title: Acute mesenteric ischemia: a vascular emergency.
abstract: BACKGROUND
  Acute mesenteric ischemia is still fatal in 50% to 70% of cases. This consensus paper was written with the participation of physicians from all of the involved specialties for the purpose of improving outcomes. Mesenteric ischemia must be recognized as a vascular emergency requiring rapid and efficient clinical evaluation and treatment.
  
  
  METHODS
  We reviewed pertinent literature that was retrieved by a PubMed search on the terms "mesenteric ischemia" AND "arterial" OR "venous" OR "clinical presentation" OR "diagnosis" OR "therapy" OR "surgery" OR " interventional radiology." Our review also took account of the existing guidelines of the American College of Cardiology/American Heart Association. Intensive discussions among the participating physicians, representing all of the specialties involved in the management of mesenteric ischemia, led to the creation of this interdisciplinary paper.
  
  
  RESULTS
  Biphasic contrast-enhanced computerized tomography is the diagnostic tool of choice for the detection of arterial or venous occlusion. If non-occlusive mesenteric ischemia is suspected, angiography should be performed, with the option of intraarterial pharmacotherapy to induce local vasodilation. Endovascular techniques have become increasingly important in the treatment of arterial occlusion. Embolic central mesenteric artery occlusion requires surgical treatment; surgery is also needed in case of peritonitis. Portal-vein thrombosis can be treated by local thrombolysis through a transhepatically placed catheter. This should be done within 3 to 4 weeks of the event to prevent later complications of portal hypertension.
  
  
  CONCLUSIONS
  Rapid diagnosis (within 4 to 6 hours of symptom onset) and interdisciplinary cooperation in the provision of treatment are required if the poor outcome of this condition is to be improved.
authors.affiliation: Department of General, Thoracic, Vascular and Transplantation Surgery, University Medical Center Rostock, Germany. ernst.klar@med.uni-rostock.de
authors.forename: Ernst
authors.initials: E
authors.lastname: Klar
authors.forename: Parwis B
authors.initials: PB
authors.lastname: Rahmanian
authors.forename: Arno
authors.initials: A
authors.lastname: Bücker
authors.forename: Karlheinz
authors.initials: K
authors.lastname: Hauenstein
authors.forename: Karl-Walter
authors.initials: KW
authors.lastname: Jauch
authors.forename: Bernd
authors.initials: B
authors.lastname: Luther
mesh_terms: D003422:Critical Care / Q000379:methods*; D003952:Diagnostic Imaging / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D007511:Ischemia / Q000175:diagnosis* / Q000628:therapy*; D065666:Mesenteric Ischemia; D014652:Vascular Diseases / Q000175:diagnosis* / Q000628:therapy*