title: Modern treatment of acute mesenteric ischaemia.
abstract: BACKGROUND
  Diagnosis of acute mesenteric ischaemia in the early stages is now possible with modern computed tomography (CT), using intravenous contrast enhancement and imaging in the arterial and/or portal venous phase. The availability of CT around the clock means that more patients with acute mesenteric ischaemia may be treated with urgent intestinal revascularization.
  
  
  METHODS
  This was a review of modern treatment strategies for acute mesenteric ischaemia.
  
  
  RESULTS
  Endovascular therapy has become an important alternative, especially in patients with acute thrombotic superior mesenteric artery (SMA) occlusion, where the occlusive lesion can be recanalized either antegradely from the femoral or brachial artery, or retrogradely from an exposed SMA after laparotomy, and stented. Aspiration embolectomy, thrombolysis and open surgical embolectomy, followed by on-table angiography, are the treatment options for embolic SMA occlusion. Endovascular therapy may be an option in the few patients with mesenteric venous thrombosis who do not respond to anticoagulation therapy. Laparotomy is needed to evaluate the extent and severity of visceral organ ischaemia, which is treated according to the principles of damage control surgery.
  
  
  CONCLUSIONS
  Modern treatment of acute mesenteric ischaemia involves a specialized approach that considers surgical and, increasingly, endovascular options for best outcomes.
authors.affiliation: Vascular Centre, Skåne University Hospital, Malmö, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Acosta
authors.forename: M
authors.initials: M
authors.lastname: Björck
mesh_terms: D000328:Adult; D000368:Aged; D017128:Embolectomy / Q000379:methods; D004617:Embolism / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D008297:Male; D017538:Mesenteric Artery, Superior; D065666:Mesenteric Ischemia; D008641:Mesenteric Vascular Occlusion / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D008642:Mesenteric Veins; D008875:Middle Aged; D015424:Reperfusion / Q000379:methods; D015607:Stents; D015912:Thrombolytic Therapy / Q000379:methods; D013927:Thrombosis / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D020246:Venous Thrombosis / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery