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Mesenteric ischemia

Acosta, Stefan

Current Opinion in Critical Care: April 2015 - Volume 21 - Issue 2 - p 171–178
doi: 10.1097/MCC.0000000000000189
GASTROINTESTINAL SYSTEM: Edited by André Van Gossum
Editor's Choice

Purpose of review Diagnosis of acute mesenteric ischemia 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 ischemia may be treated with urgent intestinal revascularization.

Recent findings The establishment of a hybrid operation room is most important to be able to perform explorative laparotomy for evaluation of the extent of mesenteric ischemia and successful intestinal revascularization. Endovascular recanalization and stenting has become an important alternative, especially in patients with both acute and chronic thrombotic superior mesenteric artery (SMA) occlusion. 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. The concept of damage-control surgery is recommended after intestinal revascularization.

Summary Intestinal revascularization in patients with arterial occlusive mesenteric ischemia reduces bowel morbidity and mortality. Observational studies report that both endovascular and open vascular therapy options are effective, but endovascular technique may be preferred in these often elderly and fragile patients.

Vascular Centre, Malmö, Skåne University Hospital, Malmö, Sweden

Correspondence to Dr Stefan Acosta, Vascular Centre, Malmö University Hospital, S205 02 Malmö, Sweden. Tel: +4640338093; fax: +4640338097; e-mail: stefan.acosta@telia.com

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