Materiały źródłowe

• #1 Acute Mesenteric Ischemia Treatment & Management: Approach Considerations, Initial Resuscitation and Stabilization, Pharmacologic Therapy

  https://emedicine.medscape.com/article/189146-treatment

  Recognition of acute mesenteric ischemia (AMI) before permanent tissue damage occurs is the best way of improving patient survival, and only angiography or exploratory surgery makes early diagnosis possible. […] Treatment options depend on the etiology of intestinal ischemia, as well as on the hemodynamic stability of the patient and the experience/expertise of the treating staff. Generally speaking, nonocclusive AMI is treated medically, whereas occlusive AMI is correctable with surgery. Definitive treatment options include the following: […] All cases of mesenteric ischemia with signs of peritonitis or possible bowel infarction, regardless of etiology, generally warrant immediate surgical intervention for the resection of ischemic or necrotic intestines. […] Surgical treatment may be contraindicated if the risks from comorbid conditions preclude survival after general anesthesia. If the ischemia is thought to be caused by vasospasm, surgery is not indicated. Medical management with anticoagulants and intra-arterial vasodilators is appropriate.

• #2 Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00443-x

  Acute mesenteric ischemia (AMI) is a group of diseases characterized by an interruption of the blood supply to varying portions of the intestine, leading to ischemia and secondary inflammatory changes. […] Early diagnosis and timely surgical intervention are the cornerstones of modern treatment to reduce the high mortality associated with this entity. […] Traditionally, AMI has been treated with open surgery. Over the past two decades, the rapid development of endovascular techniques has made this approach an important alternative for patients with occlusion of the superior mesenteric artery (SMA). […] The assessment and therapy carried out by an interdisciplinary team should keep the time-to-reperfusion interval as short as possible. […] Accordingly, the present paper aims to provide an update with recommendations based on the most currently accepted concepts in the management of AMI.

• #3 Acute Mesenteric Ischemia: Review of Etiologies and Treatment Options

  https://www.heraldopenaccess.us/openaccess/acute-mesenteric-ischemia-review-of-etiologies-and-treatment-options

  Acute mesenteric ischemia is a life-threatening condition that can be caused by several different pathologies. Numerous treatment options are available including endovascular intervention and open surgical revascularization. Here we review the most common etiologies of acute mesenteric ischemia and modern treatment options. […] Rapid diagnosis of AMI is critical. Mortality rates rise steadily with time from onset. Mortality rates are 0-10% with immediate treatment, 50-60% for delays of 6-12 hours, and 80-100% with treatment delays of 24 hours. […] Once the diagnosis is made, fluid resuscitation should begin and broad-spectrum antibiotics should be administered as there is a significant risk of bacterial translocation across the intestinal membrane. […] Although endovascular interventions are available and widely accepted for the treatment of arterial embolism, there is nearly universal agreement that patients presenting with frank ischemia of the bowel should undergo immediate laparotomy.

• #4 Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00443-x

  When the diagnosis of AMI is made, fluid resuscitation should commence immediately to enhance visceral perfusion. […] Broad-spectrum antibiotics should be immediately administered. […] Prompt laparoscopy/laparotomy should be done for patients with an overt peritonitis. […] The goal of surgical intervention for AMI includes: 1) Re-establishment of the blood supply to the ischemic bowel. 2) Resection of all non-viable regions. 3) Preservation of all viable bowel. […] Revascularization when relevant has an essential role in the multidisciplinary approach to AMI. […] Endovascular revascularization procedures are the primary option in cases of arterial occlusion when sufficient expertise is available. […] Damage control surgery (DCS) with temporary abdominal closure is an important adjunct for patients who require intestinal resection allowing reassessment of bowel viability and in situations of severe abdominal sepsis.

• #5 Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-017-0150-5

  Acute mesenteric ischemia (AMI) is typically defined as a group of diseases characterized by an interruption of the blood supply to varying portions of the small intestine, leading to ischemia and secondary inflammatory changes. […] Early diagnosis and timely surgical intervention are the cornerstones of modern treatment and are essential to reduce the high mortality associated with this entity. […] Some of the key points include the prompt use of CT angiography to establish the diagnosis, evaluation of the potential for revascularization to re-establish blood flow to ischemic bowel, resection of necrotic intestine, and use of damage control techniques when appropriate to allow for re-assessment of bowel viability prior to definitive anastomosis and abdominal closure. […] When the diagnosis of AMI is made, fluid resuscitation should commence immediately to enhance visceral perfusion. Electrolyte abnormalities should be corrected, and nasogastric decompression initiated.

• #6 EM@3AM: Mesenteric Ischemia – emDocs

  https://www.emdocs.net/em3am-mesenteric-ischemia/

  Treatment: […] NPO and fluid resuscitate with crystalloid and correct electrolyte and base deficit. […] Broad spectrum antibiotics: ceftriaxone and metronidazole or piperacillin/tazobactam. […] If persistently hypotensive after fluid resuscitation, vasopressors. […] Ask surgeons if they want heparin started. […] If mesenteric venous thrombosis confirmed on CT venography, systemically anticoagulate with unfractionated heparin. […] Postoperative intra-arterial papaverin infusion into SMA to reduce vasospasm. […] Disposition: […] Early surgical consultation. […] AMI secondary to SMV thrombosis => heparin infusion and to MICU. […] May involve IR for endovascular thrombectomy. […] Endovascular thrombectomy success rates vs open. […] Bowel resection reduces mortality to 30% though the need for bowel resection reflects the degree of ischemia and was found to be an independent mortality predictor.

• #7 Acute Mesenteric Ischemia Treatment & Management: Approach Considerations, Initial Resuscitation and Stabilization, Pharmacologic Therapy

  https://emedicine.medscape.com/article/189146-treatment

  Some experience with percutaneous endovascular interventions has been accumulated. In select cases, especially in isolated spontaneous dissection of the SMA, stent placement may be the preferred option. […] Guidelines for the management of AMI have been published by the World Society of Emergency Surgery. […] Papaverine is an opium derivative that functions as a phosphodiesterase inhibitor, which acts to relax vascular smooth muscle. It is usually infused directly into the SMA, thus improving intestinal blood flow. […] Thrombolytic agents infused through the angiography catheter can be life-saving for selected patients with AMAE. […] Heparin anticoagulation is the main therapy for MVT. […] Surgical treatment of AMAT (ie, thrombotic AMI) involves exploratory laparotomy, followed by identification of the involved artery and bowel.

• #8 Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00443-x

  When the diagnosis of AMI is made, fluid resuscitation should commence immediately to enhance visceral perfusion. […] Broad-spectrum antibiotics should be immediately administered. […] Prompt laparoscopy/laparotomy should be done for patients with an overt peritonitis. […] The goal of surgical intervention for AMI includes: 1) Re-establishment of the blood supply to the ischemic bowel. 2) Resection of all non-viable regions. 3) Preservation of all viable bowel. […] Revascularization when relevant has an essential role in the multidisciplinary approach to AMI. […] Endovascular revascularization procedures are the primary option in cases of arterial occlusion when sufficient expertise is available. […] Damage control surgery (DCS) with temporary abdominal closure is an important adjunct for patients who require intestinal resection allowing reassessment of bowel viability and in situations of severe abdominal sepsis.

• #9 Acute Mesenteric Ischemia Treatment & Management: Approach Considerations, Initial Resuscitation and Stabilization, Pharmacologic Therapy

  https://emedicine.medscape.com/article/189146-treatment

  Recognition of acute mesenteric ischemia (AMI) before permanent tissue damage occurs is the best way of improving patient survival, and only angiography or exploratory surgery makes early diagnosis possible. […] Treatment options depend on the etiology of intestinal ischemia, as well as on the hemodynamic stability of the patient and the experience/expertise of the treating staff. Generally speaking, nonocclusive AMI is treated medically, whereas occlusive AMI is correctable with surgery. Definitive treatment options include the following: […] All cases of mesenteric ischemia with signs of peritonitis or possible bowel infarction, regardless of etiology, generally warrant immediate surgical intervention for the resection of ischemic or necrotic intestines. […] Surgical treatment may be contraindicated if the risks from comorbid conditions preclude survival after general anesthesia. If the ischemia is thought to be caused by vasospasm, surgery is not indicated. Medical management with anticoagulants and intra-arterial vasodilators is appropriate.

• #10 Update in management of mesenteric ischemia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4087969/

  Mesenteric ischemia disorders are precipitated by a circulation insufficiency event that deprives one or several abdominal organs of adequate respiration to meet metabolic demands. […] The successful outcome is dependent upon a high index of suspicion and prompt management. […] Despite advances in both diagnosis and treatment, prompt diagnosis and supportive care remain critical for successful outcome. New imaging techniques, endovascular therapy and emerging research may improve our approach to this deadly condition. […] Management of mesenteric ischemia clearly depends on the nature, acuity and severity of disease. Early intervention involves resection of nonviable bowel, restoration of blood flow to the ischemic intestine and supportive care. […] In the acute thromboembolic event, operative embolectomy has been the traditional procedure with reasonable short and long term outcomes.

• #11 Acute Mesenteric Ischemia Treatment & Management: Approach Considerations, Initial Resuscitation and Stabilization, Pharmacologic Therapy

  https://emedicine.medscape.com/article/189146-treatment

  Recognition of acute mesenteric ischemia (AMI) before permanent tissue damage occurs is the best way of improving patient survival, and only angiography or exploratory surgery makes early diagnosis possible. […] Treatment options depend on the etiology of intestinal ischemia, as well as on the hemodynamic stability of the patient and the experience/expertise of the treating staff. Generally speaking, nonocclusive AMI is treated medically, whereas occlusive AMI is correctable with surgery. Definitive treatment options include the following: […] All cases of mesenteric ischemia with signs of peritonitis or possible bowel infarction, regardless of etiology, generally warrant immediate surgical intervention for the resection of ischemic or necrotic intestines. […] Surgical treatment may be contraindicated if the risks from comorbid conditions preclude survival after general anesthesia. If the ischemia is thought to be caused by vasospasm, surgery is not indicated. Medical management with anticoagulants and intra-arterial vasodilators is appropriate.

• #12 Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00443-x

  When the diagnosis of AMI is made, fluid resuscitation should commence immediately to enhance visceral perfusion. […] Broad-spectrum antibiotics should be immediately administered. […] Prompt laparoscopy/laparotomy should be done for patients with an overt peritonitis. […] The goal of surgical intervention for AMI includes: 1) Re-establishment of the blood supply to the ischemic bowel. 2) Resection of all non-viable regions. 3) Preservation of all viable bowel. […] Revascularization when relevant has an essential role in the multidisciplinary approach to AMI. […] Endovascular revascularization procedures are the primary option in cases of arterial occlusion when sufficient expertise is available. […] Damage control surgery (DCS) with temporary abdominal closure is an important adjunct for patients who require intestinal resection allowing reassessment of bowel viability and in situations of severe abdominal sepsis.

• #13 Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00443-x

  When the diagnosis of AMI is made, fluid resuscitation should commence immediately to enhance visceral perfusion. […] Broad-spectrum antibiotics should be immediately administered. […] Prompt laparoscopy/laparotomy should be done for patients with an overt peritonitis. […] The goal of surgical intervention for AMI includes: 1) Re-establishment of the blood supply to the ischemic bowel. 2) Resection of all non-viable regions. 3) Preservation of all viable bowel. […] Revascularization when relevant has an essential role in the multidisciplinary approach to AMI. […] Endovascular revascularization procedures are the primary option in cases of arterial occlusion when sufficient expertise is available. […] Damage control surgery (DCS) with temporary abdominal closure is an important adjunct for patients who require intestinal resection allowing reassessment of bowel viability and in situations of severe abdominal sepsis.

• #14 Mesenteric ischemia: Pathogenesis and challenging diagnostic and therapeutic modalities

  https://www.wjgnet.com/2150-5330/full/v7/i1/125.htm

  Mesenteric ischemia (MI) is an uncommon medical condition with high mortality rates. […] Therapeutic approach of MI includes both medical and surgical treatment. Surgical procedures include restoration of the blood flow with arteriotomy, endarterectomy or anterograde bypass, while resection of necrotic bowel is always implemented. […] The aim of this review was to evaluate the results of surgical treatment for MI and to present the recent literature in order to provide an update on the current concepts of surgical management of the disease. […] AMI high mortality rates indicate the importance of urgent medical treatment. […] Different drug treatment protocols have been suggested according to the subtypes of AMI. […] Recent knowledge has generated a multidisciplinary surgical management of AMI.

• #15 Update in management of mesenteric ischemia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4087969/

  Surgical revascularization for visceral ischemia due to an occluded SMA was first described by Shaw et al in 1958, in which they reported two successful cases of mesenteric thromboendarterectomy. […] For chronic occlusive disease, when revascularization is considered, single-vessel bypass to the superior mesenteric artery has been very successful, even in patients with multiple-vessel occlusions. […] Antegrade aortoceliac bypass and transaortic endarterectomy have been successful for poor-risk patients, and are usually adequate for multiple outflows. […] Since the first reports of percutaneous transluminal angioplasty of the visceral vessels in 1980, endovascular therapy for atherosclerotic disease has rapidly expanded in both scope and indication in the last ten years. […] In both the acute and chronic presentation of intestinal ischemia, endoluminal therapy has emerged as a main, if not first-line therapy.

• #16 Acute Mesenteric Ischemia: Review of Etiologies and Treatment Options

  https://www.heraldopenaccess.us/openaccess/acute-mesenteric-ischemia-review-of-etiologies-and-treatment-options

  Options for revascularization include the following: Open embolectomy of the SMA, which is typically performed through the small bowel mesentery Bypass to a distal, patent portion of the SMA from either the aorta or iliac artery A hybrid approach utilizing retrograde endovascular techniques through the distal SMA, which can be used to performed angioplasty or stenting of ostial or proximal SMA stenosis. […] Endovascular techniques are also available for treating acute emboli to the SMA. If there is no evidence of frank bowel ischemia and the patient is hemodynamically stable, it is reasonable to attempt an endovascular approach. […] Patients presenting with evidence of frank bowel ischemia should proceed with surgical exploration. Open thrombectomy of the portal or mesenteric veins can be performed through laparotomy although this approach is rarely indicated.

• #17 Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00443-x

  When the diagnosis of AMI is made, fluid resuscitation should commence immediately to enhance visceral perfusion. […] Broad-spectrum antibiotics should be immediately administered. […] Prompt laparoscopy/laparotomy should be done for patients with an overt peritonitis. […] The goal of surgical intervention for AMI includes: 1) Re-establishment of the blood supply to the ischemic bowel. 2) Resection of all non-viable regions. 3) Preservation of all viable bowel. […] Revascularization when relevant has an essential role in the multidisciplinary approach to AMI. […] Endovascular revascularization procedures are the primary option in cases of arterial occlusion when sufficient expertise is available. […] Damage control surgery (DCS) with temporary abdominal closure is an important adjunct for patients who require intestinal resection allowing reassessment of bowel viability and in situations of severe abdominal sepsis.

• #18 Mesenteric ischemia – WikEM

  https://wikem.org/wiki/Mesenteric_ischemia

  PLUS/MINUS 24-48 hour second-look surgery […] Transcatheter vasodilation via: PGE1, alprostadil […] PGI2, epoprostenol […] Papaverine, most commonly used, though use in caution with angina, recent stroke, MI, glaucoma […] Heparin/warfarin either alone or in combination with surgery […] Immediate heparinization should be started even when surgical intervention is indicated […] Decreases progression of thrombosis and improves survival […] PLUS/MINUS tPA intra-arterial thrombolysis with IR […] PLUS/MINUS laparotomy for evidence of bowel necrosis, peritonitis, stricture, severe GI bleeding […] Angioplasty with or without stent placement or surgical revascularization.

• #19 Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00443-x

  Acute mesenteric ischemia (AMI) is a group of diseases characterized by an interruption of the blood supply to varying portions of the intestine, leading to ischemia and secondary inflammatory changes. […] Early diagnosis and timely surgical intervention are the cornerstones of modern treatment to reduce the high mortality associated with this entity. […] Traditionally, AMI has been treated with open surgery. Over the past two decades, the rapid development of endovascular techniques has made this approach an important alternative for patients with occlusion of the superior mesenteric artery (SMA). […] The assessment and therapy carried out by an interdisciplinary team should keep the time-to-reperfusion interval as short as possible. […] Accordingly, the present paper aims to provide an update with recommendations based on the most currently accepted concepts in the management of AMI.

• #20 Diagnosis and Management of Acute Mesenteric Ischemia – Endovascular Today

  https://evtoday.com/articles/2021-jan/diagnosis-and-management-of-acute-mesenteric-ischemia

  Acute mesenteric ischemia is caused by one of four mechanisms: acute arterial embolism (40%-50%), acute arterial thrombosis (20%-30%), nonocclusive mesenteric ischemia (NOMI) (20%), and mesenteric venous thrombosis (5%-15%). […] The initial management of acute mesenteric ischemia must focus on aggressive resuscitative measures. […] The administration of crystalloid fluid initially, followed by blood as necessary, should start in the emergency department. […] Broad-spectrum antibiotics directed against normal gut flora should also be given prior to proceeding to the operating room. […] Lastly, systemic heparinization should be initiated with a bolus dose of 100 units/kg as soon as acute mesenteric ischemia is suspected. […] Over the last 20 years, as endovascular techniques have become increasingly sophisticated and practitioners more adept at employing them, minimally invasive approaches to mesenteric ischemia have gained popularity.

• #21 Diagnosis and Management of Acute Mesenteric Ischemia – Endovascular Today

  https://evtoday.com/articles/2021-jan/diagnosis-and-management-of-acute-mesenteric-ischemia

  Endovascular techniques have expanded past percutaneous transluminal angioplasty and stenting to now include mechanical thrombectomy involving aspiration, pharmacologic thrombolysis, or a rheolytic system. […] The Society for Vascular Surgery and the American College of Cardiology/American Heart Association consensus guidelines support the use of percutaneous revascularization in certain situations. […] If the decision is made to start with laparotomy, a transperitoneal incision is made to expose the entire abdominal contents. […] Therapy is initiated with systemic anticoagulation and bowel resection in the setting of necrosis. […] If patients do not experience improvement within 24 to 48 hours, consideration should be given to intervention. […] Although survival for all causes of mesenteric ischemia is relatively poor, prompt recognition and intervention are key to improving outcomes.

• #22 Endovascular Treatment for Acute Mesenteric Ischemia | IntechOpen

  https://www.intechopen.com/chapters/82365

  In the absence of RCTs, evidence is based on prospective registries. […] The principles of damage control surgery are important to follow when treating these frail patients. […] Although laparotomy is not mandatory after endovascular therapy in these patients with acute bowel ischaemia, it is often necessary to inspect the bowel. […] Intra-arterial catheter thrombolysis of the superior mesenteric artery has been reported with good results. […] Dr. Erben reported in 2018 that endovascular revascularization for acute mesenteric ischemia is cost-saving, with a lower rate of in-hospital mortality. […] Dr. Lim et al. reported in 2019 that for acute mesenteric ischemia, both open surgery and endovascular revascularization are viable options in the modern era. […] For the suspected case of acute mesenteric ischemia, is following serum lactate level useful to confirm acute mesenteric ischemia?

• #23 Acute Mesenteric Ischemia Treatment & Management: Approach Considerations, Initial Resuscitation and Stabilization, Pharmacologic Therapy

  https://emedicine.medscape.com/article/189146-treatment

  Some experience with percutaneous endovascular interventions has been accumulated. In select cases, especially in isolated spontaneous dissection of the SMA, stent placement may be the preferred option. […] Guidelines for the management of AMI have been published by the World Society of Emergency Surgery. […] Papaverine is an opium derivative that functions as a phosphodiesterase inhibitor, which acts to relax vascular smooth muscle. It is usually infused directly into the SMA, thus improving intestinal blood flow. […] Thrombolytic agents infused through the angiography catheter can be life-saving for selected patients with AMAE. […] Heparin anticoagulation is the main therapy for MVT. […] Surgical treatment of AMAT (ie, thrombotic AMI) involves exploratory laparotomy, followed by identification of the involved artery and bowel.

• #24 Mesenteric ischaemia | Deranged Physiology

  https://derangedphysiology.com/main/required-reading/gastrointestinal-intensive-care/Chapter-26/mesenteric-ischaemia

  This is a common enough event in the ICU that one might have expected a serious discussion of ischaemic gut to appear in the exam with some frequency, and indeed it has now appeared four times: […] These SAQs asked for a detailed exploration of mesenteric ischaemia, specifically asking candidates to „outline the pathophysiology, diagnosis and treatment”. […] For good quality reading on this topic, the time-poor candidate is directed to either this 2014 review by Schofield et al or this NEJM article by Clair and Beach (2016). Each has helpful exam-ready headings like „Pathophysiology” and „Diagnosis”. […] Specific management: […] Occlusive mesenteric ischaemia: […] Endovascular repair […] Open repair with or without vascular bypass […] Catheter-directed clot aspiration or thrombolysis

• #25 Endovascular Treatment for Acute Mesenteric Ischemia | IntechOpen

  https://www.intechopen.com/chapters/82365

  In the absence of RCTs, evidence is based on prospective registries. […] The principles of damage control surgery are important to follow when treating these frail patients. […] Although laparotomy is not mandatory after endovascular therapy in these patients with acute bowel ischaemia, it is often necessary to inspect the bowel. […] Intra-arterial catheter thrombolysis of the superior mesenteric artery has been reported with good results. […] Dr. Erben reported in 2018 that endovascular revascularization for acute mesenteric ischemia is cost-saving, with a lower rate of in-hospital mortality. […] Dr. Lim et al. reported in 2019 that for acute mesenteric ischemia, both open surgery and endovascular revascularization are viable options in the modern era. […] For the suspected case of acute mesenteric ischemia, is following serum lactate level useful to confirm acute mesenteric ischemia?

• #26 Mesenteric ischemia: what the radiologist needs to know – Olson – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/21705/html

  In patients without frank evidence of bowel necrosis, endovascular treatment may allow for restoration of mesenteric blood flow with lower rates of in-hospital mortality. The primary disadvantage of this approach is that it does not allow for direct inspection of the bowel and assessment of viability. A hybrid technique, consisting of open surgery followed by endovascular SMA revascularization, has shown promise, as it allows for direct bowel evaluation and prompt restoration of mesenteric flow. However, experience with this technique remains limited, and its use is relatively rare. […] In patients with chronic mesenteric ischemia, endovascular repair is utilized more commonly than open repair. Endovascular repair is associated with fewer complications and shorter hospital stays, though at the expense of lower long-term patency and earlier recurrence of symptoms.

• #27 Acute Mesenteric Ischemia Medication: Vasodilators, Thrombolytics, Anticoagulants, Antibiotics, Analgesics

  https://emedicine.medscape.com/article/189146-medication

  Drug types used in the treatment of acute mesenteric ischemia (AMI) include vasodilators, thrombolytics, anticoagulants, antibiotics, and analgesics. Therapeutic drugs (except for analgesics and prophylactic antibiotics) should be withheld until the type of AMI present has been determined by means of computed tomography (CT) or angiography. […] Vasodilators dilate the mesenteric arterial system, thereby reversing reactive arterial vasospasms in AMI. […] Thrombolytics are angiographically infused to lyse thrombi. They are used in selected patients with embolic AMI. […] Anticoagulants are indicated for preventing further extension of thrombus in mesenteric venous thrombosis (MVT) or, after revascularization, in arterial occlusive AMI. […] Antibiotics are administered to prevent or treat sepsis caused by breakdown of the mucosal barrier in bowel necrosis or perforation. […] Analgesics are used to relieve pain caused by bowel ischemia.

• #28 Medication for Mesenteric Ischemia | NYU Langone Health

  https://nyulangone.org/conditions/mesenteric-ischemia/treatments/medication-for-mesenteric-ischemia

  NYU Langone specialists may prescribe medication to treat people with mesenteric ischemia. Medications can help manage blood clots and symptoms caused by a blockage, such as intestinal inflammation. […] Sometimes, these medications are used during surgery to dissolve clots. Other times, they are used to prevent blood clots from forming after treatment. […] Some dangerous blood clots require fast-acting, clot-busting medications called thrombolytics. These medications help restart blood flow to prevent damage to the intestines in people with acute mesenteric ischemia. […] Anticoagulants, or blood thinners, are used to prevent blood clots from forming after surgery to treat mesenteric ischemia. […] Vasodilators relax the arteries, helping to prevent them from narrowing. This helps increase blood and oxygen flow to the intestines. […] Your doctor may prescribe antibiotics to prevent sepsis, a potentially life-threatening complication of an infection. In people with mesenteric ischemia, infections may occur as a result of gangrene, which is cell death in the bowel.

• #29 Mesenteric ischemia – WikEM

  https://wikem.org/wiki/Mesenteric_ischemia

  PLUS/MINUS 24-48 hour second-look surgery […] Transcatheter vasodilation via: PGE1, alprostadil […] PGI2, epoprostenol […] Papaverine, most commonly used, though use in caution with angina, recent stroke, MI, glaucoma […] Heparin/warfarin either alone or in combination with surgery […] Immediate heparinization should be started even when surgical intervention is indicated […] Decreases progression of thrombosis and improves survival […] PLUS/MINUS tPA intra-arterial thrombolysis with IR […] PLUS/MINUS laparotomy for evidence of bowel necrosis, peritonitis, stricture, severe GI bleeding […] Angioplasty with or without stent placement or surgical revascularization.

• #30 Chronic Mesenteric Ischemia: Diagnosis and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3036470/

  Chronic mesenteric ischemia is a rare condition that was first described in 1918 as abdominal angina by Goodman. Its onset is gradual and it is often diagnosed late in its course. Treatment of the underlying lesion(s) is necessary to prevent the development of acute mesenteric ischemia, which may result in bowel infarction and death. […] Treatment is necessary to avoid progression to bowel ischemia and infarction. Once a diagnosis of chronic mesenteric ischemia is made, treatment options include open surgical revascularization and endovascular revascularization. […] After the diagnosis of chronic mesenteric ischemia is made, patients should undergo definitive treatment because of the risk of continued weight loss, acute infarction, perforation, sepsis, and death. […] Open surgical repair includes transaortic endarterectomy, direct reimplantation on the aorta, and antegrade or retrograde bypass grafting.

• #31 Chronic Mesenteric Ischemia Causes, Symptoms, and Treatments

  https://www.upmc.com/services/heart-vascular/conditions/chronic-mesenteric-ischemia

  Your vascular surgeon uses a blood vessel from another location to create a detour around the blockage by attaching one end to the blocked artery above the blockage and the other end below the blockage. […] Symptoms typically improve immediately and you will receive close follow-up care through regular ultrasounds. […] Decreasing the risk of atherosclerosis the condition that causes chronic mesenteric ischemia. […] Quitting smoking. […] Controlling blood sugars in people with diabetes. […] Lowering cholesterol levels. […] Lowering high blood pressure. […] Taking anti-platelet medications, such as aspirin and clopidogrel (Plavix).

• #32 Role of Endovascular Therapies in Chronic Mesenteric Ischemia: Current Status and Technical Considerations

  https://www.acc.org/latest-in-cardiology/articles/2016/12/20/07/12/role-of-endovascular-therapies-in-chronic-mesenteric-ischemia

  Initial therapy of CMI should be directed towards controlling underlying risk factors such as diabetes, hypertension, and hypercholesterolemia. […] Ultimately, most patients with CMI require revascularization, and medical management alone is usually reserved for patients who are too high risk for any revascularization options (surgical or percutaneous), or who have refractory symptoms despite failed previous revascularization attempts. […] As mentioned above, PEVT currently has a Class IB ACC/AHA recommendation for the treatment of CMI. […] Once a decision towards revascularization is made, careful consideration must be made towards selecting which vessel(s) to revascularize in situations where more than one vessel is significantly stenosed. […] However, if the SMA cannot be treated by endovascular means (e.g., due to calcification or presence of an ostial or long occlusion), an attempt at celiac angioplasty can be beneficial.

• #33 Bowel Ischaemia | Doctor

  https://patient.info/doctor/bowel-ischaemia

  These patients have a five-year mortality of 40%, with the majority of deaths attributed to myocardial infarction or cardiovascular death. […] Symptomatic chronic mesenteric ischaemia (CMI) is an indication for either open or endovascular revascularisation, as patients with untreated symptomatic CMI carry a five-year mortality rate that approaches 100%. […] Nutrition is important in pre-operative assessment, as patients are often malnourished at the time of diagnosis; total parenteral nutrition may be necessary both pre- and postoperatively. […] The optimal revascularisation approach depends heavily on the anatomy and pre-operative condition of the patient. […] Renal failure is a common postoperative complication. […] […] […] Ischaemic colitis treatment10 […] Medical care

• #34 Role of Endovascular Therapies in Chronic Mesenteric Ischemia: Current Status and Technical Considerations

  https://www.acc.org/latest-in-cardiology/articles/2016/12/20/07/12/role-of-endovascular-therapies-in-chronic-mesenteric-ischemia

  Initial therapy of CMI should be directed towards controlling underlying risk factors such as diabetes, hypertension, and hypercholesterolemia. […] Ultimately, most patients with CMI require revascularization, and medical management alone is usually reserved for patients who are too high risk for any revascularization options (surgical or percutaneous), or who have refractory symptoms despite failed previous revascularization attempts. […] As mentioned above, PEVT currently has a Class IB ACC/AHA recommendation for the treatment of CMI. […] Once a decision towards revascularization is made, careful consideration must be made towards selecting which vessel(s) to revascularize in situations where more than one vessel is significantly stenosed. […] However, if the SMA cannot be treated by endovascular means (e.g., due to calcification or presence of an ostial or long occlusion), an attempt at celiac angioplasty can be beneficial.

• #35 Chronic Mesenteric Ischemia: Diagnosis and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3036470/

  Chronic mesenteric ischemia is a rare condition that was first described in 1918 as abdominal angina by Goodman. Its onset is gradual and it is often diagnosed late in its course. Treatment of the underlying lesion(s) is necessary to prevent the development of acute mesenteric ischemia, which may result in bowel infarction and death. […] Treatment is necessary to avoid progression to bowel ischemia and infarction. Once a diagnosis of chronic mesenteric ischemia is made, treatment options include open surgical revascularization and endovascular revascularization. […] After the diagnosis of chronic mesenteric ischemia is made, patients should undergo definitive treatment because of the risk of continued weight loss, acute infarction, perforation, sepsis, and death. […] Open surgical repair includes transaortic endarterectomy, direct reimplantation on the aorta, and antegrade or retrograde bypass grafting.

• #36 Chronic Mesenteric Ischemia: Diagnosis and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3036470/

  Endovascular repair includes angioplasty and/or stent placement of lesions within the mesenteric vasculature. […] The low morbidity and mortality associated with endovascular treatment, especially in this patient subset, has led to the widespread use of this treatment modality as first-line treatment for patients diagnosed with chronic mesenteric ischemia. […] Once a patient with classic symptoms is diagnosed with a lesion within the mesenteric vasculature and the diagnosis of chronic mesenteric ischemia is made, treatment options consist of open surgical repair and endovascular revascularization techniques. Traditionally, open surgical repair has been the standard method of treatment. However, the published success rates and lower morbidity and mortality associated with endovascular revascularization techniques have led to increased popularity of this technique as a first-line treatment for patients with chronic mesenteric ischemia.

• #37 Chronic Mesenteric Ischemia: Diagnosis and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3036470/

  Endovascular repair includes angioplasty and/or stent placement of lesions within the mesenteric vasculature. […] The low morbidity and mortality associated with endovascular treatment, especially in this patient subset, has led to the widespread use of this treatment modality as first-line treatment for patients diagnosed with chronic mesenteric ischemia. […] Once a patient with classic symptoms is diagnosed with a lesion within the mesenteric vasculature and the diagnosis of chronic mesenteric ischemia is made, treatment options consist of open surgical repair and endovascular revascularization techniques. Traditionally, open surgical repair has been the standard method of treatment. However, the published success rates and lower morbidity and mortality associated with endovascular revascularization techniques have led to increased popularity of this technique as a first-line treatment for patients with chronic mesenteric ischemia.

• #38 Endovascular therapy of chronic mesenteric ischaemia | EuroIntervention

  https://eurointervention.pcronline.com/article/endovascular-therapy-of-chronic-mesenteric-ischaemia

  Chronic mesenteric ischaemia (CMI) is associated with a high morbidity and mortality. […] We report on our experience with endovascular stent therapy. […] Stenoses of mesenteric arteries resulting in symptomatic CMI can be treated successfully with stent-angioplasty; for anatomical reasons, the brachial approach should be considered. […] Recanalisation of total obstructions is feasible if a stump of the occluded artery is detectable. […] Restenosis is frequent and can easily be treated with balloon angioplasty or stent-in-stent placement. […] Endovascular therapy using balloon angioplasty (PTA) of atherosclerotic mesenteric artery stenoses has the same limitations as PTA of atherosclerotic renal artery stenoses with a limited technical success rate and high restenosis rate. […] The present study found excellent acute results, both technically and clinically, with a complete relief of symptoms in all studied patients. […] Long-term patency, especially of atherosclerotic lesions, is acceptable considering the fact that using drug eluting stents has the potential to further reduce the 21% restenosis rate. […] Endovascular interventions offer promising acute and long-term success rates with low complication rates.

• #39 Role of Endovascular Therapies in Chronic Mesenteric Ischemia: Current Status and Technical Considerations

  https://www.acc.org/latest-in-cardiology/articles/2016/12/20/07/12/role-of-endovascular-therapies-in-chronic-mesenteric-ischemia

  Once a vessel is identified for revascularization, the decision to conduct plain balloon angioplasty versus primary stenting must be made. […] PVET is technically more challenging in totally occluded vessels compared to treatment of stenosed mesenteric arteries. […] The overall complication rate of PEVT is low (0-10%), and is mostly attributed to access site complications, including access site hematoma, AV fistula, pseudoaneurysm, etc. […] Outcomes data comparing PEVT to OSR are largely limited to observational cohorts. […] In this study, mortality was significantly higher with OSR (surgical bypass) compared to PEVT (13% vs. 3.7%, p0.001). […] Once diagnosed, treatment options include PEVT and OSR. […] However, for many high surgical risk patients, PEVT is becoming the preferred treatment in atherosclerotic CMI due to reduced peri-operative morbidity and mortality compared to OSR.

• #40 Chronic Mesenteric Ischemia: Diagnosis and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3036470/

  Endovascular repair includes angioplasty and/or stent placement of lesions within the mesenteric vasculature. […] The low morbidity and mortality associated with endovascular treatment, especially in this patient subset, has led to the widespread use of this treatment modality as first-line treatment for patients diagnosed with chronic mesenteric ischemia. […] Once a patient with classic symptoms is diagnosed with a lesion within the mesenteric vasculature and the diagnosis of chronic mesenteric ischemia is made, treatment options consist of open surgical repair and endovascular revascularization techniques. Traditionally, open surgical repair has been the standard method of treatment. However, the published success rates and lower morbidity and mortality associated with endovascular revascularization techniques have led to increased popularity of this technique as a first-line treatment for patients with chronic mesenteric ischemia.

• #41 Role of Endovascular Therapies in Chronic Mesenteric Ischemia: Current Status and Technical Considerations

  https://www.acc.org/latest-in-cardiology/articles/2016/12/20/07/12/role-of-endovascular-therapies-in-chronic-mesenteric-ischemia

  Chronic mesenteric ischemia (CMI), commonly referred to as „intestinal angina” is an uncommon vascular condition with an insidious onset that often leads to severe debilitating abdominal symptoms. […] Since its introduction by Shaw et al. in 1958, open surgical repair (OSR) has been the standard of treatment for CMI. […] In years since, multiple studies have reported that percutaneous endovascular treatment (PVET) of CMI is possible with a high technical success rate and with minimal complications in properly selected patients. […] As a result, PEVT has supplanted OSR as the default treatment for CMI in many centers across the United States, especially in patients with severe cardiovascular co-morbidities. […] As of 2005, PEVT has acquired a Class IB recommendation by the ACC/AHA for the treatment of CMI due to mesenteric stenosis, which is the same level of recommendation as for surgical endarterectomy or bypass grafting.

• #42 Role of Endovascular Therapies in Chronic Mesenteric Ischemia: Current Status and Technical Considerations

  https://www.acc.org/latest-in-cardiology/articles/2016/12/20/07/12/role-of-endovascular-therapies-in-chronic-mesenteric-ischemia

  Chronic mesenteric ischemia (CMI), commonly referred to as „intestinal angina” is an uncommon vascular condition with an insidious onset that often leads to severe debilitating abdominal symptoms. […] Since its introduction by Shaw et al. in 1958, open surgical repair (OSR) has been the standard of treatment for CMI. […] In years since, multiple studies have reported that percutaneous endovascular treatment (PVET) of CMI is possible with a high technical success rate and with minimal complications in properly selected patients. […] As a result, PEVT has supplanted OSR as the default treatment for CMI in many centers across the United States, especially in patients with severe cardiovascular co-morbidities. […] As of 2005, PEVT has acquired a Class IB recommendation by the ACC/AHA for the treatment of CMI due to mesenteric stenosis, which is the same level of recommendation as for surgical endarterectomy or bypass grafting.

• #43 Endovascular therapy of chronic mesenteric ischaemia | EuroIntervention

  https://eurointervention.pcronline.com/article/endovascular-therapy-of-chronic-mesenteric-ischaemia

  Chronic mesenteric ischaemia (CMI) is associated with a high morbidity and mortality. […] We report on our experience with endovascular stent therapy. […] Stenoses of mesenteric arteries resulting in symptomatic CMI can be treated successfully with stent-angioplasty; for anatomical reasons, the brachial approach should be considered. […] Recanalisation of total obstructions is feasible if a stump of the occluded artery is detectable. […] Restenosis is frequent and can easily be treated with balloon angioplasty or stent-in-stent placement. […] Endovascular therapy using balloon angioplasty (PTA) of atherosclerotic mesenteric artery stenoses has the same limitations as PTA of atherosclerotic renal artery stenoses with a limited technical success rate and high restenosis rate. […] The present study found excellent acute results, both technically and clinically, with a complete relief of symptoms in all studied patients. […] Long-term patency, especially of atherosclerotic lesions, is acceptable considering the fact that using drug eluting stents has the potential to further reduce the 21% restenosis rate. […] Endovascular interventions offer promising acute and long-term success rates with low complication rates.

• #44 Chronic Mesenteric Ischemia: Diagnosis and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3036470/

  Chronic mesenteric ischemia is a rare condition that was first described in 1918 as abdominal angina by Goodman. Its onset is gradual and it is often diagnosed late in its course. Treatment of the underlying lesion(s) is necessary to prevent the development of acute mesenteric ischemia, which may result in bowel infarction and death. […] Treatment is necessary to avoid progression to bowel ischemia and infarction. Once a diagnosis of chronic mesenteric ischemia is made, treatment options include open surgical revascularization and endovascular revascularization. […] After the diagnosis of chronic mesenteric ischemia is made, patients should undergo definitive treatment because of the risk of continued weight loss, acute infarction, perforation, sepsis, and death. […] Open surgical repair includes transaortic endarterectomy, direct reimplantation on the aorta, and antegrade or retrograde bypass grafting.

• #45 Mesenteric Ischemia | UCSF Department of Surgery

  https://vascularsurgery.ucsf.edu/condition/mesenteric-ischemia

  The goal of treatment is to reopen the blocked mesenteric arteries to restore adequate blood flow to the intestines. […] Trans-aortic endarterectomy is a procedure often used to treat chronic mesenteric ischemia. The surgery is designed to remove the plaque blocking the mesenteric artery. A vascular surgeon makes an incision (surgical cut) in the abdomen, or side, and removes the plaque from the inner lining of the blocked mesenteric artery. […] In bypass surgery, the vascular surgeon bypasses the narrowed or blocked section of the artery by creating a new avenue for blood flow using either a vein from another part of the body (bypass graft) or a tube made from synthetic material. This creates a new path for blood to flow to the intestines. […] In this procedure, sometimes performed at the time of the angiogram, the vascular surgeon inflates a small balloon inside a narrowed mesenteric artery. After widening the artery with angioplasty, the surgeon may insert a stent, a tiny metallic mesh tube that supports the artery’s walls and keeps the blood vessels open.

• #46 Mesenteric ischemia: Pathogenesis and challenging diagnostic and therapeutic modalities

  https://www.wjgnet.com/2150-5330/full/v7/i1/125.htm

  Surgical treatment of AMI with signs of peritonitis mainly includes exploratory laparotomy with meticulous assessment of bowel viability. […] In case of embolic AMI, infusion of thrombolytics within 8 h of symptoms onset is recommended for selected patients. […] CMI’s management is mostly surgical. […] Open revascularization (OR) and endovascular revascularization (ER) are the alternative modalities of treatment in patients with CMI. […] Surgical management includes transaortic endarterectomy of the celiac or SMA, antegrade bypass from the supraceliac aorta and retrograde bypass from the infrarenal aorta or the common iliac artery.

• #47 Chronic mesenteric ischemia | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/chronic-mesenteric-ischaemia?lang=us

  Chronic mesenteric ischemia is often multifactorial in etiology. The most common cause is atherosclerosis involving the proximal portions of the celiac artery, superior mesenteric artery (SMA), or inferior mesenteric artery (IMA). […] If a diagnosis of chronic mesenteric ischemia is made, patients should undergo definitive treatment due to the risk of continued weight loss, acute infarction, perforation, sepsis, or death. Medical treatment is usually reserved for patients who are not healthy enough to be treated, either surgically or endovascularly. The treatment consists of long-term anticoagulation, such as warfarin. […] An open surgical repair includes a transaortic endarterectomy, direct reimplantation on the aorta, or antegrade or retrograde bypass grafting. Endovascular repair includes angioplasty and/or stent placement of lesions within the mesenteric vasculature.

• #48 Update in management of mesenteric ischemia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4087969/

  Surgical revascularization for visceral ischemia due to an occluded SMA was first described by Shaw et al in 1958, in which they reported two successful cases of mesenteric thromboendarterectomy. […] For chronic occlusive disease, when revascularization is considered, single-vessel bypass to the superior mesenteric artery has been very successful, even in patients with multiple-vessel occlusions. […] Antegrade aortoceliac bypass and transaortic endarterectomy have been successful for poor-risk patients, and are usually adequate for multiple outflows. […] Since the first reports of percutaneous transluminal angioplasty of the visceral vessels in 1980, endovascular therapy for atherosclerotic disease has rapidly expanded in both scope and indication in the last ten years. […] In both the acute and chronic presentation of intestinal ischemia, endoluminal therapy has emerged as a main, if not first-line therapy.

• #49 Mesenteric ischemia: what the radiologist needs to know – Olson – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/21705/html

  In patients without frank evidence of bowel necrosis, endovascular treatment may allow for restoration of mesenteric blood flow with lower rates of in-hospital mortality. The primary disadvantage of this approach is that it does not allow for direct inspection of the bowel and assessment of viability. A hybrid technique, consisting of open surgery followed by endovascular SMA revascularization, has shown promise, as it allows for direct bowel evaluation and prompt restoration of mesenteric flow. However, experience with this technique remains limited, and its use is relatively rare. […] In patients with chronic mesenteric ischemia, endovascular repair is utilized more commonly than open repair. Endovascular repair is associated with fewer complications and shorter hospital stays, though at the expense of lower long-term patency and earlier recurrence of symptoms.

• #50 Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review

  https://www.mdpi.com/2077-0383/13/5/1217

  Endovascular interventions have gained popularity in the management of acute mesenteric ischemia due to the reports of lower laparotomy requirements, reduced bowel resection, and lower mortality rates. However, no randomized controlled trials exist comparing open versus endovascular approaches. […] The Society for Vascular Surgery recommends revascularization for symptomatic patients with chronic mesenteric ischemia, aiming to reverse the presenting symptoms and improve overall quality of life. The primary target for revascularization should be the superior mesenteric artery, with the celiac and inferior mesenteric arteries considered secondary targets. […] Endovascular revascularization is strongly recommended as the initial treatment in patients with amenable lesions, with open surgical revascularization reserved for patients with lesions not amenable to an endovascular intervention approach.

• #51 Acute Mesenteric Ischemia: Review of Etiologies and Treatment Options

  https://www.heraldopenaccess.us/openaccess/acute-mesenteric-ischemia-review-of-etiologies-and-treatment-options

  Non-Occlusive Mesenteric Ischemia (NOMI) occurs during systemic circulatory failure when blood flow is redistributed to vital organs. […] Treatment should be aimed at the underlying cause and in restoring hemodynamic stability. The administration of vasoconstrictive agents may help systemic blood pressure but worsen mesenteric ischemia. […] Acute mesenteric ischemia is a life-threatening condition that requires prompt diagnosis and treatment. There is a role for endovascular intervention in selective patients, especially those with SMA thrombosis. Open surgical intervention is still often necessary and should be strongly considered as first line therapy for SMA embolism.

• #52 Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00443-x

  Mesenteric venous thrombosis can often be successfully treated with a continuous infusion of unfractionated heparin. […] When NOMI is suspected, the focus is to correct the underlying cause and improve mesenteric perfusion. Infarcted bowel should be resected promptly. […] Postoperative intensive care of AMI patients is directed toward the improved intestinal perfusion and the prevention of a multiple organ failure. […] Treatment of AMI is optimal in a dedicated center using a focused care bundle and a multidisciplinary team. […] Patients undergoing revascularization should have surveillance imaging and long-term anticoagulation.

• #53 Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-017-0150-5

  Broad-spectrum antibiotics should be administered immediately. Unless contraindicated, patients should be anticoagulated with intravenous unfractionated heparin. […] Prompt laparotomy should be done for patients with overt peritonitis. […] Damage control surgery (DCS) is an important adjunct for patients who require intestinal resection due to the necessity to reassess bowel viability and in patients with refractory sepsis. Planned re-laparotomy is an essential part of AMI management. […] Mesenteric venous thrombosis can often be successfully treated with a continuous infusion of unfractionated heparin. […] When NOMI is suspected, the focus is to correct the underlying cause wherever possible and to improve mesenteric perfusion. Infarcted bowel should be resected promptly.

• #54 Nonocclusive mesenteric ischemia – UpToDate

  https://www.uptodate.com/contents/nonocclusive-mesenteric-ischemia

  Nonocclusive mesenteric ischemia (NOMI) is most commonly due to primary mesenteric arterial vasoconstriction. […] NOMI is managed by reversal of inciting factors, including cessation of vasoconstrictive medicines, correction of the underlying cause of hypoperfusion (if possible), and anticoagulation to limit arterial thrombosis. […] Selective infusion of the SMA with papaverine or other vasodilator is an option but is uncommonly performed today. […] TREATMENT includes Hemodynamic support and monitoring, Anticoagulation, Vasodilator infusion, and Abdominal exploration.

• #55 Mesenteric ischemia: what the radiologist needs to know – Olson – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/21705/html

  Treatment of NOMI is predicated on correction of the underlying cause of reduced intestinal perfusion. Mortality in these patients, who often have extensive comorbidity and poor overall protoplasm, is high, ranging from 50% to 83%. Intravascular infusion of vasodilators such as papaverine hydrochloride may be beneficial in some patients. […] In most patients with mesenteric venous thrombosis, the only treatment necessary is long-term anticoagulation, typically in the form heparin in the acute setting followed by a transition to oral medication over 24-48 hours.

• #56

  https://www.east.org/education-resources/landmark-papers-in-trauma-and-acute-care-surgery/emergency-general-surgery/acute-mesenteric-ischemia

  Preoperative risk factors for short-term postoperative mortality of acute mesenteric ischemia after laparotomy: A Systemic Review and Meta-Analysis. Wu W, Liu J, Zhou Z. Emerg Med Int. 2020 Oct 5;2020:1382475. […] Understanding these risk factors may help improve perioperative decision making. […] Vasodilator therapy and mortality in nonocclusive mesenteric ischemia: A Nationwide Observational Study. Takiguchi T, Nakajima M, Ohbe H, Sasabuchi Y, Matsui H, Fushimi K, Kim S, Yokota H, Yasunaga H. Crit Care Med. 2020 May;48(5):e356-e361. […] Large retrospective cohort study demonstrating vasodilatory therapy is associated with lower in-hospital mortality and prevalence of abdominal surgery in patients with nonocclusive mesenteric ischemia. […] The role of endovascular therapy in acute mesenteric ischemia. Ierardi AM, Tsetis D, Sbaraini S, Angileri SA, Galanakis N, Petrillo M, Patella F, Panella S, Balestra F, Lucchina N, Carrafiello G. Ann Gastroenterol. 2017; 30(5): 526533

• #57 Diagnosis and Management of Acute Mesenteric Ischemia – Endovascular Today

  https://evtoday.com/articles/2021-jan/diagnosis-and-management-of-acute-mesenteric-ischemia

  Acute mesenteric ischemia is caused by one of four mechanisms: acute arterial embolism (40%-50%), acute arterial thrombosis (20%-30%), nonocclusive mesenteric ischemia (NOMI) (20%), and mesenteric venous thrombosis (5%-15%). […] The initial management of acute mesenteric ischemia must focus on aggressive resuscitative measures. […] The administration of crystalloid fluid initially, followed by blood as necessary, should start in the emergency department. […] Broad-spectrum antibiotics directed against normal gut flora should also be given prior to proceeding to the operating room. […] Lastly, systemic heparinization should be initiated with a bolus dose of 100 units/kg as soon as acute mesenteric ischemia is suspected. […] Over the last 20 years, as endovascular techniques have become increasingly sophisticated and practitioners more adept at employing them, minimally invasive approaches to mesenteric ischemia have gained popularity.

• #58 Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00443-x

  Mesenteric venous thrombosis can often be successfully treated with a continuous infusion of unfractionated heparin. […] When NOMI is suspected, the focus is to correct the underlying cause and improve mesenteric perfusion. Infarcted bowel should be resected promptly. […] Postoperative intensive care of AMI patients is directed toward the improved intestinal perfusion and the prevention of a multiple organ failure. […] Treatment of AMI is optimal in a dedicated center using a focused care bundle and a multidisciplinary team. […] Patients undergoing revascularization should have surveillance imaging and long-term anticoagulation.

• #59 Acute Mesenteric Ischemia Treatment & Management: Approach Considerations, Initial Resuscitation and Stabilization, Pharmacologic Therapy

  https://emedicine.medscape.com/article/189146-treatment

  Some experience with percutaneous endovascular interventions has been accumulated. In select cases, especially in isolated spontaneous dissection of the SMA, stent placement may be the preferred option. […] Guidelines for the management of AMI have been published by the World Society of Emergency Surgery. […] Papaverine is an opium derivative that functions as a phosphodiesterase inhibitor, which acts to relax vascular smooth muscle. It is usually infused directly into the SMA, thus improving intestinal blood flow. […] Thrombolytic agents infused through the angiography catheter can be life-saving for selected patients with AMAE. […] Heparin anticoagulation is the main therapy for MVT. […] Surgical treatment of AMAT (ie, thrombotic AMI) involves exploratory laparotomy, followed by identification of the involved artery and bowel.

• #60 Mesenteric ischemia: what the radiologist needs to know – Olson – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/21705/html

  Treatment of NOMI is predicated on correction of the underlying cause of reduced intestinal perfusion. Mortality in these patients, who often have extensive comorbidity and poor overall protoplasm, is high, ranging from 50% to 83%. Intravascular infusion of vasodilators such as papaverine hydrochloride may be beneficial in some patients. […] In most patients with mesenteric venous thrombosis, the only treatment necessary is long-term anticoagulation, typically in the form heparin in the acute setting followed by a transition to oral medication over 24-48 hours.

• #61 Mesenteric Ischemia : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/mesenteric-ischemia/

  Mesenteric Arterial Ischemia: Initial management: Aggressive IV fluids and electrolyte monitoring, AVOID vasopressors. IV broad-spectrum antibiotics. IV unfractionated heparin: decision should be made with surgical consult. NPO in acute mesenteric ischemia. Enteral nutrition or parenteral nutrition in chronic mesenteric ischemia. […] Stable: endovascular intervention with pharmacomechanical thrombolysis (embolic disease) or stenting (thrombotic disease). […] Unstable: laparotomy with thromboembolectomy, mesenteric bypass and/or retrograde mesenteric stent, and bowel resection, if necessary. […] Mesenteric Venous Thrombosis: Stepwise approach: If symptoms are mild and no CT evidence of compromised bowel perfusion, LMWH and transition to oral anticoagulation. If symptoms are severe and CT shows edematous bowel, continuous IV UFH. If medical treatment fails, options include percutaneous mechanical thrombectomy and/or catheter-directed thrombolysis via transhepatic access.

• #62 Mesenteric Ischemia : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/mesenteric-ischemia/

  Mesenteric Arterial Ischemia: Initial management: Aggressive IV fluids and electrolyte monitoring, AVOID vasopressors. IV broad-spectrum antibiotics. IV unfractionated heparin: decision should be made with surgical consult. NPO in acute mesenteric ischemia. Enteral nutrition or parenteral nutrition in chronic mesenteric ischemia. […] Stable: endovascular intervention with pharmacomechanical thrombolysis (embolic disease) or stenting (thrombotic disease). […] Unstable: laparotomy with thromboembolectomy, mesenteric bypass and/or retrograde mesenteric stent, and bowel resection, if necessary. […] Mesenteric Venous Thrombosis: Stepwise approach: If symptoms are mild and no CT evidence of compromised bowel perfusion, LMWH and transition to oral anticoagulation. If symptoms are severe and CT shows edematous bowel, continuous IV UFH. If medical treatment fails, options include percutaneous mechanical thrombectomy and/or catheter-directed thrombolysis via transhepatic access.

• #63 Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00443-x

  Mesenteric venous thrombosis can often be successfully treated with a continuous infusion of unfractionated heparin. […] When NOMI is suspected, the focus is to correct the underlying cause and improve mesenteric perfusion. Infarcted bowel should be resected promptly. […] Postoperative intensive care of AMI patients is directed toward the improved intestinal perfusion and the prevention of a multiple organ failure. […] Treatment of AMI is optimal in a dedicated center using a focused care bundle and a multidisciplinary team. […] Patients undergoing revascularization should have surveillance imaging and long-term anticoagulation.

• #64 Endovascular Treatment for Acute Mesenteric Ischemia | IntechOpen

  https://www.intechopen.com/chapters/82365

  Surgery and revascularization are both mandatory to provide optimal survival chances in patients with extensive bowel necrosis. […] For patients who received stenting to SMA before surgery, care must be taken not to manipulate the SMA forcefully to avoid inadvertent crush of the stent. […] ICU care after the endovascular procedure is mandatory. […] The general surgeon will check the abdominal physical exams to detect changes in peritoneal signs. […] Aspirin (100 mg) and clopidogrel (75 mg) are initiated if no bleeding is noted after overnight observation.

• #65 Acute Mesenteric Ischemia Treatment & Management: Approach Considerations, Initial Resuscitation and Stabilization, Pharmacologic Therapy

  https://emedicine.medscape.com/article/189146-treatment

  For patients with severe MVT, exploratory laparotomy with assessment of bowel viability is indicated. […] Some experience with percutaneous endovascular interventions has been accumulated. A few patients who have atherosclerotic plaques at the origin of the SMA after thrombolysis are eligible for angioplasty. […] Postoperative care should include close monitoring of blood pressure and hemoglobin level to evaluate for sepsis or hemorrhage. […] To prepare for surgery and to reduce oxygen demand on the ischemic bowel, patients must be on NPO status. […] Patients activities are dictated by their conditions. […] The following consultations should be considered in the setting of AMI: Vascular surgeon – To evaluate the patient and to perform a revascularization procedure if required; this consultation should be obtained as soon as the diagnosis is considered. […] Because of the high likelihood of concomitant vascular disease in the rest of the arterial tree, patients must be closely monitored.

• #66 Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00443-x

  Mesenteric venous thrombosis can often be successfully treated with a continuous infusion of unfractionated heparin. […] When NOMI is suspected, the focus is to correct the underlying cause and improve mesenteric perfusion. Infarcted bowel should be resected promptly. […] Postoperative intensive care of AMI patients is directed toward the improved intestinal perfusion and the prevention of a multiple organ failure. […] Treatment of AMI is optimal in a dedicated center using a focused care bundle and a multidisciplinary team. […] Patients undergoing revascularization should have surveillance imaging and long-term anticoagulation.

• #67 Mesenteric Ischemia : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/mesenteric-ischemia/

  Nonocclusive Mesenteric Ischemia: Ensure hemodynamic stability: fluid resuscitation and electrolytes, blood transfusion. Manage underlying cause (HF or sepsis). IV infusion of vasodilatory and antispasmodic agents can be used: Papaverine 60 mg bolus followed by infusion (30-60 mg/hr) with repeated angiograms obtained every 24 hours. Laparotomy when bowel necrosis is suspected. […] Long-term management: Aspirin lifelong in all patients who undergo endovascular or open repair. Clopidogrel for 1-3 months after endovascular repair. DOAC indicated in patients with atrial fibrillation, MVT. Lifestyle management: smoking cessation, exercise, manage dyslipidemia and hypertension.

• #68 Acute Mesenteric Ischemia – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/acute-abdomen-and-surgical-gastroenterology/acute-mesenteric-ischemia

  Treatment is by embolectomy, revascularization of viable segments, or resection; sometimes vasodilator therapy is successful. […] Patients should be resuscitated with intravenous fluids to improve visceral perfusion. Broad-spectrum antibiotics should be initiated. […] If diagnosis is made during exploratory laparotomy, options are surgical embolectomy, revascularization, and resection. […] If diagnosis is made by angiography, infusion of the vasodilator papaverine through the angiography catheter may improve survival in nonocclusive ischemia. […] For arterial occlusion, thrombolysis or surgical embolectomy may be done. […] Mesenteric venous thrombosis without signs of peritonitis can be treated with anticoagulant medications. […] Patients with arterial embolism or venous thrombosis should be considered for long-term anticoagulation and dual antiplatelet therapy and surveillance for graft or stent patency.

• #69 Acute Mesenteric Ischemia Treatment & Management: Approach Considerations, Initial Resuscitation and Stabilization, Pharmacologic Therapy

  https://emedicine.medscape.com/article/189146-treatment

  Some experience with percutaneous endovascular interventions has been accumulated. In select cases, especially in isolated spontaneous dissection of the SMA, stent placement may be the preferred option. […] Guidelines for the management of AMI have been published by the World Society of Emergency Surgery. […] Papaverine is an opium derivative that functions as a phosphodiesterase inhibitor, which acts to relax vascular smooth muscle. It is usually infused directly into the SMA, thus improving intestinal blood flow. […] Thrombolytic agents infused through the angiography catheter can be life-saving for selected patients with AMAE. […] Heparin anticoagulation is the main therapy for MVT. […] Surgical treatment of AMAT (ie, thrombotic AMI) involves exploratory laparotomy, followed by identification of the involved artery and bowel.

• #70 Update in management of mesenteric ischemia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4087969/

  Thrombolytic therapy in the management of intestinal ischemia was first reported in 1979 with the successful application of intraarterial streptokinase in the SMA. […] In many centers, intracatheter fibrinolysis with or without embolus retrieval is the initial treatment for SMA thromboembolism. […] In the subset of patients who suffer from nonocclusive ischemia, intraarterial vasodilator therapy has been largely responsible for the decrease in mortality from 70% in the 1980s to 50%-55% during the last decade. […] Investigational therapy in the treatment of mesenteric ischemia has focused on pharmacologic strategies to treat mesenteric ischemia. […] The dual-hit hypothesis of ischemic injury is comprised of the initial hypoxic episode and then the subsequent reperfusion injury after reestablishment of forward flow. […] In conclusion, mesenteric ischemia, a spectrum of disorders with multiple etiologies still carries significant morbidity and mortality.

• #71 Update in management of mesenteric ischemia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4087969/

  Thrombolytic therapy in the management of intestinal ischemia was first reported in 1979 with the successful application of intraarterial streptokinase in the SMA. […] In many centers, intracatheter fibrinolysis with or without embolus retrieval is the initial treatment for SMA thromboembolism. […] In the subset of patients who suffer from nonocclusive ischemia, intraarterial vasodilator therapy has been largely responsible for the decrease in mortality from 70% in the 1980s to 50%-55% during the last decade. […] Investigational therapy in the treatment of mesenteric ischemia has focused on pharmacologic strategies to treat mesenteric ischemia. […] The dual-hit hypothesis of ischemic injury is comprised of the initial hypoxic episode and then the subsequent reperfusion injury after reestablishment of forward flow. […] In conclusion, mesenteric ischemia, a spectrum of disorders with multiple etiologies still carries significant morbidity and mortality.

• #72 Advancements in Treatment Strategies for Chronic Mesenteric Ischemia: A Comprehensive Review

  https://www.mdpi.com/2077-0383/12/22/7112

  Chronic mesenteric ischemia (CMI) arises from the inability to achieve adequate intestinal blood flow after meals, leading to an imbalance between oxygen and metabolite supply and demand. […] The inaugural performance of endovascular revascularization (ER) for visceral vessels took place in 1980. […] Despite the limited quality of available evidence, the consensus among experts is strongly in favor of PMAS over PTA alone for the treatment of atherosclerotic mesenteric artery stenosis. […] There are several key areas of focus for chronic mesenteric ischemia (CMI) treatment. […] Well-designed randomized controlled trials comparing different stent types, such as covered stents versus bare metal stents, are needed to evaluate efficacy, patency rates, and long-term outcomes in CMI patients.

• #73

  https://link.springer.com/article/10.1007/s00134-024-07363-1

  A key to improve management of AMI is awareness, allowing adequately raised and communicated suspicion followed by early diagnosis and treatment. […] CT with intravenous contrast enhancement and imaging in the arterial phase followed by early revascularization in case of arterial occlusion carries the potential to rescue the bowel, whereas early systemic treatment optimizing volume status and organ perfusion is important for all subtypes of AMI, but most crucial for NOMI. Selection of initial management requires a multidisciplinary approach and cannot be based on time alone.

• #74 Acute mesenteric ischaemia in the elderly – results of combined endovascular and surgical treatment. Primary study | Scientific Reports

  https://www.nature.com/articles/s41598-024-84026-7

  The next step in improving adverse outcomes is to concentrate patients in centres where an interventional radiologist is available 24 hours a day, where there are highly specialised intensive care units and where surgical follow-up is available, and to establish a common care algorithm. […] To achieve the best possible therapeutic outcome, correct early diagnosis and treatment of the disease as soon as possible after the onset of symptoms is necessary.

• #75 Mesenteric ischemia | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/mesenteric-ischaemia?lang=us

  Mesenteric ischemia, also commonly referred to as bowel or intestinal ischemia, refers to vascular compromise of the bowel and its mesentery that in the acute setting has a very high mortality if not treated expediently. […] Although treatment will vary according to the severity and cause of the ischemia, in general the treatment is surgical. The bowel needs to be assessed for viability and if necrotic needs to be resected. In some instances, endovascular thrombolysis/thrombectomy may be beneficial. Mortality rate is high at ~60% (range 30-90%).

• #76 Mesenteric ischemia: what the radiologist needs to know – Olson – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/21705/html

  Treatment of NOMI is predicated on correction of the underlying cause of reduced intestinal perfusion. Mortality in these patients, who often have extensive comorbidity and poor overall protoplasm, is high, ranging from 50% to 83%. Intravascular infusion of vasodilators such as papaverine hydrochloride may be beneficial in some patients. […] In most patients with mesenteric venous thrombosis, the only treatment necessary is long-term anticoagulation, typically in the form heparin in the acute setting followed by a transition to oral medication over 24-48 hours.

• #77 Acute Mesenteric Ischemia: Review of Etiologies and Treatment Options

  https://www.heraldopenaccess.us/openaccess/acute-mesenteric-ischemia-review-of-etiologies-and-treatment-options

  Acute mesenteric ischemia is a life-threatening condition that can be caused by several different pathologies. Numerous treatment options are available including endovascular intervention and open surgical revascularization. Here we review the most common etiologies of acute mesenteric ischemia and modern treatment options. […] Rapid diagnosis of AMI is critical. Mortality rates rise steadily with time from onset. Mortality rates are 0-10% with immediate treatment, 50-60% for delays of 6-12 hours, and 80-100% with treatment delays of 24 hours. […] Once the diagnosis is made, fluid resuscitation should begin and broad-spectrum antibiotics should be administered as there is a significant risk of bacterial translocation across the intestinal membrane. […] Although endovascular interventions are available and widely accepted for the treatment of arterial embolism, there is nearly universal agreement that patients presenting with frank ischemia of the bowel should undergo immediate laparotomy.

• #78 Role of Endovascular Therapies in Chronic Mesenteric Ischemia: Current Status and Technical Considerations

  https://www.acc.org/latest-in-cardiology/articles/2016/12/20/07/12/role-of-endovascular-therapies-in-chronic-mesenteric-ischemia

  Once a vessel is identified for revascularization, the decision to conduct plain balloon angioplasty versus primary stenting must be made. […] PVET is technically more challenging in totally occluded vessels compared to treatment of stenosed mesenteric arteries. […] The overall complication rate of PEVT is low (0-10%), and is mostly attributed to access site complications, including access site hematoma, AV fistula, pseudoaneurysm, etc. […] Outcomes data comparing PEVT to OSR are largely limited to observational cohorts. […] In this study, mortality was significantly higher with OSR (surgical bypass) compared to PEVT (13% vs. 3.7%, p0.001). […] Once diagnosed, treatment options include PEVT and OSR. […] However, for many high surgical risk patients, PEVT is becoming the preferred treatment in atherosclerotic CMI due to reduced peri-operative morbidity and mortality compared to OSR.

• #79 Mesenteric ischemia: what the radiologist needs to know – Olson – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/21705/html

  In patients without frank evidence of bowel necrosis, endovascular treatment may allow for restoration of mesenteric blood flow with lower rates of in-hospital mortality. The primary disadvantage of this approach is that it does not allow for direct inspection of the bowel and assessment of viability. A hybrid technique, consisting of open surgery followed by endovascular SMA revascularization, has shown promise, as it allows for direct bowel evaluation and prompt restoration of mesenteric flow. However, experience with this technique remains limited, and its use is relatively rare. […] In patients with chronic mesenteric ischemia, endovascular repair is utilized more commonly than open repair. Endovascular repair is associated with fewer complications and shorter hospital stays, though at the expense of lower long-term patency and earlier recurrence of symptoms.

• #80 Mesenteric ischemia: what the radiologist needs to know – Olson – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/21705/html

  The treatment of mesenteric ischemia depends on its acuity, the patients clinical presentation, and preoperative comorbidities. […] Initial medical management strategies in the treatment of AMI focus on preservation of hemodynamic status. Aggressive fluid resuscitation and avoidance of oral intake may be helpful in preventing exacerbation of intestinal ischemia. Bowel infarction can result in hyperkalemia and metabolic acidosis, which may precipitate a systemic inflammatory response or sepsis. The early initiation of heparin, antibiotic therapy, and, if needed, vasodilators is also a vital component of care. […] The most important prognostic factor in patients with AMI is intestinal viability. Those with peritonitis and clear signs of bowel infarction or perforation should undergo emergent open laparotomy, which allows for direct visualization of the bowel, reestablishment of blood flow to areas of ischemic bowel, and resection of all regions of non-viable intestine. Revascularization methods include embolectomy, angioplasty, and bypass.

• #81 EM@3AM: Mesenteric Ischemia – emDocs

  https://www.emdocs.net/em3am-mesenteric-ischemia/

  Treatment: […] NPO and fluid resuscitate with crystalloid and correct electrolyte and base deficit. […] Broad spectrum antibiotics: ceftriaxone and metronidazole or piperacillin/tazobactam. […] If persistently hypotensive after fluid resuscitation, vasopressors. […] Ask surgeons if they want heparin started. […] If mesenteric venous thrombosis confirmed on CT venography, systemically anticoagulate with unfractionated heparin. […] Postoperative intra-arterial papaverin infusion into SMA to reduce vasospasm. […] Disposition: […] Early surgical consultation. […] AMI secondary to SMV thrombosis => heparin infusion and to MICU. […] May involve IR for endovascular thrombectomy. […] Endovascular thrombectomy success rates vs open. […] Bowel resection reduces mortality to 30% though the need for bowel resection reflects the degree of ischemia and was found to be an independent mortality predictor.

• #82 Update in management of mesenteric ischemia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4087969/

  Mesenteric ischemia disorders are precipitated by a circulation insufficiency event that deprives one or several abdominal organs of adequate respiration to meet metabolic demands. […] The successful outcome is dependent upon a high index of suspicion and prompt management. […] Despite advances in both diagnosis and treatment, prompt diagnosis and supportive care remain critical for successful outcome. New imaging techniques, endovascular therapy and emerging research may improve our approach to this deadly condition. […] Management of mesenteric ischemia clearly depends on the nature, acuity and severity of disease. Early intervention involves resection of nonviable bowel, restoration of blood flow to the ischemic intestine and supportive care. […] In the acute thromboembolic event, operative embolectomy has been the traditional procedure with reasonable short and long term outcomes.

• #83 Diagnosis and Management of Acute Mesenteric Ischemia – Endovascular Today

  https://evtoday.com/articles/2021-jan/diagnosis-and-management-of-acute-mesenteric-ischemia

  Endovascular techniques have expanded past percutaneous transluminal angioplasty and stenting to now include mechanical thrombectomy involving aspiration, pharmacologic thrombolysis, or a rheolytic system. […] The Society for Vascular Surgery and the American College of Cardiology/American Heart Association consensus guidelines support the use of percutaneous revascularization in certain situations. […] If the decision is made to start with laparotomy, a transperitoneal incision is made to expose the entire abdominal contents. […] Therapy is initiated with systemic anticoagulation and bowel resection in the setting of necrosis. […] If patients do not experience improvement within 24 to 48 hours, consideration should be given to intervention. […] Although survival for all causes of mesenteric ischemia is relatively poor, prompt recognition and intervention are key to improving outcomes.

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