To compare pre- and post-therapy dosimetry in association with clinical outcomes in a large cohort of hepatocellular carcinoma treated with yttrium 90 (90Y) labelled resin-microspheres. This was a retrospective study from a single centre of data collected (146 patients) between March 2015 and October 2019. Pre-therapeutic tumour-absorbed doses was computed using technetium 99m (99mTc) macroaggregated human albumin SPECT/CT. Post therapeutic tumour-absorbed dose was computed using 90Y PET/CT. The mRECIST response criteria at 6 months was correlated to the tumour-absorbed doses by receiver-operator-curve (ROC) analysis and disease control probability modelling. Overall survival was stratified according to the results of the ROC analysis. One hundred and fourteen (114) patients (median age 67.5, 89 men) were evaluated in the study. Objective response was observed in 40

OBJECTIVE:To report the 3-year experience of endovascular revascularization of acute arterial mesenteric ischemia (AMI) from an intestinal stroke center unit (ISCU).METHOD:All data from patients admitted to the ISCU between January 2016 and January 2019 for arterial AMI who underwent endovascular recanalization were prospectively acquired and retrospectively analyzed. Patient demographics, clinical and laboratory characteristics at presentation, and CT scans were reviewed. The type (thrombolysis, thrombectomy, stenting) and the outcome of endovascular procedures (technical success or failure, complications) were noted. Care pathways were described focusing on post-procedural treatments (surgical revascularization, bowel resection) and the mortality rate was evaluated in subgroups.RESULTS:Fifty-eight patients (34 men [59%], mean 69 ± 29 years) were included. Endovascular revascularization was technically successful in 51/58 (88%) patients, and 10 (17%) patients had post-procedural complications. Stenting and in situ thrombolysis were performed in most patients (n = 33 and n = 19, respectively). Thirty-two patients (55%) were recurrence-free and required no further treatment after the procedure, while 9 (16%), 5 (9%), and 5 (9%) patients underwent 2nd-line bowel resection, surgical revascularization, or both. Overall, 46 (79%), 45 (78%), and 34 patients (63%) were alive at 3 months, 1 year, and 3 years. No significant difference in survival was found in care pathways or baseline characteristics.CONCLUSION:Endovascular revascularization is highly feasible for the treatment of arterial AMI, and is associated with an acceptable rate of complications. Results of endovascular revascularization shall only be interpreted as part of a multidisciplinary patient management strategy.KEY POINTS:• Endovascular revascularization is highly feasible for the treatment of arterial AMI, and is associated with an acceptable rate of complications. • Several techniques are available to perform endovascular revascularization, and their use depends on the cause, the location, and the quality of underlying arteries of patients. • Results of endovascular revascularization shall only be interpreted in relation to its role in an integrated multidisciplinary and patient management strategy.

A Correction to this paper has been published: https://doi.org/10.1007/s00330-020-07506-0

AbstractBackgroundTo evaluate the predictive value of the lipiodol retention pattern for local progression of HCC with a complete response (CR) on CT according to mRECIST criteria after a first session of conventional chemoembolization (cTACE).MethodsFrom January 2014 to May 2016 all consecutive patients undergoing a first cTACE session for HCC were identified. Inclusion criteria were the presence of ≤3 HCCs and available pre- and post-cTACE CT. Tumor response was classified according to mRECIST criteria. The analysis focused on tumors with a CR. The lipiodol retention pattern in these tumors was classified as complete (C-Lip, covering the entire tumor volume), or incomplete (I-Lip). Local progression was defined as the reappearance of areas of enhancement on arterial-phase images with washout on portal/delayed phase images within 2 cm from treated tumors on follow-up CT.ResultsThe final population included 50 patients with 82 HCCs. A total of 46 (56%) HCCs were classified with a CR, including 16 (35%) with I-Lip, and 30 (65%) with C-Lip. After a median follow-up of 14 months (3.2–35.9 months), 15/16 (94%) and 10/30 (30%) of I-Lip and C-Lip HCCs showed local progression on CT, respectively (p < 0.001), with no significant difference in the time to progression (mean 11.1 ± 2 vs. 13.4 ± 3 months for I-Lip and C-Lip, respectivelyp = 0.51).ConclusionsHCCs with incomplete lipiodol retention after a first cTACE session have a high risk of local progression even when there is a CR according to mRECIST, and should be considered to be incompletely treated.

Type 1 Gaucher disease is a rare genetic lysosomal disorder due to acid betaglucosidase deficiency. The main features are thrombocytopenia, anemia, hepatosplenomegaly and complex skeletal disease. Complications include pulmonary hypertension, cirrhosis and splenic infarction; comorbidities, such as autoimmune phenomena, B-cell malignancies and Parkinson disease also occur. Visceral aneurysms have been only rarely noted in Gaucher disease. We report the retrospective data from patients with Gaucher disease type 1 and splenic arterial aneurysm. We describe the different outcomes of a giant splenic arterial aneurysm in five patients with type 1 Gaucher disease and discuss the main possible pathophysiological explanations. Aneurysms of the splenic artery are rare in Gaucher disease but are probably greatly under-reported.

To assess the impact of recently developed respiratory motion correction software on contrast-enhanced cone beam CT angiography (CBCT-a) for intraprocedural image guidance during intra-arterial liver-directed therapy.

Purpose To evaluate the long-term safety, technical success, and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in a series of patients with Budd-Chiari syndrome (BCS), and to determine the predictors of shunt dysfunction. Materials and Methods From 2004 to 2013, all patients with primary BCS referred for TIPS placement were included in the study. The primary and secondary technical success rates and the number and types of early (ie, before day 7) complications were noted. Factors associated with dysfunction were analyzed with uni- and multivariate analyses. Survival was analyzed with Kaplan-Meier curves. Results Fifty-four patients (34 women [63%]; mean age, 36 years ± 12 [standard deviation]) were included. Twenty-eight patients (52%) had myeloproliferative neoplasms. The mean Model for End-Stage Liver Disease score was 14.5 ± 4. The most frequent indication for TIPS was refractory ascites (50 of 54; 93%). Primary and secondary technical success rates were 93% and 98%, respectively. Early complications occurred in 17 patients (32%). After a mean follow-up of 56 months ± 41 (interquartile range, 22-92), 22 patients (42%) experienced at least one episode of TIPS dysfunction (median delay between administration of TIPS and first episode of dysfunction, 10.8 months). Cumulative 1-, 2-, 3-, 5-, and 10-year primary patency rates were 64%, 59%, 54%, 45%, and 45%, respectively. Dysfunction was associated with a myeloproliferative neoplasm (hazard ratio, 8.18; 95% confidence interval: 1.45, 46.18; P = .017), more than two initial stents (hazard ratio, 3.90; 95% confidence interval:1.16, 13.10; P = .027), and the occurrence of early complications (hazard ratio, 11.34; 95% confidence interval: 1.82, 70.69; P = .009). The 10-year survival rate was 76%. Conclusion TIPS placement in patients with chronic primary BCS was associated with a nonnegligible rate of early complications and required endovascular revision or revisions in 42% of patients. Nevertheless, secondary patency was close to 100%, and long-term survival was good. © RSNA, 2016 Online supplemental material is available for this article.

Background Sorafenib is the recommended treatment for patients with advanced hepatocellular carcinoma. We aimed to compare the efficacy and safety of sorafenib to that of selective internal radiotherapy (SIRT) with yttrium-90 (Y-90) resin microspheres in patients with hepatocellular carcinoma. Methods SARAH was a multicentre, open-label, randomised, controlled, investigator-initiated, phase 3 trial done at 25 centres specialising in liver diseases in France. Patients were eligible if they were aged at least 18 years with a life expectancy greater than 3 months, had an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1, Child-Pugh liver function class A or B score of 7 or lower, and locally advanced hepatocellular carcinoma (Barcelona Clinic Liver Cancer [BCLC] stage C), or new hepatocellular carcinoma not eligible for surgical resection, liver transplantation, or thermal ablation after a previously cured hepatocellular carcinoma (cured by surgery or thermoablative therapy), or hepatocellular carcinoma with two unsuccessful rounds of transarterial chemoembolisation. Patients were randomly assigned (1:1) by a permutated block method with block sizes two and four to receive continuous oral sorafenib (400 mg twice daily) or SIRT with Y-90-loaded resin microspheres 2-5 weeks after randomisation. Patients were stratified according to randomising centre, ECOG performance status, previous transarterial chemoembolisation, and presence of macroscopic vascular invasion. The primary endpoint was overall survival. Analyses were done on the intention-to-treat population; safety was assessed in all patients who received at least one dose of sorafenib or underwent at least one of the SIRT work-up exams. This study has been completed and the final results are reported here. The trial is registered with ClinicalTrials. gov, number NCT01482442. Findings Between Dec 5, 2011, and March 12, 2015, 467 patients were randomly assigned; after eight patients withdrew consent, 237 were assigned to SIRT and 222 to sorafenib. In the SIRT group, 53 (22%) of 237 patients did not receive SIRT; 26 (49%) of these 53 patients were treated with sorafenib. Median follow-up was 27.9 months (IQR 21.9-33.6) in the SIRT group and 28.1 months (20.0-35.3) in the sorafenib group. Median overall survival was 8.0 months (95% CI 6.7-9.9) in the SIRT group versus 9.9 months (8.7-11.4) in the sorafenib group (hazard ratio 1.15 [95% CI 0.94-1.41] for SIRT vs sorafenib; p=0.18). In the safety population, at least one serious adverse event was reported in 174 (77%) of 226 patients in the SIRT group and in 176 (82%) of 216 in the sorafenib group. The most frequent grade 3 or worse treatment-related adverse events were fatigue (20 [9%] vs 41 [19%]), liver dysfunction (25 [11%] vs 27 [13%]), increased laboratory liver values (20 [9%] vs 16 [7%]), haematological abnormalities (23 [10%] vs 30 [14%]), diarrhoea (three [1%] vs 30 [14%]), abdominal pain (six [3%] vs 14 [6%]), increased creatinine (four [2%] vs 12 [6%]), and hand-foot skin reaction (one [<1%] vs 12 [6%]). 19 deaths in the SIRT group and 12 in the sorafenib group were deemed to be treatment related. Interpretation In patients with locally advanced or intermediate-stage hepatocellular carcinoma after unsuccessful transarterial chemoembolisation, overall survival did not significantly differ between the two groups. Quality of life and tolerance might help when choosing between the two treatments.

Background: Sorafenib is the recommended treatment for advanced hepatocellular carcinoma (HCC) but dose-limiting toxicity prevents optimal treatment in a considerable proportion of patients. Large cohort studies have indicated potential efficacy of selective internal radiation therapy (SIRT) with yttrium-90 (Y-90) resin microspheres in intermediate and advanced HCC and therefore the SARAH trial was initiated to directly compare the efficacy and safety of SIRT with sorafenib. Method: SARAH was a randomised, controlled, open-label, multicentre, investigator-initiated, phase III trial. Adult patients with locally advanced or recurrent HCC, not amenable to other treatments or after 2 failed rounds of chemoembolisation, were randomised 1:1 to SIRT with Y-90 resin microspheres (SIR-Spheres; Sirtex, North Sydney, Australia) or oral sorafenib 400 mg bid. The primary endpoint was overall survival (OS; Kaplan-Meier analysis). Secondary endpoints included progression-free survival (PFS; Kaplan-Meier analysis), time to radiological progression at any site and in the liver as the first event (competing risk analysis), tumour response, adverse event (AE) rates and quality of life (QoL) measured with the global health status sub-score of the QLQ-C30. Results: Of 459 patients randomised (237 received SIRT; 222 received sorafenib), 67.8% had advanced HCC, 43.6% had chemoembolisation failure and 60.3% had macrovascular invasion, with 33.3% of these having main portal vein involvement. There were no clinically relevant differences between treatment groups at baseline. In the intention-to-treat (ITT) analysis, median OS was 8.0 months and 9.9 months in the SIRT and sorafenib groups, respectively (HR, 1.15; 95% CI, 0.94–1.41; p = 0.18). In the population of 174 SIRT and 206 sorafenib patients that received treatment per protocol (PP), median OS was 9.9 months in both groups (HR, 0.99; 95% CI 0.79–1.24; p = 0.92). Median PFS in the ITT analysis was 4.1 months and 3.7 months in the SIRT and sorafenib groups, respectively (HR, 1.03; 95% CI, 0.85-1.25; p = 0.76). Cumulative incidence of radiological progression in the liver as first event was significantly lower in the SIRT than in the sorafenib group (ITT HR, 0.72; 95% CI, 0.56-0.93; p = 0.014). Objective response rate (complete response or partial response) was significantly higher in the SIRT than in the sorafenib group (19.0% vs. 11.6%, p = 0.042). The number of patients with ≥1 treatment-related AE was 173 (76.5%) and 203 (94.0%; p < 0.001), including 92 (40.7%) and 136 (63.0%) grade ≥3 AEs (p < 0.001) in the SIRT and sorafenib groups, respectively. QoL was significantly better in the SIRT than in the sorafenib group (group effect p = 0.005; time effect p < 0.001), and the between-group difference tended to increase with time (group-time interaction p = 0.045). Conclusions: OS was not statistically different between sorafenib and SIRT in patients with locally advanced or recurrent HCC. However, liver-directed SIRT was significantly more effective than daily sorafenib systemic treatment in controlling tumour progression in the liver, provides a better tumour response rate, produced fewer treatment-related adverse events, and maintained a better QoL over the first 12 months of treatment.

BACKGROUND AND OBJECTIVES:Without prompt superior mesenteric artery (SMA) revascularization, acute mesenteric ischemia (AMI) frequently leads to death or short bowel syndrome (SBS). In SBS patients, persistent or chronic intestinal ischemia (PII) of the remnant bowel can lead to recurrences of AMI. Since SMA revascularization is sometimes unfeasible, celiac artery (CA) revascularization may improve blood supply to the remnant bowel. The aim of this study was to describe and to assess our experience of the CA revascularization in case of SMA occlusion unsuitable for revascularization in the setting of PII in SBS patients. METHODS:All consecutive patients with i) SBS consecutive to AMI, ii) persistent intestinal ischemia (PII), iii) irreversible SMA occlusion, i.e unsuitable for radiological or surgical revascularization and iv) occlusion or severe stenosis of the CA were included. RESULTS:Thirteen patients (7 males/6 females, mean age = 47.2 ± 12.1 years) were included. The mean length of remnant small bowel was 47 ± 39 cm and 77% of patients had a stoma. The types of revascularization included anterograde aorto-hepatic bypass n = 11 (84%), ilio-hepatic bypass n = 1 (8%) and endarterectomy n = 1 (8%). Major adverse events were observed in 5 cases: bypass graft infection (n = 2), hemorrhagic pericarditis (n = 2), hemorrhagic shock (n = 2) and aortic false aneurysm (n = 1). After a mean follow-up of 27.0 ± 25.2 months, symptoms of PII relieved in 12 cases (92%) allowing for digestive surgical rehabilitation with continuity restoration in 7 patients (54%). PN was weaned for 2 patients. One-year and 3-year survival rates were 73.8% and 73.8% respectively. No recurrence of AMI or further need for bowel resection was noticed. CONCLUSION:For patients with SBS suffering from PII with CA occlusion or stenosis without possibility of SMA revascularization, the surgical revascularization of the CA allowed digestive rehabilitation with acceptable morbidity and mortality rates.

Introduction: One of the major cause of chronic intestinal failure in adults is short bowel syndrome due to acute intestinal ischemic injury (i3). We previously showed that acute i3 could be reversible allowing to avoid intestinal resection (1,2). On January 4th, 2016, the Assistance Publique-Hopitaux de Paris institution created an Intestinal Stroke Center (so called SURVI i.e Structure d’URgences Vasculaires Intestinales). This unique structure offers to patients with intestinal ischemic injuries a dedicated multidisciplinary management focusing on intestinal viability. The aim of this study was to describe the results of this management after one year. Methods: The Intestinal Stroke Center includes an intensive care unit specialized in acute intestinal failure and i3, under the supervision of gastroenterologists. The multimodal and multidisciplinary strategy aimed at targeting intestinal viability and combines a pathophysiological-based medical protocol, a decisional algorithm for radiological and/or surgical arterial revascularization and/or digestive surgery (1, 2). Results: From 04 January to 31 December 2016, 124 patients (mean age 63 years), were admitted to SURVI and prospectively followed. At the admission i was acute and/or chronic in 91 and 45 cases, respectively. The origin of i3 was arterial, venous or both in 104, 19, and 1 case, respectively. Arterial causes were athero-thrombotic (n = 70), embolic (n = 12), dissection (n = 10) or other mechanism (n =12). Revascularization was performed in 54 cases, surgically (n = 25), radiologically (n = 33) or both (n = 5). Intestinal resection (n = 47, 38%) was performed before and/or after admission to SURVI in 26 (21%) and 34 (27%) patients, leading to short bowel syndrome in 31 patients (25%). Intestinal failure requiring parenteral nutrition was observed in 23 patients (18%) and in 14 (15%) acute i3patients. Overall survival and survival of acute i3 patients were 87% and 86% respectively, with a median follow-up of 166 (0–374) days. Conclusion: The management of intestinal ischemic injuries in a dedicated Intestinal Stroke Center allows to reduce mortality and intestinal resection rates to less than 20% and 30%, respectively. The management of intestinal failure should integrate a prevention strategy to avoid large intestinal resection. SURVI could serve as a model for comparable care centers in other regions or countries to improve the global prognosis of intestinal ischemia. MSD Avenir. References: 1. Nuzzo A, Corcos O. Reversible Acute Mesenteric Ischemia. New England Journal of Medicine. 2016 Oct 13;375(15):e31. 2. Corcos O, Castier Y, Sibert A, Gaujoux S, Ronot M, Joly F, et al. Effects of a multimodal management strategy for acute mesenteric ischemia on survival and intestinal failure. Clin Gastroenterol Hepatol. 2013;11:158–65.e2.

On January 4th, 2016, a Structure of Intestinal Vascular Emergencies (SURVI) was opened for the Paris Hospitals which offers to the patients presenting intestinal ischemia (II) a dedicated multidisciplinary management. The aim of this study was to describe the results of this management one year after the opening.

BACKGROUND & AIMS:Post-procedural pain is frequent after transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC), and is only partially prevented by treatment selectivity. Our aim was to determine the risk factors of severe pain after selective TACE for HCC. METHODS:From January 2012 to June 2014, all treatment-naïve patients undergoing a first selective TACE were included. Risk factors for severe pain, that is, the need for opioid analgesics (grade II-III), were identified by uni- and multivariate analysis. Internal validation of a logistic regression model for prediction of opioid intake was done with bootstrapping. RESULTS:We analysed 335 tumours (mean 47 ± 37 mm) in 159 patients (131 men), mean 63.4 years old (20-92). Twenty-seven patients (17%) requested opioids. In univariate analysis, opioid intake was associated with young age (P=.021), doxorubicin dose received (P=.031), large HCC (P=.038), absence of chronic liver disease (P<.001) and alpha-foetoprotein levels (P=.03). In multivariate analysis, opioid intake was associated with young age (OR=0.65 per 10 years increment, P=.048), absence of chronic liver disease (OR=31.7, P<.001) and a higher fraction of the doxorubicin dose (OR=1.32 per 10% increment, P=.009). The optimism-corrected area under the curve of the prediction model for opioid intake using these three factors was 0.751. CONCLUSION:In patients with HCC treated with TACE, selective procedure does not always prevent from severe pain. Young patients without chronic liver disease may be more susceptible to severe pain.

Idiopathic noncirrhotic portal hypertension is a heterogeneous group of diseases characterized by portal hypertension in the absence of cirrhosis. The efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) in this population are unknown. The charts of patients with idiopathic noncirrhotic portal hypertension undergoing TIPS in seven centers between 2000 and 2014 were retrospectively reviewed. Forty-one patients were included. Indications for TIPS were recurrent variceal bleeding (n=25) and refractory ascites (n=16). Patients were categorized according to the presence (n=27) or absence (n=14) of significant extrahepatic comorbidities. Associated conditions were hematologic, prothrombotic, neoplastic, immune, and exposure to toxins. During follow-up (mean 27 +/- 29 months), variceal rebleeding occurred in 7/25 (28%), including three with early thrombosis of the stent. Post-TIPS overt hepatic encephalopathy was present in 14 patients (34%). Eleven patients died, five due the liver disease or complications of the procedure and six because of the associated comorbidities. The procedure was complicated by hemoperitoneum in four patients (10%), which was fatal in one case. Serum creatinine (P=0.005), ascites as indication for TIPS (P=0.04), and the presence of significant comorbidities (P=0.01) at the time of the procedure were associated with death. Mortality was higher in patients with significant comorbidities and creatinine >100 mu mol/L (P < 0.001). Conclusion: In patients with idiopathic noncirrhotic portal hypertension who have normal kidney function or do not have severe extrahepatic conditions, TIPS is an excellent option to treat severe complications of portal hypertension.

AIM:To investigate the feasibility and accuracy of cone beam computed tomography (CBCT) in assessing the ablation zone after liver tumor ablation.METHODS:Twenty-three patients (17 men and 6 women, range: 45-85 years old, mean age 65 years) with malignant liver tumors underwent ultrasound-guided percutaneous tumor ablation [radiofrequency (n = 14), microwave (n = 9)] followed by intravenous contrast-enhanced CBCT. Baseline multidetector computed tomography (MDCT) and peri-procedural CBCT images were compared. CBCT image quality was assessed as poor, good, or excellent. Image fusion was performed to assess tumor coverage, and quality of fusion was rated as bad, good, or excellent. Ablation zone volumes on peri-procedural CBCT and post-procedural MDCT were compared using the non-parametric paired Wilcoxon t-test.RESULTS:Rate of primary ablation effectiveness was 100%. There were no complications related to ablation. Local tumor recurrence and new liver tumors were found 3 mo after initial treatment in one patient (4%). The ablation zone was identified in 21/23 (91.3%) patients on CBCT. The fusion of baseline MDCT and peri-procedural CBCT images was feasible in all patients and showed satisfactory tumor coverage (at least 5-mm margin). CBCT image quality was poor, good, and excellent in 2 (9%), 8 (35%), and 13 (56%), patients respectively. Registration quality between peri-procedural CBCT and post-procedural MDCT images was good to excellent in 17/23 (74%) patients. The median ablation volume on peri-procedural CBCT and post-procedural MDCT was 30 cm(3) (range: 4-95 cm(3)) and 30 cm(3) (range: 4-124 cm(3)), respectively (P-value > 0.2). There was a good correlation (r = 0.79) between the volumes of the two techniques.CONCLUSION:Contrast-enhanced CBCT after tumor ablation of the liver allows early assessment of the ablation zone.

The presence of liver metastases (LM) in neuroendocrine tumors (NET) is a major factor altering both quality of life and prognosis. Surgery is recognized as the sole curative treatment. When it is not possible, radiological directed therapies are crucial. This chapter addresses the various roles, technical issues, clinical efficacy and safety of thermal ablation (radiofrequency, microwave, and cryotherapy), and transarterial embolization (bland embolization, chemoembolization, and radioembolization) as liver-directed therapies. The choice of management depends on liver burden and metastases pattern, but also on origin of the primary tumor, tumor differentiation, and tumor proliferative activity. The treatment for neuroendocrine LM still needs to be standardized. Management in centers of expertise should be strongly encouraged in order to enable a multidisciplinary approach to limit morbidity and mortality.

The present report describes a mesenteric fistula involving the proximal branches of the superior mesenteric artery (SMA) associated with venous ectasia in a patient with cirrhosis, which was successfully managed by a combined transarterial and transhepatic portal venous approach. This report was approved by the local institutional review board.

Objective: Arterial acute mesenteric ischemia (AAMI) is a vascular and gastroenterologic emergency, most often surgical, still associated with a poor prognosis and frequent short bowel syndrome in survivors. We report the results of revascularization in AAMI patients after the creation of an intestinal stroke center.Methods: Since July 2009, we developed a multimodal and multidisciplinary management for AMI, focusing on intestinal viability and involving gastroenterologists, vascular and abdominal surgeons, radiologists, and intensive care specialists. This management was the first step to the creation of an intestinal stroke center, based on the stroke unit model. All patients received: (1) a specific medical protocol; (2) endovascular and/or open surgical revascularization whenever possible; and/or (3) resection of non-viable small bowel. We aimed to study survival, morbidity, type of revascularization, and bowel resection in patients who benefited from arterial revascularization in our intestinal stroke center.Results: Eighty-three patients with AMI were prospectively enrolled in the intestinal stroke center. Among them, 29 patients with AAMI underwent revascularization. The mean age was 50.2 +/- 12 years, with 41% of male gender. The mean follow-up was 22.7 +/- 19 months. Overall 2-year survival was 89.2%, and 30-day operative mortality was 6.9%. Surgical revascularization included bypass grafting (65%), endarterectomy with patch angioplasty (21%) 6 retrograde open mesenteric stenting of the superior mesenteric artery (7%), and endovascular revascularization as first stage procedure (38%). The 2-year primary patency rate of open revascularization was 88%. The rate and the median length of bowel resected were 24% and 43 cm (range, 36-49 cm), respectively.Conclusions: In our experience, revascularization of AAMI patients as part of a multidisciplinary and multimodal management leads to encouraging results. Vascular surgeons have a central role in a dedicated intestinal stroke center.