Case report: direct revascularization in acute mesenteric ischemia by an endovascular approach

Acute mesenteric ischemia is a relatively rare but life-threatening clinical condition. Outcome depends on early diagnosis and prompt intervention.

A 85-year-old man and a 75-year-old woman developed acute mesenteric ischemia due to cardiac embolism. The first patient received an insufficient dose of anticoagulants for atrial fibrillation and the second patient dicontinued her anticoagulantia to avoid bleeding during a routine colonoscopy. Both patients presented with severe abdominal pain and computed tomography showed thrombus in de superior mesenteric artery. Successfulrevascularization with good clinical outcome was achieved by means of an endovascular first approach.

This case report shows that an endovascular approach - in contrast to open surgery - not only enables to revascularize main trunk lesions but can also facilitate revascularization of side branches. Endovascular treatment used to be limited to a selected group of patients without signs of bowel necrosis, but there is a tendency to initiate endovascular revascularization in all patients because it is associated with a reduced mortality, a reduced laparotomy rate and reduction in the resected length of bowel.