Endovascular Management of Acute and Chronic Mesenteric Ischemia

Background

Mesenteric ischemia demands prompt and effective revascularization. Endovascular therapy (EVT) has become a well-established treatment modality with several benefits. This review examines current EVT options for managing acute and chronic mesenteric ischemia (CMI) in contemporary practice.

Method

A comprehensive literature review was conducted to evaluate endovascular techniques for mesenteric ischemia, including angioplasty, stenting, thrombectomy, thrombolysis, pharmacological thrombectomy, local vasodilator infusion, and hybrid approaches. We also evaluated access sites and postoperative management.

Results

EVT offers several advantages in the management of mesenteric ischemia, with various access sites and techniques available for single or combined use. EVT has largely replaced open revascularization for CMI and is increasing in use for acute mesenteric ischemia (AMI). The utility of each approach varies by disease chronicity, with different risk-benefit profiles. While short-term outcomes are favorable, long-term patency rates and the need for reinterventions remain concerns. Further research is needed to compare open to endovascular revascularization.

Conclusion

EVT provides diverse revascularization options for mesenteric ischemia, particularly for high-risk patients. While it has favorable short-term outcomes, EVT may be associated with higher rates of restenosis and reintervention in the long term and the overall mortality rates for this disease process remain high, particularly for AMI. The choice between endovascular and open surgical approaches should be individualized on patient factors, lesion characteristics, and surgeon or interventionist expertise. Further prospective and randomized trials are needed to better elucidate outcomes from this approach and guide operative management.