Endovascular Versus Open Surgical Approaches for Acute Mesenteric Ischemia: A Systematic Review of Outcomes

Acute mesenteric ischemia (AMI) remains a life-threatening vascular emergency, with significant clinical challenges despite advances in diagnostic and therapeutic approaches. This systematic review compared the efficacy and outcomes of endovascular versus open surgical interventions in AMI management. A comprehensive search of PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library was conducted from database inception through February 15, 2025, yielding six retrospective cohort studies that met inclusion criteria. Endovascular intervention was associated with lower in-hospital mortality compared to open surgery in most studies. Patients undergoing endovascular therapy demonstrated significantly lower bowel resection rates and preserved intestinal length. Additional benefits included shorter hospital stays, reduced ICU length of stay, and fewer complications, including acute renal failure and pulmonary complications. However, endovascular approaches were associated with higher reintervention rates. Independent predictors of mortality included elevated lactate concentration, pneumatosis intestinalis, increased white blood cell count, chronic renal insufficiency, and extensive bowel necrosis. Endovascular therapy represents a promising approach for AMI management, particularly in patients without evidence of bowel necrosis at presentation, though careful patient selection and vigilant monitoring are essential due to higher reintervention rates. Prospective studies are needed to better define optimal treatment strategies for different AMI patient subgroups.