Title: Treatment of acute mesenteric ischemia between 2010 and 2020 – a German nation-wide
study
Version: 2 Date: 05 Jun 2023
Reviewer's report:
Overall evaluation:
The main problem with this data is the unvalidated data and the large insecurity of the different
subtypes of acute mesenteric ischaemia. These different subtypes can not be lumped together.
That is why operation is related with poor outcome, since the worst cases need surgery, while
mesenteric venous thrombosis can be managed by anticoagulation alone. You can not mix
acute arterial occlusive ischaemia with mesenteric venous thrombosis with colonic ischaemia
detected at colonoscopy at the outpatient clinic. K55.0 can not be studied without scrutinizing
case records. Why include Acute mesenteric ischaemia as a secondary diagnosis? From the
introduction it seems that the paper was on true primary acute mesenteric ischaemia? If there was
no surgery performed, then nearly 100% of patients with true acute arterial mesenteric ischaemia
would have died. So the outcome of your study can not be translated in a meaningful way.
It is even more unclear why the authors decided to study the influence of COVID-19 on their
data.
The majority of patients with acute mesenteric arterial occlusive disease will not have any
surgery at all, so there is a mismatch related to the results and interpretation of vascular and
surgical management. As you saw the percentage of endovascular and vascular surgery was
extremely small, and had nothing to do with the overall outcomes of this study.
Specific comments:
Abstract.
1. What is vWs?
2. Why don´t you also state that surgery was associated with increased mortality?
3. First wave or first year of COVID-19?
Figures.
Figure 3. 2019 was not a COVID-19 year as it shows in the graph.
Discussion.
Page 9, line 15. Is it controversial that patients undergo visceral surgery instead of vascular
surgery? There is no probability of undergoing vascular surgery in secondary diagnosis.
Title: Treatment of acute mesenteric ischemia between 2010 and 2020 – a German nation-wide
study
Version: 2 Date: 05 Jun 2023
Reviewer's report:
Overall evaluation:
The main problem with this data is the unvalidated data and the large insecurity of the different
subtypes of acute mesenteric ischaemia. These different subtypes can not be lumped together.
That is why operation is related with poor outcome, since the worst cases need surgery, while
mesenteric venous thrombosis can be managed by anticoagulation alone. You can not mix
acute arterial occlusive ischaemia with mesenteric venous thrombosis with colonic ischaemia
detected at colonoscopy at the outpatient clinic. K55.0 can not be studied without scrutinizing
case records. Why include Acute mesenteric ischaemia as a secondary diagnosis? From the
introduction it seems that the paper was on true primary acute mesenteric ischaemia? If there was
no surgery performed, then nearly 100% of patients with true acute arterial mesenteric ischaemia
would have died. So the outcome of your study can not be translated in a meaningful way.
It is even more unclear why the authors decided to study the influence of COVID-19 on their
data.
The majority of patients with acute mesenteric arterial occlusive disease will not have any
surgery at all, so there is a mismatch related to the results and interpretation of vascular and
surgical management. As you saw the percentage of endovascular and vascular surgery was
extremely small, and had nothing to do with the overall outcomes of this study.
Specific comments:
Abstract.
1. What is vWs?
2. Why don´t you also state that surgery was associated with increased mortality?
3. First wave or first year of COVID-19?
Figures.
Figure 3. 2019 was not a COVID-19 year as it shows in the graph.
Discussion.
Page 9, line 15. Is it controversial that patients undergo visceral surgery instead of vascular
surgery? There is no probability of undergoing vascular surgery in secondary diagnosis.
Please review this paper.
user
Title: Treatment of acute mesenteric ischemia between 2010 and 2020 – a German nation-wide
study
Version: 2 Date: 05 Jun 2023
Reviewer's report:
Overall evaluation:
The main problem with this data is the unvalidated data and the large insecurity of the different
subtypes of acute mesenteric ischaemia. These different subtypes can not be lumped together.
That is why operation is related with poor outcome, since the worst cases need surgery, while
mesenteric venous thrombosis can be managed by anticoagulation alone. You can not mix
acute arterial occlusive ischaemia with mesenteric venous thrombosis with colonic ischaemia
detected at colonoscopy at the outpatient clinic. K55.0 can not be studied without scrutinizing
case records. Why include Acute mesenteric ischaemia as a secondary diagnosis? From the
introduction it seems that the paper was on true primary acute mesenteric ischaemia? If there was
no surgery performed, then nearly 100% of patients with true acute arterial mesenteric ischaemia
would have died. So the outcome of your study can not be translated in a meaningful way.
It is even more unclear why the authors decided to study the influence of COVID-19 on their
data.
The majority of patients with acute mesenteric arterial occlusive disease will not have any
surgery at all, so there is a mismatch related to the results and interpretation of vascular and
surgical management. As you saw the percentage of endovascular and vascular surgery was
extremely small, and had nothing to do with the overall outcomes of this study.
Specific comments:
Abstract.
1. What is vWs?
2. Why don´t you also state that surgery was associated with increased mortality?
3. First wave or first year of COVID-19?
Figures.
Figure 3. 2019 was not a COVID-19 year as it shows in the graph.
Discussion.
Page 9, line 15. Is it controversial that patients undergo visceral surgery instead of vascular
surgery? There is no probability of undergoing vascular surgery in secondary diagnosis.
assistant