title: Acute mesenteric ischemia (Part II) - Vascular and endovascular surgical approaches.
abstract: The modern treatment of acute mesenteric ischemia (AMI) requires seamless collaboration of gastrointestinal surgeons, vascular surgeons, and interventional radiologists. The treatment strategy is straightforward aiming at rapid restoration of blood flow to the intestine. Bowel resection is performed on demand. The first thing to consider is the patient's clinical condition at presentation, whether there are signs of peritonitis or not, and whether the patient is hemodynamically stable or not. Second, there are four etiologies of AMI that need to be distinguished as they differ in treatment: superior mesenteric artery embolism, mesenteric arterial occlusive disease, mesenteric venous thrombosis, and non-occlusive mesenteric ischemia. In this review, we describe the basic vascular and endovascular treatment modalities accompanied by a simple algorithm for the various situations in AMI. Furthermore, the indications for damage control and primary definitive surgery are discussed.
authors.affiliation: Heart Center, Kuopio University Hospital, P.O. Box 100, 70029 Kuopio, Finland. Electronic address: jkarkkai@gmail.com.
authors.forename: Jussi M
authors.initials: JM
authors.lastname: Kärkkäinen
authors.affiliation: Department of Clinical Sciences Malmö, Lund University, Sweden. Electronic address: stefan.acosta@med.lu.se.
authors.forename: Stefan
authors.initials: S
authors.lastname: Acosta
mesh_terms: D000208:Acute Disease; D057510:Endovascular Procedures / Q000379:methods*; D006801:Humans; D065666:Mesenteric Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Acute mesenteric ischemia; Acute on chronic mesenteric ischemia; Angioplasty; Embolectomy; Endovascular procedures; Endovascular therapy; Mechanical thrombolysis; Mesenteric venous thrombosis; Nonocclusive mesenteric ischemia; Surgical treatment