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Updated: Dec 24, 2025
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
[Endovascular surgery for acute mesenteric ischemia]
A I Khripun1, A B Mironkov2, A D Pryamikov2
1Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Department of Surgery and Endoscopy of the Faculty of Additional Professional Education, Moscow, Russia.
Objective:
To demonstrate the results of endovascular treatment of 15 patients with acute mesenteric ischemia.
Material And Methods:
There were 15 patients with acute mesenteric ischemia who underwent surgery (9 men and 6 women). Mean age was 77±11 years. Acute intestinal ischemia was caused by thromboembolism of superior mesenteric artery (9 patients), thrombosis of superior mesenteric artery (5 patients) and critical stenosis of the ostia of superior mesenteric artery and celiac trunk (1 patient). Mean time from clinical manifestation of disease to admission to the hospital was 13 hours (range 2-72 hours). In-hospital development of acute mesenteric ischemia was noted in 2 patients. Indications for endovascular intervention and techniques of endovascular revascularization of superior mesenteric artery are described in the article.
Results:
Blood flow restoration in superior mesenteric artery was achieved in 14 (93%) out of 15 patients. Laparotomy was required in 4 (27%) patients for extensive resection of necrotic intestine (n=1, 6.7%), local resection of small bowel (n=2, 13%). In another (6.7%) patient, intestine was recognized as viable after laparotomy. A bulk of intestine was preserved in most patients (n=14, 93%). In-hospital mortality rate was 47% (7 patients died). The main cause of nosocomial death (6 cases) was reperfusion syndrome followed by respiratory distress syndrome and multiple organ failure.
Conclusion:
New methods of prevention and treatment of reperfusion syndrome can improve the results of treatment of acute mesenteric ischemia.
Insights
Endovascular treatment successfully restored superior mesenteric artery blood flow in 93% of acute mesenteric ischemia patients. However, high mortality persists, primarily due to reperfusion syndrome.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Gastroenterology
Background:
- Acute mesenteric ischemia (AMI) is a critical condition with high mortality.
- Endovascular techniques offer a minimally invasive approach to revascularization.
Purpose of the Study:
- To evaluate the outcomes of endovascular treatment for AMI.
- To assess the efficacy and safety of endovascular revascularization of the superior mesenteric artery.
Main Methods:
- Retrospective analysis of 15 patients with AMI who underwent endovascular treatment.
- Details of endovascular intervention techniques and indications are described.
- Causes of AMI included thromboembolism, thrombosis, and stenosis of the superior mesenteric artery.
Main Results:
- Successful blood flow restoration in the superior mesenteric artery was achieved in 14 out of 15 patients (93%).
- Intestinal viability was preserved in most patients (93%), with limited need for bowel resection.
- The in-hospital mortality rate was 47%, with reperfusion syndrome being the leading cause of death.
Conclusions:
- Endovascular treatment can effectively restore mesenteric blood flow and preserve bowel viability in AMI.
- High mortality remains a significant challenge, largely attributed to reperfusion syndrome.
- Developing novel strategies for preventing and managing reperfusion syndrome is crucial for improving AMI outcomes.
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