{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T03:39:43Z","timestamp":1793417983066,"version":"4.5.0"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2020,5,22]],"date-time":"2020-05-22T00:00:00Z","timestamp":1590105600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,5,22]],"date-time":"2020-05-22T00:00:00Z","timestamp":1590105600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Cardiovasc Intervent Radiol"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To investigate the outcome of local intra-arterial papaverine infusion therapy in patients with non-occlusive mesenteric ischemia (NOMI), and factors influencing survival, in comparison with a conservative approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      From 2013 to 2019\n                      <jats:italic>,<\/jats:italic>\n                      patients with NOMI confirmed by imaging were included in a retrospective two-center study. According to different in-house standard procedures, patients were treated in each center either conservatively or interventionally by a standardized local infusion of intra-arterial papaverine into the splanchnic arteries. Thirty-day mortality and factors influencing the outcome, such as different demographics and laboratories, were compared between groups using Kaplan\u2013Meier survival analysis and Cox regression, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 66 patients with NOMI were included, with\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200935 treated interventionally (21 males, mean age 67.7\u2009\u00b1\u200912.3\u00a0years) and\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200931 treated conservatively (18 females, mean age 71.6\u2009\u00b1\u20099.6\u00a0years). There was a significant difference in 30-day mortality between the interventional (65.7%; 12\/35 survived) and the conservative group (96.8%; 1\/31 survived) (hazard ratio 2.44;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.005). Thresholds associated with a worse outcome of interventional therapy are\u2009&gt;\u20097.68\u00a0mmol\/l for lactate,\u2009&lt;\u20097.31 for pH and\u2009&lt;\u2009\u2009\u2212\u20094.55 for base excess.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Local intra-arterial papaverine infusion therapy in patients with NOMI significantly increases survival rate in comparison with conservative treatment. High lactate levels, low pH and high base excess, and high demand for catecholamines are associated with a poor outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00270-020-02515-4","type":"journal-article","created":{"date-parts":[[2020,5,22]],"date-time":"2020-05-22T13:02:40Z","timestamp":1590152560000},"page":"1148-1155","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["Local Intra-arterial Vasodilator Infusion in Non-Occlusive Mesenteric Ischemia Significantly Increases Survival Rate"],"prefix":"10.1007","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6650-3992","authenticated-orcid":false,"given":"Robert","family":"Winzer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dieter","family":"Fedders","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moritz","family":"Backes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Till","family":"Ittermann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Gr\u00fcndling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birger","family":"Mensel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanns-Christoph","family":"Held","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Luise","family":"Kromrey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Weitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf-Thorsten","family":"Hoffmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin","family":"B\u00fclow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens-Peter","family":"K\u00fchn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,5,22]]},"reference":[{"issue":"1","key":"2515_CR1","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1053\/j.semvascsurg.2009.12.001","volume":"23","author":"S Acosta","year":"2010","unstructured":"Acosta S. Epidemiology of mesenteric vascular disease: clinical implications. Semin Vasc Surg. 2010;23(1):4\u20138.","journal-title":"Semin Vasc Surg"},{"issue":"2","key":"2515_CR2","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1016\/S0889-8553(21)00499-4","volume":"19","author":"JF Reinus","year":"1990","unstructured":"Reinus JF, Brandt LJ, Boley SJ. Ischemic diseases of the bowel. Gastroenterol Clin N Am. 1990;19(2):319\u201343.","journal-title":"Gastroenterol Clin N Am"},{"issue":"3","key":"2515_CR3","first-page":"489","volume":"114","author":"RJ Stoney","year":"1993","unstructured":"Stoney RJ, Cunningham CG. Acute mesenteric ischemia. Surgery. 1993;114(3):489\u201390.","journal-title":"Surgery"},{"key":"2515_CR4","doi-asserted-by":"crossref","unstructured":"Al-Diery H, Phillips A, Evennett N, Pandanaboyana S, Gilham M, Windsor JA. The pathogenesis of nonocclusive mesenteric ischemia: implications for research and clinical practice. J Intensive Care Med. 2019;34(10):771\u201381.","DOI":"10.1177\/0885066618788827"},{"issue":"2","key":"2515_CR5","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1007\/s00068-016-0634-0","volume":"42","author":"JV Tilsed","year":"2016","unstructured":"Tilsed JV, Casamassima A, Kurihara H, Mariani D, Martinez I, Pereira J, Ponchietti L, Shamiyeh A, Al-Ayoubi F, Barco LA, Ceolin M, D'Almeida AJ, Hilario S, Olavarria AL, Ozmen MM, Pinheiro LF, Poeze M, Triantos G, Fuentes FT, Sierra SU, Soreide K, Yanar H. ESTES guidelines: acute mesenteric ischaemia. Eur J Trauma Emerg Surg. 2016;42(2):253\u201370.","journal-title":"Eur J Trauma Emerg Surg"},{"issue":"6","key":"2515_CR6","first-page":"848","volume":"82","author":"SJ Boley","year":"1977","unstructured":"Boley SJ, Sprayregan S, Siegelman SS, Veith FJ. Initial results from an agressive roentgenological and surgical approach to acute mesenteric ischemia. Surgery. 1977;82(6):848\u201355.","journal-title":"Surgery"},{"issue":"1","key":"2515_CR7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/028418516700600101","volume":"6","author":"T Aakhus","year":"1967","unstructured":"Aakhus T, Brabrand G. Angiography in acute superior mesenteric arterial insufficiency. Acta Radiol Diagn. 1967;6(1):1\u201312.","journal-title":"Acta Radiol Diagn"},{"issue":"1","key":"2515_CR8","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1016\/S0016-5085(75)80060-6","volume":"68","author":"CA Athanasoulis","year":"1975","unstructured":"Athanasoulis CA, Wittenberg J, Bernstein R, Williams LF. Vasodilatory drugs in the management of nonocclusive bowel ischemia. Gastroenterology. 1975;68(1):146\u201350.","journal-title":"Gastroenterology"},{"issue":"5","key":"2515_CR9","doi-asserted-by":"publisher","first-page":"1179","DOI":"10.1007\/s00330-001-1220-2","volume":"12","author":"M Trompeter","year":"2002","unstructured":"Trompeter M, Brazda T, Remy CT, Vestring T, Reimer P. Non-occlusive mesenteric ischemia: etiology, diagnosis, and interventional therapy. Eur Radiol. 2002;12(5):1179\u201387.","journal-title":"Eur Radiol"},{"issue":"1","key":"2515_CR10","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1016\/j.ejrad.2009.05.012","volume":"76","author":"R Woodhams","year":"2010","unstructured":"Woodhams R, Nishimaki H, Fujii K, Kakita S, Hayakawa K. Usefulness of multidetector-row CT (MDCT) for the diagnosis of non-occlusive mesenteric ischemia (NOMI): assessment of morphology and diameter of the superior mesenteric artery (SMA) on multi-planar reconstructed (MPR) images. Eur J Radiol. 2010;76(1):96\u2013102.","journal-title":"Eur J Radiol"},{"issue":"1081","key":"2515_CR11","doi-asserted-by":"publisher","first-page":"20170492","DOI":"10.1259\/bjr.20170492","volume":"91","author":"C Perez-Garcia","year":"2018","unstructured":"Perez-Garcia C, de Miguel Campos E, Fernandez Gonzalo A, Malfaz C, Martin Pinacho JJ, Fernandez Alvarez C, Herranz Perez R. Non-occlusive mesenteric ischaemia: CT findings, clinical outcomes and assessment of the diameter of the superior mesenteric artery. Br J Radiol. 2018;91(1081):20170492.","journal-title":"Br J Radiol"},{"issue":"1","key":"2515_CR12","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1016\/j.ccc.2014.08.006","volume":"31","author":"A Joosten","year":"2015","unstructured":"Joosten A, Alexander B, Cannesson M. Defining goals of resuscitation in the critically ill patient. Crit Care Clin. 2015;31(1):113\u201332.","journal-title":"Crit Care Clin"},{"issue":"2","key":"2515_CR13","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1016\/j.jcrc.2013.10.019","volume":"29","author":"H Wilms","year":"2014","unstructured":"Wilms H, Mittal A, Haydock MD, van den Heever M, Devaud M, Windsor JA. A systematic review of goal directed fluid therapy: rating of evidence for goals and monitoring methods. J Crit Care. 2014;29(2):204\u20139.","journal-title":"J Crit Care"},{"issue":"10","key":"2515_CR14","doi-asserted-by":"publisher","first-page":"1059","DOI":"10.1093\/oxfordjournals.aje.a008670","volume":"143","author":"FJ Nieto","year":"1996","unstructured":"Nieto FJ, Coresh J. Adjusting survival curves for confounders: a review and a new method. Am J Epidemiol. 1996;143(10):1059\u201368.","journal-title":"Am J Epidemiol"},{"issue":"1","key":"2515_CR15","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1016\/j.suc.2013.10.012","volume":"94","author":"MJ Sise","year":"2014","unstructured":"Sise MJ. Acute mesenteric ischemia. Surg Clin N Am. 2014;94(1):165\u201381.","journal-title":"Surg Clin N Am"},{"key":"2515_CR16","first-page":"425","volume":"3","author":"S Boley","year":"1971","unstructured":"Boley S. Persistent vasoconstriction-a major factor in nonocclusive mesenteric ischemia. Curr Top Surg Res. 1971;3:425\u201333.","journal-title":"Curr Top Surg Res"},{"issue":"3","key":"2515_CR17","doi-asserted-by":"publisher","first-page":"555","DOI":"10.2214\/ajr.142.3.555","volume":"142","author":"RA Clark","year":"1984","unstructured":"Clark RA, Gallant TE. Acute mesenteric ischemia: angiographic spectrum. AJR Am J Roentgenol. 1984;142(3):555\u201362.","journal-title":"AJR Am J Roentgenol"},{"issue":"2","key":"2515_CR18","first-page":"144","volume":"125","author":"H Stockmann","year":"2000","unstructured":"Stockmann H, Roblick UJ, Kluge N, Kunze U, Schimmelpenning H, Kujath P, Muller G, Bruch HP. Diagnosis and therapy of non-occlusive mesenteric ischemia (NOMI). Zentralbl Chir. 2000;125(2):144\u201351.","journal-title":"Zentralbl Chir"},{"issue":"5","key":"2515_CR19","doi-asserted-by":"publisher","first-page":"1583","DOI":"10.1016\/S0003-4975(01)03179-4","volume":"72","author":"S Klotz","year":"2001","unstructured":"Klotz S, Vestring T, Rotker J, Schmidt C, Scheld HH, Schmid C. Diagnosis and treatment of nonocclusive mesenteric ischemia after open heart surgery. Ann Thorac Surg. 2001;72(5):1583\u20136.","journal-title":"Ann Thorac Surg"},{"issue":"4","key":"2515_CR20","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1055\/s-2003-38441","volume":"175","author":"S Ernst","year":"2003","unstructured":"Ernst S, Luther B, Zimmermann N, Bohner H, Wilke R, Feindt P, Furst G. Current diagnosis and therapy of non-occlusive mesenteric ischemia. RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin. 2003;175(4):515\u201323.","journal-title":"RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin"},{"issue":"2","key":"2515_CR21","doi-asserted-by":"publisher","first-page":"114","DOI":"10.2310\/6670.2004.20769","volume":"12","author":"H Huwer","year":"2004","unstructured":"Huwer H, Winning J, Straub U, Isringhaus H, Kalweit G. Clinically diagnosed nonocclusive mesenteric ischemia after cardiopulmonary bypass: retrospective study. Vascular. 2004;12(2):114\u201320.","journal-title":"Vascular"},{"issue":"2","key":"2515_CR22","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1097\/01.sla.0000263157.59422.76","volume":"246","author":"A Mitsuyoshi","year":"2007","unstructured":"Mitsuyoshi A, Obama K, Shinkura N, Ito T, Zaima M. Survival in nonocclusive mesenteric ischemia: early diagnosis by multidetector row computed tomography and early treatment with continuous intravenous high-dose prostaglandin E(1). Ann Surg. 2007;246(2):229\u201335.","journal-title":"Ann Surg"},{"key":"2515_CR23","doi-asserted-by":"publisher","first-page":"631534","DOI":"10.1155\/2013\/631534","volume":"2013","author":"C Eris","year":"2013","unstructured":"Eris C, Yavuz S, Yalcinkaya S, Gucu A, Toktas F, Yumun G, Erdolu B, Ozyazicioglu A. Acute mesenteric ischemia after cardiac surgery: an analysis of 52 patients. Sci World J. 2013;2013:631534.","journal-title":"Sci World J"},{"issue":"3","key":"2515_CR24","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1016\/j.athoracsur.2016.03.025","volume":"102","author":"H Bomberg","year":"2016","unstructured":"Bomberg H, Groesdonk HV, Raffel M, Minko P, Schmied W, Klingele M, Schafers HJ. Vasopressin as therapy during nonocclusive mesenteric ischemia. Ann Thorac Surg. 2016;102(3):813\u20139.","journal-title":"Ann Thorac Surg"},{"key":"2515_CR25","doi-asserted-by":"publisher","DOI":"10.1177\/0885066619837911","author":"K Stahl","year":"2019","unstructured":"Stahl K, Busch M, Maschke SK, Schneider A, Manns MP, Fuge J, Wiesner O, Meyer BC, Hoeper MM, Hinrichs JB, David S. A retrospective analysis of nonocclusive mesenteric ischemia in medical and surgical ICU patients: clinical data on demography, clinical signs, and survival. J Intensive Care Med. 2019. https:\/\/doi.org\/10.1177\/0885066619837911.","journal-title":"J Intensive Care Med"},{"issue":"6","key":"2515_CR26","doi-asserted-by":"publisher","first-page":"1817","DOI":"10.1016\/0003-4975(95)01198-6","volume":"61","author":"U Niederhauser","year":"1996","unstructured":"Niederhauser U, Genoni M, von Segesser LK, Bruhlmann W, Turina MI. Mesenteric ischemia after a cardiac operation: conservative treatment with local vasodilation. Ann Thoracic Surg. 1996;61(6):1817\u20139.","journal-title":"Ann Thoracic Surg"},{"key":"2515_CR27","doi-asserted-by":"publisher","first-page":"8038796","DOI":"10.1155\/2017\/8038796","volume":"2017","author":"PC Ambe","year":"2017","unstructured":"Ambe PC, Kang K, Papadakis M, Zirngibl H. Can the preoperative serum lactate level predict the extent of bowel ischemia in patients presenting to the emergency department with acute mesenteric ischemia? BioMed Res Int. 2017;2017:8038796.","journal-title":"BioMed Res Int"},{"issue":"4","key":"2515_CR28","first-page":"203","volume":"19","author":"AM Simundic","year":"2009","unstructured":"Simundic AM. Measures of diagnostic accuracy: basic definitions. Ejifcc. 2009;19(4):203\u201311.","journal-title":"Ejifcc"},{"issue":"2","key":"2515_CR29","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1016\/S1010-7940(98)00260-7","volume":"15","author":"A Eker","year":"1999","unstructured":"Eker A, Malzac B, Teboul J, Jourdan J. Mesenteric ischemia after coronary artery bypass grafting: should local continuous intra-arterial perfusion with papaverine be regarded as a treatment? Eur J Cardio-Thorac Surg. 1999;15(2):218\u201320.","journal-title":"Eur J Cardio-Thorac Surg"},{"issue":"3","key":"2515_CR30","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1097\/SHK.0000000000000866","volume":"48","author":"C Mahlke","year":"2017","unstructured":"Mahlke C, Kuhn JP, Mensel B, Schreiber A, Juretzko A, Steinbach A, Grisk O. Iloprost, prostaglandin e1, and papaverine relax human mesenteric arteries with similar potency. Shock (Augusta, Ga.). 2017;48(3):333\u20139.","journal-title":"Shock (Augusta, Ga.)"}],"updated-by":[{"DOI":"10.1007\/s00270-021-02900-7","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2021,7,12]],"date-time":"2021-07-12T00:00:00Z","timestamp":1626048000000}}],"container-title":["CardioVascular and Interventional Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00270-020-02515-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00270-020-02515-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00270-020-02515-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,13]],"date-time":"2021-07-13T02:08:10Z","timestamp":1626142090000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00270-020-02515-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,22]]},"references-count":30,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2020,8]]}},"alternative-id":["2515"],"URL":"https:\/\/doi.org\/10.1007\/s00270-020-02515-4","relation":{},"ISSN":["0174-1551","1432-086X"],"issn-type":[{"value":"0174-1551","type":"print"},{"value":"1432-086X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5,22]]},"assertion":[{"value":"14 October 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 May 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 May 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 July 2021","order":4,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Correction","order":5,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"A Correction to this paper has been published:","order":6,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"https:\/\/doi.org\/10.1007\/s00270-021-02900-7","URL":"https:\/\/doi.org\/10.1007\/s00270-021-02900-7","order":7,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"To the best of our knowledge, this study is the first to compare an interventional and conservative treatment approach of NOMI directly. We confirm that this manuscript or similar work has not been published elsewhere and is not under consideration by another journal. There was no conflict of interest: Robert Winzer, MD: nothing to disclose, Dieter Fedders, MD: nothing to disclose, Moritz Backes: nothing to disclose, Till Ittermann: nothing to disclose, Matthias Gr\u00fcndling, MD: nothing to disclose, Birger Mensel, MD: nothing to disclose, Hanns-Christoph Held, MD: nothing to disclose, Marie-Luise Kromrey, MD: nothing to disclose, J\u00fcrgen Weitz, MD: nothing to disclose, Ralf-Thorsten Hoffmann, MD: nothing to disclose, Jens-Peter K\u00fchn, MD: nothing to disclose, Robin B\u00fclow, MD: nothing to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"For this type of study, formal consent is not required. The ethics committees of the University Medical Center Dresden and Greifswald confirmed the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"This study has obtained IRB approval from the relevant board, and the need for informed consent was waived.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"For this type of study consent for publication is not required.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}]}}