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Updated: Aug 19, 2025

Multimodality Diagnosis of Mesenteric Ischemia

Multimodality Diagnosis of Mesenteric Ischemia

Published on: July 21, 2023

ACR Appropriateness Criteria® Radiologic Management of Mesenteric Ischemia: 2022 Update.

, Alexander Lam¹, Yoon-Jin Kim²

¹University of California, San Francisco, San Francisco, California.

Journal of the American College of Radiology : JACR

|November 27, 2022

Summary

Mesenteric ischemia, a condition of reduced small bowel blood supply, has varied treatments. Acute cases often use endovascular methods, while chronic cases favor revascularization, with surgery as an alternative.

Keywords:

AUC Appropriate Use Criteria Appropriateness Criteria Chronic mesenteric ischemia Median arcuate ligament Mesenteric ischemia NOMI Nonocclusive mesenteric ischemia Venous ischemia

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Area of Science:

Vascular Surgery
Interventional Radiology
Gastroenterology

Background:

Mesenteric ischemia involves insufficient blood supply to the small bowel, presenting acute or chronic forms.
Treatment strategies vary based on the type of ischemia, including occlusive, nonocclusive, and venous.
Median arcuate ligament syndrome diagnosis is debated, but angiography aids diagnosis with surgical release as preferred treatment.

Framework:

ACR Appropriateness Criteria provide evidence-based guidelines for clinical conditions.
Methodology involves systematic literature analysis using principles like GRADE.
RAND/UCLA Appropriateness Method guides procedure appropriateness assessment.

Implementation:

Acute mesenteric ischemia: Endovascular interventions (embolectomy, thrombolysis, angioplasty/stenting).
Nonocclusive mesenteric ischemia: Transarterial vasodilator infusion (papaverine, prostaglandin E1).
Chronic mesenteric ischemia: Endovascular revascularization (angioplasty/stenting) preferred; surgery is alternative.
Venous mesenteric ischemia: Systemic anticoagulation initially; transcatheter thrombolysis if failed.

Implications:

Guidelines aid in selecting appropriate diagnostic and therapeutic procedures for mesenteric ischemia.
Evidence-based recommendations optimize patient outcomes and resource utilization.
Expert consensus addresses areas with limited peer-reviewed literature.