Retrograde Open Mesenteric Stenting Is Associated With Superior Outcomes for Acute Mesenteric Ischemia

Data regarding retrograde open mesenteric stenting (ROMS) for acute mesenteric ischemia is limited. Outcomes of patients with acute mesenteric ischemia requiring emergency surgical intervention were evaluated. Retrospective cohort study of patients with mesenteric ischemia requiring an emergency procedure was queried from the National Inpatient Sample database (2018-2020). International Classification of Diseases, 10th edition, diagnosis and procedure codes were used. Groups were open bypass (BYPASS), open superior mesenteric artery embolectomy (EMBO), and ROMS. We utilized t tests, χ2 tests, and multivariate regression. A total of 898 patients with acute mesenteric ischemia were included: 284 underwent BYPASS, 363 EMBO, and 251 ROMS. There were no significant differences in gender or race among groups. Patients undergoing ROMS were more likely to be older (70.2 years vs BYPASS 66.8 years and EMBO 67.2 years; P = .004) and had a higher Charlson Comorbidity Index (2.9 vs 2.5 BYPASS and 2.6 EMBO; P = .029). ROMS had the lowest mortality (15.9% vs BYPASS 19.7%, and EMBO 34.5%; P < .0001). ROMS was associated with decreased length of stay and lower hospital charges (P < .0001 and P = .0004, respectively). Multivariate regression demonstrated that ROMS was associated with a greater than 50% reduction in mortality (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.26-0.71; P < .0001). Open SMA embolectomy was associated with increased mortality (OR, 2.0; 95% CI 1.33-3.01; P < .001). Myocardial infarction was associated with mortality (OR 2.21; 95% CI, 1.17-4.18; P = .01) (Table). ROMS was associated with a significant mortality and hospital utilization benefit compared with other procedures for patients with acute mesenteric ischemia. Advanced age, myocardial infarction, and open SMA embolectomy were associated with increased risk of mortality. ROMS may offer greater revascularization in the emergency setting compared with embolectomy alone. These data support further evaluation for ROMS as the procedure of choice for the management of acute mesenteric ischemia in the emergency setting.TableLogistic regression model for mortality in patients undergoing open emergency superior mesenteric artery interventionCharacteristicOR95% CIP valueRace WhiteRef Black1.140.66-1.99.8158 Hispanic1.130.64-2.02.8538Sex MaleRef Female0.800.56-1.14.2074Procedure BypassRef Open SMA embolectomy2.001.33-3.01<.0001 ROMS0.430.26-0.71<.0001Myocardial infarction2.211.17-4.18.0142Charlson Comorbidity Index1.050.95-1.15.3305Age1.031.01-1.04.0003Length of stay0.930.91-0.95<.0001CI, Confidence interval; MI, myocardial infarction; OR, odds ratio; ROMS, retrograde open mesenteric stenting; SMA, superior mesenteric artery. Open table in a new tab