title: Contemporary results of treatment of acute arterial mesenteric thrombosis: has endovascular treatment improved outcomes?
abstract: Acute mesenteric ischemia is an uncommon but highly complex clinical problem and carries a high mortality. Traditional treatment has yielded only modest improvements in mortality and an endovascular first treatment paradigm has been adopted by selected centers over the past decade. However, the technique does not allow for immediate assessment of intestinal viability and availability of the expertise and equipment is mostly limited to tertiary referral centers. Experience gained with endovascular treatment thus far suggests that careful patient selection, procedure planning, and meticulous technique are the key to further improving results. Most important, prolonged attempts at percutaneous intervention should not be allowed to delay laparotomy and bowel assessment. In patients requiring urgent laparotomy, intraoperative retrograde superior mesenteric artery recanalization remains an attractive option and should be given due consideration. Liberal use of second-look laparotomy is to be encouraged for continued bowel assessment and eventual reestablishment of bowel continuity. Early recognition of the problem with expeditious implementation of the appropriate treatment is likely to improve outcomes of this challenging problem in the future.
authors.affiliation: 1Mayo Clinic, Rochester, MN, USA.
authors.forename: Manju
authors.initials: M
authors.lastname: Kalra
authors.forename: Evan J
authors.initials: EJ
authors.lastname: Ryer
authors.forename: Gustavo S
authors.initials: GS
authors.lastname: Oderich
authors.forename: Audra A
authors.initials: AA
authors.lastname: Duncan
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Bower
authors.forename: Peter
authors.initials: P
authors.lastname: Gloviczki
mesh_terms: D000208:Acute Disease; D057510:Endovascular Procedures / Q000009:adverse effects; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000628:therapy*; D008638:Mesenteric Arteries; D065666:Mesenteric Ischemia; D008641:Mesenteric Vascular Occlusion / Q000175:diagnosis / Q000628:therapy*; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D024162:Second-Look Surgery; D013927:Thrombosis / Q000175:diagnosis / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000175:diagnosis / Q000628:therapy*
keywords: acute mesenteric ischemia; endovascular treatment; second-look laparotomy