Nonocclusive Mesenteric Ischemia in Aortic Surgery: What You Need to Know

Abstract

Background

Nonocclusive mesenteric ischemia (NOMI), a subtype of acute mesenteric ischemia (AMI), is primarily caused by mesenteric arterial vasoconstriction and decreased vascular resistance, leading to impaired intestinal perfusion.Commonly observed after cardiac surgery, NOMI affects older patients with cardiovascular or systemic diseases, accounting for 20–30% of AMI cases with a mortality rate of ∼50%. This review explores NOMI's pathophysiology, clinical implications in aortic dissection, and the unmet needs in diagnosis and management, emphasizing its prognostic significance.

Methods

A comprehensive literature review was conducted using multiple electronic databases to extract relevant data and information.

Results

NOMI is a life-threatening condition characterized by mesenteric vasoconstriction and reduced splanchnic blood flow, often triggered by cardiac surgery, hemodialysis, or hypotensive episodes. Epidemiological studies highlight its prevalence in intensive care unit settings, with a high mortality rate linked to delayed diagnosis and systemic hypoperfusion. Risk factors include advanced age, vasopressor use, and inflammatory markers. Biomarkers such as intestinal fatty acid binding protein, citrulline, and D-lactate show potential for early detection but lack robust clinical validation. Management includes fluid resuscitation, vasodilators, and surgical intervention for bowel necrosis. Emerging endovascular approaches show promise but are limited to select cases without bowel infarction. This review underscores the critical need for timely diagnosis, risk factor identification, and tailored interventions to improve outcomes.

Conclusion

NOMI remains poorly understood despite advances in surgical and perioperative care. Its pathophysiology, linked to cardiopulmonary bypass and intraoperative factors, requires heightened clinical vigilance. Limited evidence underscores the need for a multidisciplinary approach involving surgeons, radiologists, and anesthetists to improve diagnosis, management, and outcomes in aortic surgery patients.