Acute Mesenteric Ischemia: A Simple and Practical Approach

Abstract

The diagnosis and management of acute mesenteric ischemia (AMI) have evolved considerably since first described nearly 150 years ago. Angiography remains the gold standard for establishing a definitive diagnosis. Today, several therapeutic options—both percutaneous and surgical—are available for combatting AMI. Vasodilation, lytic, and balloon angioplastic procedures are percutaneous approaches that can be considered in a subset of patients in whom the clinical examination does not necessitate immediate laparotomy. When laparotomy is mandatory, embolectomy, thromboendarterectomy, and a variety of mesenteric revascularization procedures have enabled intestinal salvage. As a result, the morbidity and mortality of AMI have declined. The authors offer an algorithm that simplifies the approach to AMI, emphasizes rapid diagnosis and early intervention, and includes percutaneous therapy as an option to consider.