Objectives: Acute mesenteric ischemia (AMI) is a life-threatening disease with high morbidity and mortality. In COVID-19 patients, the incidence of AMI is not yet fully known. The exact pathological mechanism leading to AMI in COVID-19 patients is not well understood at present. Systemic reactions and hypercoagulability play a role in this situation. Aim of this study was to study the results of acute vascular surgical reconstruction for AMI in acute COVID-19 infection.
Methods: Data on all consecutive COVID-19 patients undergoing mesenteric revascularization for AMI at a tertiary university center between April 2020 and December 2021 were collected prospectively in a dedicated database and compared to data in non-COVID-19 patients treated for AMI.
Results: In a total of 12 patients (8 men, 4 women, age 39-84 years, mean age 69.2 + 12.6 years) the diagnosis of AMI was established by CT angiography. 11 patients underwent thrombembolectomy of the superior mesenteric artery, in 2 cases with closure of the arteriotomy using a venous patch. In one patient primary aortomesenteric bypass surgery was performed. Additional bowel resection at time of primary revascularization was necessary in 2 patients. Second-look relaparotomy was performed in 4 patients with secondary bowel resection in 2 patients. In one patient, additional aortomesenteric bypass surgery was required at postoperative day 1. 5 patients (2 women, 3 men) were tested positive for COVID-19 by PCR perioperatively. In-hospital mortality was 14% in non-COVID and 60% in COVID-19 patients. All deaths occurred in the later postoperative period between day 21 and 38 due to multi organ failure. After a mean follow-up of 8 months (range 1-19 months), 8 patients are alive (2 COVID-19 patients post 1 and 14 months). Limitation of the study is the lack of information regarding patients with AMI who underwent explorative or therapeutic laparotomy without involvement of a vascular surgeon.
Conclusions: Acute mesenteric ischemia is a severe complication in COVID-19 patients with high morbidity and mortality. Literature reports on 100% mortality in COVID-19 patients undergoing conservative treatment. However, successful surgical revascularization and patient recovery is possible. In this patient group 40% of COVID-19 patients survived and were discharged home, If the patient´s condition permits, early CT-Angiography to diagnose AMI, and open surgical treatment for acute mesenteric ischemia as well as generous indication for second-look laparotomy in COVID-19 patients is recommended.
