was performed in all patients, associated with balloon angioplasty (7/20; 50%), stent deployment (5/20; 25%), intraoperative selective thrombolysis (4/20; 20%) and catheter-assisted aspiration in 10% (2/20) of patients. Average time between admission and computed tomography angiography was 1.5 ± 0.5 hr, between admission and angiographic procedure was 2.5 ± 1 hr, and between admission and surgery was 9 ± 5 hr. Following recanalization, 14 patients (70%) underwent open surgery. Laparotomy with intestinal resection (enterectomy, colectomy) and transit deviation was the most common procedure. Complications directly related to the endovascular procedure occurred in 2 patients, represented by self-limited small perforations. Overall 30-day mortality was 40% (n = 8). During the period of this study, no patient died as a result of complications related to the use of rotational thrombectomy. 3
8. Liu YR, Tong Z, Hou CB, et al. Aspiration therapy for acute embolic occlusion of the superior mesenteric artery. World J Gastroenterol. 25(7):848-858, 2019 Feb 21. Observational-Tx 8 patients To evaluate the complications, feasibility, effectiveness, and safety of endovascular treatment for the acute embolic occlusion of the SMA. Six (75%) patients were male, and the mean patient age was 70.00 ± 8.43 years (range, 60-84 years). The acute embolic occlusion of the SMA was initially diagnosed by CTA. All patients had undertaken anticoagulation primarily, and percutaneous aspiration using a guiding catheter was then undertaken because the emboli had large amounts of thrombus residue. No death occurred among the patients. Complete patency of the suffering artery trunk was achieved in six patients, and defect filling was accomplished in two patients. The in-hospital mortality was 0%. The overall 12-mo survival rate was 100%. All patients survived, and two of the eight patients had complications (the clot broke off during aspiration). 2
9. Ryer EJ, Kalra M, Oderich GS, et al. Revascularization for acute mesenteric ischemia. J Vasc Surg 2012;55:1682-9. Observational-Tx 93 patients To evaluate our experience with AMI over the last 2 decades to evaluate changes in management and assess current outcomes. Over the last 2 decades, 93 patients with AMI underwent emergency arterial revascularization. Forty-five patients were treated during the 1990s and 48 during the 2000s. The majority of these patients were transferred from outside facilities. Patient demographics and risk factors were similar between the 2 decades with the exception that the more contemporary patients were significantly older (65.1 +/- 14 vs 71.3 +/- 14; P = .04). Etiology remained constant between the groups with in situ thrombosis being the most common followed by arterial embolus. The majority of patients were treated with open revascularization. Endovascular therapy alone or as a hybrid procedure was used in 11 total patients, eight of which were treated in the last 10 years. The use of second-look laparotomy was much more liberal in the last decade (80% vs 48%; P = .003) Thirty-day mortality was 27% in the 1990s and 17% during the 2000s (P = 0.28). Major adverse events occurred in 47% of patients with no difference between decades. There was no significant difference in outcomes between open and endovascular revascularization. On univariate analysis, elevated SVS comorbidity score, congestive heart failure, and chronic kidney disease predicted early death, while a history of chronic mesenteric ischemia appeared protective. On multivariate analysis, no factor independently predicted perioperative mortality. Bowel resection and cerebrovascular disease predicted postoperative morbidity, while advanced age and connective tissue disease predicted long-term mortality. 2
10. Swerdlow NJ, Varkevisser RRB, Soden PA, et al. Thirty-Day Outcomes After Open Revascularization for Acute Mesenteric Ischemia From the American College of Surgeons National Surgical Quality Improvement Program. Ann Vasc Surg. 61:148-155, 2019 Nov. Observational-Tx 918 patients To evaluate 30-day mortality after open revascularization for AMI and identify preoperative factors associated with mortality. The study cohort included 918 patients; their median age was 70 years (interquartile range: 59-80 years), 62% were female, and 90% were white. Thirty-day mortality after open revascularization for AMI was 32%, specifically 35% after embolectomy, 31% after thromboendarterectomy, and 28% after mesenteric bypass. Mortality was higher in patients requiring concomitant bowel resection (38% vs. 29%, respectively, P < 0.01). The preoperative factor most strongly associated with 30-day mortality was disseminated cancer (odds ratio = 8.8, 95% confidence interval = 2.4-32, P = 0.001). Other factors independently associated with mortality were renal dysfunction, preoperative intubation, preoperative blood transfusion, diabetes, elevated preoperative international normalized ratio, elevated preoperative white blood cell count, and increasing age. 3
11. Bjornsson S, Bjorck M, Block T, Resch T, Acosta S. Thrombolysis for acute occlusion of the superior mesenteric artery. J Vasc Surg 2011;54:1734-42. Observational-Tx 34 patients To evaluate the incidence, complications, and outcome of local intra-arterial thrombolytic therapy for acute superior mesenteric artery (SMA) occlusion in Sweden. Included were 34 patients (20 women) from 12 hospitals. Median age was 78 years. The first patient was treated in 1997, and the annual number of patients undergoing thrombolysis increased continuously from 2004 to 2009. Twenty-eight patients (82%) had embolic occlusion. No patients (0%) had acute peritonitis, and one (3%) had bloody stools at admission. Thirty-two patients (94%) were diagnosed by computed tomography with intravenous contrast enhancement. The median dose of alteplase was 20 mg (interquartile range, 11.6-34.0). Successful thrombolysis was achieved in 30 patients (88%). Initial adjunctive aspiration thromboembolectomy was performed in 10 patients. There were six self-limiting bleeding complications; one from the gastrointestinal tract. Thirteen explorative laparotomies, 10 repeat laparotomies, and eight bowel resections were performed. The in-hospital mortality rate was 26% (9 of 34). Age was not associated with in-hospital death (P = .42). Successful thrombolysis was associated with decreased mortality (P = .048). 2
12. Yanar F, Agcaoglu O, Sarici IS, et al. Local thrombolytic therapy in acute mesenteric ischemia. World J Emerg Surg 2013;8:8. Observational-Tx 13 patients (LTT), 56 patients (necrotic bowel resection), 7 patients (tromboembolectomy) To evaluate the local thrombolytic therapy (LTT) in combination with laparoscopy, in management of acute mesenteric ischemia (AMI). LTT was performed in 13 (17.1%), out of 76 patients. From the remaining patients, 56 underwent necrotic bowel resection and 7 underwent tromboembolectomy. The median age was 62 years (45-87). The median duration of symptoms was 24 h. Four (30.7%) patients presented within 24 h onset of symptoms, whilst 9 (69.3%) patients presented after 24 h onset of symptoms. There were 5 (39.5%) patients, who presented with abdominal pain without peritoneal signs on physical examination and 8 (61.5%) patients, who had peritoneal signs. The mortality rate was 20% (1/5) in the first group who presented without peritoneal signs, whilst it was 62.5% (5/8) in the remaining. 3
13. Altintas U, Lawaetz M, de la Motte L, et al. Endovascular Treatment of Chronic and Acute on Chronic Mesenteric Ischaemia: Results From a National Cohort of 245 Cases. Eur J Vasc Endovasc Surg 2021;61:603-11. Observational-Tx CMI patients (n = 178); AoCMI patients (n = 67) To assess short and mid term outcome after first line endovascular revascularisation of chronic mesenteric ischaemia (CMI) and acute on chronic mesenteric ischaemia (AoCMI). In total, 245 patients had an endovascular intervention for CMI (n = 178; 72.6%) and AoCMI (n = 67; 27.3%). One and three year survival estimates were 85% (95% confidence interval [CI] 79 - 90) and 74% (95% CI 67 - 80) in the CMI-group, and 67% (95% CI 54 - 77) and 54% (95% CI 41 - 65) in the AoCMI group. The hazard ratio for death was 1.89 (95% CI 1.23 - 2.9) for AoCMI, relative to patients with CMI. Superior mesenteric artery (SMA) stenosis, rather then occlusion, significantly increased the success of SMA recanalisation: OR 19.4 (95% CI 6.2 - 61.4) and 9.3 (95% CI 1.6 - 53.6) in the CMI and AoCMI groups, respectively. The proportion of patients reporting clinical improvement was 71% (n = 127) in the CMI group and 59% (n = 39) in the AoCMI group. Five patients (3%) in the CMI and 30 (45%) in the AoCMI groups underwent bowel resection (p < .001), and the overall length of hospital stay (LoS) was a median of two days (interquartile range [IQR] 1 - 3 days) in the CMI group and seven days (IQR 3 - 23 days) in the AoCMI group. Within the first year, re-intervention was performed in 14 patients (5.7%). 3
14. Forbrig R, Renner P, Kasprzak P, et al. Outcome of primary percutaneous stent-revascularization in patients with atherosclerotic acute mesenteric ischemia. Acta Radiol. 58(3):311-315, 2017 Mar. Observational-Tx 19 patients To investigate the feasibility of primary percutaneous stent-revascularization (PPSR) in atherosclerotic AMI and its impact on patients’ outcome. The majority of patients presented with severe co-morbidities (CCIa >4 in 17 of 19 patients, 89%). Median symptom duration was 50 h. Technical and clinical success rates of PPSR were 95% (21 of 22 arteries) and 53% (10 of 19 patients). Seven patients underwent subsequent laparotomy with bowel resection in four cases. Thirty-day mortality was 42% (8 of 19 patients). 2
15. Beaulieu RJ, Arnaoutakis KD, Abularrage CJ, Efron DT, Schneider E, Black JH, 3rd. Comparison of open and endovascular treatment of acute mesenteric ischemia. J Vasc Surg 2014;59:159-64. Observational-Tx N/A To compare open and endovascular treatment of acute mesenteric ischemia. Of 23,744 patients presenting with AMI, 4665 underwent interventional treatment from 2005 through 2009. Of these patients, 57.1% were female, and the mean age was 70.5 years. A total of 679 patients underwent vascular intervention; 514 (75.7%) underwent open surgery and 165 (24.3%) underwent endovascular treatment overall during the study period. The proportion of patients undergoing endovascular repair increased from 11.9% of patients in 2005 to 30.0% in 2009. Severity of comorbidities, as measured by the Charlson index, did not differ significantly between the treatment groups. Mortality was significantly more commonly associated with open revascularization compared with endovascular intervention (39.3% vs 24.9%; P = .01). Length of stay was also significantly longer in the patient group undergoing open revascularization (12.9 vs 17.1 days; P = .006). During the study time period, 14.4% of patients undergoing endovascular procedures required bowel resection compared with 33.4% for open revascularization (P < .001). Endovascular repair was also less commonly associated with requirement for TPN support (13.7% vs 24.4%; P = .025). 3
16. Sakamoto T, Fujiogi M, Matsui H, Fushimi K, Yasunaga H. Clinical features and outcomes of nonocclusive mesenteric ischemia after cardiac surgery: a retrospective cohort study. Heart Vessels. 35(5):630-636, 2020 May. Observational-Tx bowel resection (n = 34), bowel resection and IVR (n = 15), IVR (n = 15), no bowel resection or IVR (n=60) To clarify patients' backgrounds, clinical features and mortality of nonocclusive mesenteric ischemia after cardiac surgery, using a Japanese national inpatient database. We identified 221,900 eligible patients to find 568 (0.26%) patients with bowel ischemia in the same admission. Of these, 124 (0.06%) patients developed nonocclusive mesenteric ischemia, and in-hospital mortality after nonocclusive mesenteric ischemia was 77%. Treatment options for nonocclusive mesenteric ischemia included bowel resection alone (n = 34), interventional radiology (n = 15), or both (n = 15); 27, 10, and 8 patients died, respectively. Seven patients (5.6%) were discharged to home. Among 60 patients without bowel resection or interventional radiology, 50 patients died. In multivariable regression analysis, older age, preoperative hemodialysis, preoperative circulatory support, and hypothermic cardiopulmonary bypass were associated with nonocclusive mesenteric ischemia (NOMI). 2
17. Winzer R, Fedders D, Backes M, et al. Local Intra-arterial Vasodilator Infusion in Non-Occlusive Mesenteric Ischemia Significantly Increases Survival Rate. Cardiovasc Intervent Radiol 2020;43:1148-55. Observational-Tx interventional treatment (n=35), conservative treatment (n=31) 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. A 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. 3
18. Miyazawa R, Kamo M. What affects the prognosis of NOMI patients? Analysis of clinical data and CT findings. Surg Endosc 2020;34:5327-30. Observational-Tx 21 consecutive patients (8 patients in survivor group, 11 patients in non-survivor group) To investigate prognostic factors of clinical data and computed tomography (CT) findings in patients with NOMI. Eight patients belonged to ''survivor'' group, whereas eleven were allocated to ''non-survivor'' group. None of CT findings showed significant difference between survivor group and non-survivor group [defect of mural enhancement: 75% and 100% (p = 0.16), pneumatosis intestinalis: 50% and 45.5% (p = 1.00), hepatic portal venous gas: 37.5% and 45.5% (p = 1.00), paralytic bowel dilatation: 12.5% and 63.6% (p = 0.06), and bowel wall thinning: 50% and 45.5% (p = 1.00)]. The diameters of the relevant vessels did not have significant difference either. Time from CT to injecting vasodilator was revealed to be significantly shorter in survivor group [187.5 (122.5-294) min and 310 (187-925.5)] (p = 0.048). None of the other clinical information had significant difference between each group. 3
19. Bala M, Kashuk J, Moore EE, et al. Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery. [Review]. World Journal Of Emergency Surgery. 12:38, 2017. Review/Other-Tx N/A To address the concepts of AMI with the aim of focusing on specific areas where early diagnosis and management hold the strongest potential for improving outcomes in this disease process. No results provided. 4
20. Stahl K, Busch M, Maschke SK, et al. A Retrospective Analysis of Nonocclusive Mesenteric Ischemia in Medical and Surgical ICU Patients: Clinical Data on Demography, Clinical Signs, and Survival. J Intensive Care Med 2020;35:1162-72. Observational-Tx 455 intensive care patients with acute arterial mesenteric perfusion disorder To analyze demography, clinical signs, and survival of intensive care patients diagnosed with nonocclusive mesenteric ischemia (NOMI) and to evaluate the effect of a local intra-arterial prostaglandin therapy. Patients were 60.5 (49.3-73) years old and had multiple comorbidities. Most of them were diagnosed with septic shock requiring high doses of norepinephrine (NE: 0.382 [0.249-0.627] µg/kg/min). The Sequential Organ Failure Assessment (SOFA) score was 18 (16-20). A decrease in oxygenation (Pao 2/Fio 2), pH, and bicarbonate and an increase in international normalized ratio, lactate, bilirubin, leucocyte count, and NE dose were early indicators of NOMI. Median SOFA score significantly increased in the last 24 hours before diagnosis of NOMI (16 vs 18, P < .0001). Overall, 28-day mortality was 75% (81% nonintervention vs 64% intervention cohort; P = .579). Median SOFA scores 24 hours after intervention increased by +5% in the nonintervention group and decreased by 5.5% in the intervention group (P = .0059). 3
21. Roussel A, Della Schiava N, Coscas R, et al. Results of retrograde open mesenteric stenting for acute thrombotic mesenteric ischemia. J Vasc Surg. 69(4):1137-1142, 2019 Apr. Observational-Tx 25 patients To assess the results of retrograde open mesenteric stenting (ROMS) in thrombotic acute mesenteric ischemia (AMI) in a retrospective multicenter study. Twenty-five patients (14 men and 11 women; mean age, 64.9 ± 11.6 years) were included. In two patients, ROMS was not possible because of failure of re-entry in the aortic lumen (technical success, 92%). One patient required revascularization of two visceral arteries and underwent an aortohepatic bypass. Five patients (20%) underwent endarterectomy and patch angioplasty of the superior mesenteric artery before retrograde stenting. Thirteen patients (52%) required bowel or colon resection (11 patients required both resections) during the initial procedure with a mean length of small bowel resection of 52 ± 87 cm. The 30-day operative mortality rate was 25%, and the overall 1-year survival rate was 65%. The 1-year primary patency rate was 92%. In one patient, postoperative imaging at 1 month showed stent migration in the aortic bifurcation. 2
22. Tracci MC.. Median arcuate ligament compression of the mesenteric vasculature. [Review]. Tech Vasc Interv Radiol. 18(1):43-50, 2015 Mar. Review/Other-Tx N/A To discuss the management of Median Arcuate Ligament. N/A 4
23. van Petersen AS, Kolkman JJ, Gerrits DG, van der Palen J, Zeebregts CJ, Geelkerken RH. Clinical significance of mesenteric arterial collateral circulation in patients with celiac artery compression syndrome. Journal of Vascular Surgery. 65(5):1366-1374, 2017 05. Observational-Tx 135 patients with celiac artery compression syndrome To classify the presence of mesenteric arterial collateral circulation in patients with CACS and to evaluate the relation with clinical improvement after treatment. Between 2002 and 2013, there were 135 consecutive patients with suspected CACS who were operated on. In 129 patients, preoperative angiograms allowed classification of collateral circulation. Primary assisted anatomic success was 93% (120/129). In patients with grade 0 collaterals, clinical success was 81% (39 of 48 patients); with grade 1 collaterals, 89% (25 of 28 patients); and with grade 2 collaterals, 52% (23 of 44 patients; P < .001). 2
24. Delis KT, Gloviczki P, Altuwaijri M, McKusick MA. Median arcuate ligament syndrome: open celiac artery reconstruction and ligament division after endovascular failure. J Vasc Surg 2007;46:799-802. Review/Other-Tx N/A To report on a young woman who after three consecutive attempts of endovascular therapy with balloon angioplasty and stenting for MALS, each followed by gross symptom recurrence and a cumulative weight loss of 10 kg, underwent open surgical division of the ligament and reconstruction of the celiac artery. No results in abstract. 4
25. Duffy AJ, Panait L, Eisenberg D, Bell RL, Roberts KE, Sumpio B. Management of median arcuate ligament syndrome: a new paradigm. Annals of vascular surgery 2009;23:778-84. Review/Other-Tx 1 case To review the management of MAL syndrome, with special emphasis on the minimally invasive approaches.To report the first case of successful combination of minimally invasive surgery and endovascular therapy in the treatment of this syndrome. No results in abstract. 4
26. Matsumoto AH, Angle JF, Spinosa DJ, et al. Percutaneous transluminal angioplasty and stenting in the treatment of chronic mesenteric ischemia: results and longterm followup. J Am Coll Surg 2002;194:S22-31. Observational-Tx 21 patients getting PTA (32 vessels); 12 patients (15 vessels) getting PTA and stenting To review the results of percutaneous transluminal angioplasty (PTA), stenting, or both in the treatment of patients who present with symptoms and angiographic findings most consistent with chronic mesenteric ischemia. There were 12 men and 21 women with a mean age of 63 years (range 40 to 89 years). Median weight loss was 28 lb (range 6 to 80 lb). Postprandial pain was present in 88% of the patients (29 of 33). All lesions treated were stenoses. PTA alone was performed in 21 patients (32 vessels), and PTA and stenting were performed in 12 patients (15 vessels). PTA was technically successful in 26 of 32 vessels (81.3%); PTA plus stenting was technically successful in 15 of 15 vessels (100%) (p = 0.073). Complete alleviation of symptoms occurred immediately in 27 of the patients (82%), and 2 patients (6%) had significant improvement in symptoms. There were four immediate clinical failures (12%): two patients were found to have occult malignancy and one had immediate relief of symptoms after surgical release of the median arcuate ligament. Followup data were obtained in all patients with clinically successful procedures (mean 38 months, median 25 months, range 1 to 123 months). Angiographic followup was available in 52% of the patients (15 of 29), at a mean of 20 months. The primary longterm clinical success rate was 83.3% (24 of 29). Four of the five patients with recurrent symptoms were successfully retreated with endovascular therapy. The primary assisted longterm clinical success rate was 96.6% (28 of 29). The 5-year survival rate was 76.1%. Major complications occurred in 13% of the procedures, with a 30-day mortality rate of 0%. 2
27. Wang X, Impeduglia T, Dubin Z, Dardik H. Celiac revascularization as a requisite for treating the median arcuate ligament syndrome. Annals of vascular surgery 2008;22:571-4. Review/Other-Tx 1 case To report on a case involving a patient with similar symptoms not only to provide further support for the validity for this syndrome but also to emphasize the critical need for revascularization once pathological changes develop in the celiac artery. No results in abstract. 4
28. Columbo JA, Trus T, Nolan B, et al. Contemporary management of median arcuate ligament syndrome provides early symptom improvement. Journal of Vascular Surgery. 62(1):151-6, 2015 Jul. Observational-Tx 21 patients To examine our contemporary outcomes of patients treated for median arcuate ligament syndrome (MALS). During the study interval, 21 patients (24% male), with a median age of 42 years, were treated for MALS. All patients complained of abdominal pain in the presence of a celiac stenosis, 16 (76%) also reported weight loss at the time of presentation, and 57% had a concomitant psychiatric history. Diagnostic imaging most commonly used included duplex ultrasound (81%), computed tomography angiography (66%), angiography (57%), and magnetic resonance angiography (5%). Fourteen patients (67%) underwent multiple diagnostic studies. All patients underwent initial laparoscopic MAL release. Seven patients (33%) underwent subsequent celiac stent placement in the setting of recurrent or unresolved symptoms with persistent celiac stenosis at a mean interval of 49 days. Two patients required surgical bypass after an endovascular intervention failed. The 6-month freedom from symptoms was 75% and freedom from reintervention was 64%. Eighteen patients (81%) reported early symptom improvement and weight gain, and 66% were able to return to work. 2
29. Ho KKF, Walker P, Smithers BM, et al. Outcome predictors in median arcuate ligament syndrome. J Vasc Surg 2017;65:1745-52. Observational-Tx 43 patients (surgery); 24 patients (without surgery) To identify factors that predict outcomes of surgical and nonoperative treatment in these patients. There were 67 patients, 43 (64%) treated surgically and 24 (36%) managed without surgery, with a median follow-up of 25 months and 24 months, respectively. After surgical treatment, 16 (37%) were asymptomatic, 24 (56%) were partially improved, 3 (7%) had no changes in symptoms, and none had worsening of symptoms. Postexertional pain predicted improvement after surgery (P = .022). Vomiting (P = .046) and unprovoked pain (P = .006) were predictors of poor surgical outcome. After nonoperative management, 1 (4%) was asymptomatic, 7 (29%) were partially improved, 12 (50%) had no changes in symptoms, and 4 (17%) had worsening of symptoms. No outcome predictors of nonoperative treatment were identified. 2
30. Weber JM, Boules M, Fong K, et al. Median Arcuate Ligament Syndrome Is Not a Vascular Disease. Annals of vascular surgery 2016;30:22-7. Observational-Tx 39 patients To report on our continued experience using a laparoscopic approach for the uncommon diagnosis of median arcuate ligament syndrome. A total of 39 patients (33 women and 6 men) underwent laparoscopic MAL release from March 2007 to July 2014. Mean age was 40.6 years (range, 17-77 years). Thirty of 39 patients had a postoperative celiac axis ultrasound. Twenty-three had a patent celiac axis on postoperative duplex. Of the remaining 7, 5 with residual celiac axis stenosis and 1 with occlusion, reported complete resolution of their symptoms. One remaining patient with occlusion remained symptomatic. Thirty-three of 39 (84.6%) reported symptom relief after surgery. Nine of 33 (27.3%) responders had cardiovascular risk factors versus 4 of 6 (67%) nonresponders. Five patients with atypical presentations underwent preoperative diagnostic celiac plexus block using local anesthetic, with 4 reporting symptom reliefs after block. These 4 patients also reported postoperative symptom relief. One patient of 39 received a postoperative celiac stent placement and remained symptomatic. There were 4 conversions to open surgery (10.3%) and no deaths. 3
31. Reilly LM, Ammar AD, Stoney RJ, Ehrenfeld WK. Late results following operative repair for celiac artery compression syndrome. J Vasc Surg. 1985;2(1):79-91. Review/Other-Tx 44 patients Retrospective review of outcomes after operative treatment for celiac artery compression. Celiac revascularization in addition to decompression provided better symptom relief than decompression alone. Authors identified indicators of favorable and unfavorable outcomes. Favorable; postprandial pain, age 40–60, weight loss of = 20lbs. Unfavorable; atypical pain, history of psychiatric disorder or alcohol abuse, age >60, weight loss <20lbs. 4
32. Duran M, Simon F, Ertas N, Schelzig H, Floros N. Open vascular treatment of median arcuate ligament syndrome. BMC Surg 2017;17:95. Observational-Tx 17 patients (division of median arcuate ligament); 14 patients (vascular reconstruction of the celiac artery) To evaluate the central priority of open vascular therapy in the treatment of median arcuate ligament syndrome. In a 20-year period, 31 patients (n = 26 women, n = 5 men) were treated with division of median arcuate ligament (n = 17) or vascular reconstruction in combination with division of median arcuate ligament (n = 14). The mean age of patients was 44.8 ± 15.13 years. The complication rate was 16.1% (n = 5). Revisions were performed in 4 cases. The 30-day mortality rate was 0%. The mean in-hospital stay was 10.7 days. Follow-up data were obtained for 30 patients. The mean follow-up period was 52.2 months (range 2-149 months). Patients were grouped into a decompression group (n = 17) and revascularisation group (n = 13). The estimated Freedom From Symptoms rates were 93.3, 77.8, and 69.1% for the decompression group and 100, 83.3, and 83.3% for the revascularisation group after 12, 24 and 60 months respectively. We found no significant difference in the Freedom From Re-Intervention CA rates of the decompression (100% at 12, 24 and 60 months post-surgery) and revascularisation (100% at 12 months, and 91.7% at 24 and 60 months post-surgery) groups during follow-up (p = 0.26). 2
33. Pillai AK, Kalva SP, Hsu SL, et al. Quality Improvement Guidelines for Mesenteric Angioplasty and Stent Placement for the Treatment of Chronic Mesenteric Ischemia. J Vasc Interv Radiol. 29(5):642-647, 2018 05. Review/Other-Tx N/A To be used in quality-improvement programs to assess mesenteric angioplasty and stent placement procedures. The most important aspects of care that affect quality of the intervention are (i)patient selection, (ii) performance of the procedure, and (iii) follow-up care of the patient. No results provided. 4
34. Goldman MP, Reeve TE, Craven TE, et al. Endovascular Treatment of Chronic Mesenteric Ischemia in the Setting of Occlusive Superior Mesenteric Artery Lesions. Ann Vasc Surg. 38:29-35, 2017 Jan. Observational-Tx CA-only intervention (16 patients); SMA revascularization with or without CA intervention (38 patients) To evaluate anatomic predictors of clinical outcomes associated with endovascular treatment of chronic mesenteric ischemia (CMI) among patients with occlusive superior mesenteric arteries (SMA) lesions. Fifty-four patients with CMI were analyzed. Sixteen (29.6%) patients had CA-only intervention, and 38 (70.4%) patients had SMA revascularization with or without CA intervention. No significant differences in demographics or comorbidity were identified between groups. In the CA-only intervention group, 8 of the 16 (50%) patients developed symptomatic recurrence compared with 8 of the 31 (21.1%) patients whose intervention included the SMA. Patients treated without SMA intervention also had decreased freedom from both symptomatic recurrence (hazard ratio [HR] 3.2, 95% confidence interval [CI] 1.2-8.6, P = 0.016) and repeat intervention (HR 5.5, 95% CI 1.8-16.3, P = 0.001). 2
35. Haben C, Park WM, Bena JF, Parodi FE, Lyden SP. Improving midterm results justify the continued use of bare-metal stents for endovascular therapy for chronic mesenteric ischemia. J Vasc Surg. 71(1):111-120, 2020 01. Observational-Tx 150 patients (intervention on CA or SMA); 38 patients (intervention on both CA and SMA) To evaluate the contemporary results of interventions in the celiac axis (CA) and superior mesenteric artery (SMA) for chronic mesenteric ischemia (CMI) and factors associated with patency and symptom-free survival. From 2003 to 2014, there were 150 patients (39 men, 111 women; age, 70.7 ± 11.1 years) with CMI who underwent interventions on the CA (56 vessels) and the SMA (133 vessels); 38 patients had both CA and SMA intervention. Primary patency for the CA was 86% (95% confidence interval [CI], 73-99) at 1 year and 66% (95% CI, 46-87) 3 years; for the SMA, primary patency was 81% (95% CI, 72-89) at 1 year and 69.0% (95% CI, 58-81) at 3 years. Increased age was associated with improved results in the SMA (hazard ratio [HR], 0.96; 95% CI, 0.92-1.00; P = .028). Chronic total occlusion in the SMA conferred worse patency compared with stenosis (HR, 2.38; 95% CI, 1.03-5.47; P = .042), and younger patients (<70 years) had a higher proportion of SMA occlusion (38.9% vs 22.8; P = .045). In the SMA, comparing early (2003-2008; 68 patients) vs late (2009-2014; 65 patients), primary patency was better in the late experience (3 years, 59% vs 77%; P = .016). The late cohort was older (early, 68.1 ± 12.5 years vs 72.5 ± 9.7 years; P = .024). The late cohort had a higher incidence of ostial flaring of the stent (early, 44.1%; late, 72.3%; P < .001). Multivariable analysis revealed only ostial flaring to be associated with improved patency in the SMA (HR, 0.29; 95% CI, 0.12-0.69; P = .006). 2
36. Zacharias N, Eghbalieh SD, Chang BB, et al. Chronic mesenteric ischemia outcome analysis and predictors of endovascular failure. J Vasc Surg. 63(6):1582-7, 2016 Jun. Observational-Tx 116 patients To identify predictors of endovascular failure. There were 116 patients who were first treated with ER (72%) and 45 patients with OR (28%). Overall mortality was 6.8% (11/161). Among the ER patients, 27 developed restenosis and required OR (23%). Patients treated with ER were older (73 vs 66 years; P = .014), had similar comorbidities, and had higher rate of short lesions (</=2 cm) on preoperative angiograms (23% vs 47%; P = .004). Primary patency at 3 years was higher in the OR group compared with the ER group (91% vs 74%; P = .018). Long-term survival rates were higher in the ER group (95% vs 78%; P = .003). Hospital length of stay and intensive care unit length of stay were shorter in the ER group (<.001). Perioperative mortality (30-day) was not statistically significant between the groups (5.2% vs 11%; P = .165). A subgroup analysis was performed between the patients with successful ER and failure of ER requiring OR. Patients with failure of ER had significantly higher rates of aortic occlusive disease (86% vs 49%; P = .005) and long lesions >/=2 cm on angiography (57% vs 12%; P < .001) that were close to the mesenteric takeoff. Perioperative mortality was higher in the ER failure group (15% vs 2%; P = .009). 2
37. Huber TS, Bjorck M, Chandra A, et al. Chronic mesenteric ischemia: Clinical practice guidelines from the Society for Vascular Surgery. J Vasc Surg. 73(1S):87S-115S, 2021 01. Review/Other-Tx N/A To provide the best possible evidence for the diagnosis and treatment of patients with CMI from atherosclerosis. Patients with symptoms consistent with CMI should undergo an expedited workup, including a computed tomography arteriogram, to exclude other potential causes. The diagnosis is supported by significant arterial occlusive disease in the mesenteric vessels, particularly the superior mesenteric artery. Treatment requires revascularization with the primary target being the superior mesenteric artery. Endovascular revascularization with a balloon-expandable covered intraluminal stent is the recommended initial treatment with open repair reserved for select younger patients and those who are not endovascular candidates. Long-term follow-up and surveillance are recommended after revascularization and for asymptomatic patients with severe mesenteric occlusive disease. Patient with recurrent symptoms after revascularization owing to recurrent stenoses should be treated with an endovascular-first approach, similar to the de novo lesion. 4
38. Lima FV, Kolte D, Kennedy KF, et al. Endovascular Versus Surgical Revascularization for Chronic Mesenteric Ischemia: Insights From the National Inpatient Sample Database. JACC Cardiovasc Interv. 10(23):2440-2447, 2017 12 11. Observational-Tx 3,206 patients (endovascular therapy); 944 patients (surgery) To compare in-hospital major adverse cardiac and cerebrovascular events (MACCE) following endovascular therapy with open surgery for chronic mesenteric ischemia (CMI). Of 4,150 patients with CMI, 3,206 (77.2%) underwent endovascular therapy and 944 (22.8%) underwent surgery (weighted national estimates of 15,850 and 4,687, respectively). In the propensity-matched cohort, MACCE and composite in-hospital complications occurred significantly less often after endovascular therapy than surgery (8.6% vs. 15.9%; p < 0.001; and 15.3% vs. 20.3%; p < 0.006). Endovascular therapy was also associated with lower median hospital costs ($20,807.00 [interquartile range: $13,640.20 to $32.754.50] vs. $31,137.00 [interquartile range: $21,680.40 to $52,152.20]; p < 0.001, respectively) and shorter length of stay (5 [interquartile range: 2 to 10] vs. 10 [interquartile range: 7 to 17] days, respectively; p < 0.001) compared with open surgery. 3
39. Alahdab F, Arwani R, Pasha AK, et al. A systematic review and meta-analysis of endovascular versus open surgical revascularization for chronic mesenteric ischemia. J Vasc Surg 2018;67:1598-605. Meta-analysis 100 observational studies To provide an up-to-date comprehensive evidence synthesis evaluating the two approaches. We included 100 observational studies (22 comparative, 78 noncomparative; 18,726 patients; mean age, 69 years). Open surgery was associated with a statistically significant increase in the risk of in-hospital complications (relative risk [RR], 2.2; 95% confidence interval [CI], 1.8-2.6) and a nonsignificant increase in mortality at 30 days (RR, 1.57; 95% CI, 0.84-2.93). Open surgery was associated with lower risk of 3-year recurrence rates (RR, 0.47; 95% CI, 0.34-0.66) and a similar 3-year survival. Data from noncomparative studies provided similar inferences. The quality of evidence was low. Good
40. Oderich GS, Bower TC, Sullivan TM, Bjarnason H, Cha S, Gloviczki P. Open versus endovascular revascularization for chronic mesenteric ischemia: risk-stratified outcomes. J Vasc Surg 2009;49:1472-9 e3. Observational-Tx 146 patients (treated with OR); 83 patients (treated with ER) To analyze the risk stratified outcomes in patients treated for CMI with open (OR) and endovascular revascularization (ER). The ER patients were significantly older (71 +/- 15 vs 65 +/- 11 years; P < .05), had higher risk (58% vs 31%), and fewer vessels revascularized (1.3 +/- 0.5 vs 1.8 +/- 0.4). Four (2.7%) procedurally related deaths occurred in the OR and two (2.4%) in the ER group (P = NS). Mortality was higher for high-risk patients (OR, 6.7% vs 0.9%; ER, 4.8% vs 0%; P < .05), but differences were not significant among low-risk or high-risk OR vs ER patients. OR patients had more complications (36% vs 18%; P < .001) and longer hospitalization (12 +/- 8 vs 3 +/- 5 days; P < .001). At 5 years, OR had improved (P < .05) recurrence-free survival (89% +/- 4% vs 51% +/- 9%), and primary (88% +/- 3% vs 41% +/- 9%) and secondary patency rates (97% +/- 2% vs 88% +/- 4%). More restenoses (hazard ratio [HR], 5.1; 95% confidence interval [CI], 2.4-10.2), recurrences (HR, 6.7; 95% CI, 3.3-13.8), and reinterventions occurred in the ER group (HR, 4.3; 95% CI, 1.9-9.7). At last follow-up, significant symptom improvement was noted in 137 OR (96%) and 72 ER patients (92%, P = NS). In the subset analysis of patients having first-time operations vs stenting, OR resulted in improved (P < .05) recurrence-free survival (91% +/- 3% vs 56% +/- 8% at 5 years) and better primary and secondary patency rates (93% +/- 2% and 98% +/- 1% vs 52% +/- 8% and 93% +/- 4% at 3 years). 2
41. Yang S, Zhang L, Liu K, et al. Postoperative Catheter-Directed Thrombolysis Versus Systemic Anticoagulation for Acute Superior Mesenteric Venous Thrombosis. Ann Vasc Surg. 35:88-97, 2016 Aug. Observational-Tx 17 patients (group I); 15 patients (group II) To compare the outcomes of ASMVT patients receiving CDT via superior mesenteric artery (SMA) with those who had systemic anticoagulation after emergent laparotomy. Thirty-two patients (20 males, mean age of 44.9 ± 10.6 years) were included, 17 in group I and 15 in group II. No significant differences of demographic data, etiology, baseline value, and perioperative comorbidity were found. The rate of complete thrombus removal was significantly higher in group II than group I (29.4% vs. 80.0%, P = 0.001). The secondlook laparotomy and repeat bowel resection (58.8% vs. 13.3%, P = 0.002) were required in fewer patients in group II (20.0% vs. 70.6%, P = 0.001). The incidence of short-bowel syndrome (SBS; 41.2% vs. 6.7%, P = 0.001) and 30-day mortality (41.2% vs. 6.7%, P = 0.001)were lower in group II. The 1-year survival was also better in group II (52.9% vs. 93.3%, P = 0.014). The incidence of massive abdominal hemorrhage requiring blood transfusion and surgical intervention was 11.8% in group I and 20.0% in group II (P = 0.645). The age, serum D-dimer level, SBS, and postoperative CDT were significant risk factors of 30-day mortality in this study. 3
42. Liu FY, Wang MQ, Fan QS, Duan F, Wang ZJ, Song P. Interventional treatment for symptomatic acute-subacute portal and superior mesenteric vein thrombosis. World J Gastroenterol. 2009;15(40):5028-5034. Review/Other-Tx 46 patients To summarize methods and experience with interventional treatment for symptomatic acute-subacute portal vein and superior MVT. Blood reperfusion of portal vein and superior MVT was achieved completely or partially in 34 patients 3–13 days after thrombolysis. Interventional treatment, including direct or indirect portal vein and superior MVT, is a safe and effective method for patients with symptomatic acute-subacute portal vein and superior MVT. 4
43. Marshad M, Maresch M, Al Abbasi T. Intraoperative catheter directed thrombolytic therapy for the treatment of superior mesenteric and portal Vein thrombosis. Int J Surg Case Rep 2018;53:242-45. Review/Other-Tx 1 patient To present a case of 54 year old male who presented with generalized abdominal pain which was later accompanied by hemodynamic instability and radiological diagnosis of portal vein and superior mesenteric vein thrombosis. No results in abstract. 4
44. Plessier A, Darwish-Murad S, Hernandez-Guerra M, et al. Acute portal vein thrombosis unrelated to cirrhosis: a prospective multicenter follow-up study. Hepatology 2010;51:210-8. Observational-Tx 102 patients To prospectively assess (1) patient characteristics of those presenting with acute PVT unrelated to cirrhosis or malignancy; (2) the incidence and predictive factors of recanalization in patients managed according to recent recommendations; and (3) the incidence of disease- and treatment-related complications. We enrolled 102 patients with acute thrombosis of the portal vein, or its left or right branch. Laboratory investigations for prothrombotic factors were centralized. Thrombus extension and recanalization were assessed by expert radiologists. A local risk factor was identified in 21% of patients, and one or several general prothrombotic conditions in 52%. Anticoagulation was given to 95 patients. After a median of 234 days, the portal vein and its left or right branch were patent in 39% of anticoagulated patients (versus 13% initially), the splenic vein in 80% (versus 57% initially), and the superior mesenteric vein in 73% (versus 42% initially). Failure to recanalize the portal vein was independently related to the presence of ascites (hazard ratio 3.8, 95% confidence interval 1.3-11.1) and an occluded splenic vein (hazard ratio 3.5, 95% confidence interval 1.4-8.9). Gastrointestinal bleeding and intestinal infarction occurred in nine and two patients, respectively. Two patients died from causes unrelated to thrombosis or anticoagulation therapy. 2
45. Benmassaoud A, AlRubaiy L, Yu D, et al. A stepwise thrombolysis regimen in the management of acute portal vein thrombosis in patients with evidence of intestinal ischaemia. Aliment Pharmacol Ther. 50(9):1049-1058, 2019 11. Observational-Tx 22 patients To develop a new standard of care for patients with acute PVT and evidence of intestinal ischaemia. Twenty-two patients were included. The mean age was 44.6 (standard deviation [SD] 16.0) years, and 64% had an identifiable prothrombotic risk factor. All patients had intestinal wall oedema and 77% had complete occlusion of all portomesenteric veins. Systemic thrombolysis was started 18.7 (SD 11.2) days after the onset of symptoms. 55% of patients underwent TIPSS insertion for CDT. At the end of treatment, symptoms resolved in 91% of patients and recanalisation in 86%. Only one patient required resection for intestinal ischaemia, and there were no deaths. Major complications occurred in two patients (9%). 2
46. Yang S, Wu X, Li J. Transcatheter thrombolysis centered stepwise management strategy for acute superior mesenteric venous thrombosis. [Review]. Int J Surg. 12(5):442-51, 2014. Review/Other-Tx N/A To outline the endovascular therapy centered stepwise management strategy of acute superior mesenteric venous thrombosis (ASMVT). N/A 4
47. Hollingshead M, Burke CT, Mauro MA, Weeks SM, Dixon RG, Jaques PF. Transcatheter thrombolytic therapy for acute mesenteric and portal vein thrombosis. J Vasc Interv Radiol. 2005;16(5):651-661. Review/Other-Tx 20 patients Retrospective study to evaluate the utility of transcatheter thrombolytic therapy in patients with acute or subacute (symptoms <40 days) portal and/or MVT with severe symptoms, deteriorating clinical condition, and/or persistent symptoms despite anticoagulation. 15/20 patients showed some degree of lysis of the thrombus. 3 patients had complete resolution, 12 had partial resolution, and 5 patients had no resolution. 85% of patients (n = 17) had resolution of symptoms. 60% of patients (n = 12) developed a major complication. Transcatheter thrombolysis was beneficial in avoiding patient death, resolving thrombus, improving symptoms, and avoiding bowel resection. However, there was a high complication rate, indicating that this therapy should be reserved for patients with severe disease. Further evaluation of these techniques and outcomes should continue to be pursued. 4
48. Rosenqvist K, Eriksson LG, Rorsman F, Sangfelt P, Nyman R. Endovascular treatment of acute and chronic portal vein thrombosis in patients with cirrhotic and non-cirrhotic liver. Acta Radiol. 57(5):572-9, 2016 May. Review/Other-Tx 21 patients To assess the safety and efficiency of endovascular treatment of acute and chronic PVT in patients with cirrhotic and non-cirrhotic liver. Four non-cirrhotic patients with acute extensive PVT and bowel ischemia were treated with local thrombolysis, in three combined with placement of a transjugular intrahepatic portosystemic shunt (TIPS) placement. Three recovered and have survived more than 6 years. In six non-cirrhotic patients with chronic PVT and acute or threatening variceal bleeding recanalization and TIPS were successful in three and failed in three. Eleven cirrhotic patients with PVT and variceal bleeding or refractory ascites were successfully treated with recanalization and TIPS. Re-intervention was performed in five of these patients and five patients died, three within 12 months of intervention. Four cirrhotic patients had episodes of shunt-related encephalopathy and three had variceal re-bleeding. 4
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