[Mesenteric infarct--when is the vascular surgeon needed?]

The treatment of acute mesenteric infarction is a therpeutical challenge. The mortality rate of these, mainly beyond 70 year old patients has remained extraordinary high despite diagnostic and therapeutic efforts and progress in intensive care medicine. Additionally to the initial hypoxaemia of the bowel a more severe tissue damage is induced via the "reperfusion injury", with increase of the vital risk. Besides the detection of occlusive vascular lesions of different etiology, which have to be treated immediately, "non occlusive mesenteric ischemia" can be identified. Visceral biplane angiography is the diagnostic tool of choice, giving basic informations on concomitant lesions, for a rational vascular surgical intervention and additionally the opportunity to administer vasoactive drugs. Despite increasing treatment modalities influencing the severity of the "reperfusion injury" the most important criteria for the patients' survival is the early diagnosis and immediate treatment. Therefore, close cooperation of general practitioners, internists, radiologists, angiologists, general surgeons and vascular surgeons is required. The support of a vascular surgeon is necessary for complex arterial reconstructions as success and patency rate are significantly influenced by experience. Reocclusion and "redo"-surgery increase the risk substantially.