Nelson, Jack

BACKGROUND: Acute mesenteric ischemia (AMI) is a vascular emergency where delays in diagnosis or treatment can lead to irreversible bowel injury and death. Many patients initially present to hospitals without surgical or vascular capabilities and require interhospital transfer. The clinical impact of such transfers on treatment and outcomes in AMI remains poorly defined. STUDY DESIGN: We performed a retrospective cohort study using the National Inpatient Sample (2019 to 2021) to evaluate the association between interhospital transfer and outcomes in patients with AMI. Adult patients with a primary diagnosis of AMI were identified using ICD-10 codes. Patients were categorized by transfer status. Multivariable logistic regression was used to evaluate associations with in-hospital mortality and procedural interventions, adjusting for age and comorbidity burden. RESULTS: Of 39,690 hospitalizations for AMI, 14.6% involved interhospital transfer. Transferred patients had a higher comorbidity burden and were more often treated at rural or micropolitan hospitals. They were significantly more likely to undergo major surgical and vascular procedures, including bowel resection (odds ratio [OR] 3.48), mesenteric bypass (OR 3.32), and angioplasty (OR 2.66; all p < 0.0001). Markers of critical illness, such as intubation (OR 2.15) and dialysis (OR 1.30), were also more frequent in this group. In-hospital mortality was significantly higher among transferred patients (OR 2.05), and transfer remained independently associated with increased mortality after adjusting for age and comorbidity burden (adjusted OR 1.67, 95% CI 1.32 to 2.10). CONCLUSIONS: Interhospital transfer in AMI is strongly associated with increased clinical severity and in-hospital mortality. These findings emphasize the urgency of early diagnosis, rapid triage, and timely access to definitive care, supporting the need for structured regional systems and transfer protocols for AMI.

Introduction Lower Extremity Extracorporeal Distal Revascularization (LEEDR) is a novel, preclinically tested technique designed to provide temporary limb perfusion in cases of acute limb ischemia when immediate revascularization is not feasible. Methods LEEDR employs an extracorporeal pump and circuit to draw arterial blood from a proximal inflow site and deliver it to an outflow artery within the ischemic limb. The system is designed for bedside initiation using percutaneous access. Results ALI from embolism, thrombosis, or trauma rapidly leads to irreversible tissue damage. Delays in revascularization are associated with high rates of limb loss and systemic complications. LEEDR offers a time-sensitive intervention aimed at mitigating these risks and preserving limb viability until definitive treatment is available. Conclusion LEEDR is a promising temporary perfusion strategy for limb salvage in ALI. This manuscript outlines its procedural components, technical considerations, and anticipated role in bridging patients to definitive revascularization.