Endovascular Procedures for Mesenteric Ischemia

Mesenteric ischemia is a condition caused by compromised blood flow to the small and large intestines. Patients can present with chronic mesenteric ischemia (CMI), most commonly due to atherosclerosis, or acute mesenteric ischemia (AMI), most commonly due to arterial thrombosis or arterial embolism. Endovascular options for CMI include angioplasty and stenting, whereas options for AMI include catheter-directed thrombolysis and suction embolectomy followed by angioplasty and stenting of the underlying lesion. For treatment of CMI, an endovascular approach is associated with lower morbidity and mortality with good immediate technical success rates but may be less durable than surgical intervention, with reported lower long-term patency and a higher recurrence rate. There are no randomized trials comparing open versus endovascular interventions for AMI. Even after successful endovascular treatment, there should be a low threshold for laparotomy to visually inspect the bowel. Postoperative imaging is important, and close follow-up is mandatory. This review contains 8 figures, and 26 references.