(PC180) Time is Intestine: The Impact of Timely Intervention on Acute Mesenteric Ischemia Outcomes

Objectives: Acute mesenteric ischemia (AMI) is a highly morbid presentation associated with high peri-operative mortality. Early diagnosis and prompt surgical revascularization are pivotal in reducing mortality and morbidity rates. This study investigates the impact of time from symptom onset to operative intervention in outcome determination in AMI patients.

Methods: A single-center retrospective review of all patients who underwent revascularization for AMI at a quaternary medical center between 2014-2024 was performed. AMI was defined as acute symptom onset of ≤2 weeks duration. Patients with AMI secondary to aortic dissection were excluded. The optimal time threshold from symptom onset to intervention to achieve optimal outcomes was determined using Receiver Operating Characteristic curves and the Youden index. Kaplan Meier and Cox-regression analysis were used to evaluate the long-term outcomes of survival, primary patency, re-intervention, and AMI recurrence.

Results: A total of 92 patients (35 males, 57 females) with a mean age of 67 years were included. Surgical interventions included open revascularization in 30% of patients, endovascular revascularization in 60%, and retrograde open mesenteric stenting (ROMS) in 10%. The median time from symptom onset to intervention was 48 hours. Demographics and baseline characteristics were similar between patients treated within 48 hours and those treated >48 hours from acute symptom onset (Table 1). Overall mortality was 24% at 30 days and 33% at one year. Patients undergoing revascularization >48 hours after acute symptom onset were more likely to be transferred from an outside hospital (76% vs 55%, p=0.04), required greater bowel resection (97 cm vs 25 cm, p=0.013), and had higher 30-day mortality (38% vs 14%, p=0.010). One-year mortality was also higher in the patient population undergoing intervention >48 hours from symptom onset (45% vs 23%, p=0.033) (Figure 1). Multivariate analysis revealed a 15% increase in the risk of 30-day mortality for each day of delayed intervention (OR 1.15, 95% CI 1.02-1.29, p=0.019).

Conclusions: Early recognition and prompt intervention are crucial in managing AMI and improving survival rates. The time to revascularization is an important factor which, when prolonged, leads to increased bowel loss, and higher short- and long-term mortality. Strategies to expedite diagnosis and treatment are needed to improve survival and recovery in patients with AMI.