• Best Pract Res Clin Gastroenterol · Feb 2017

    Review

    Acute mesenteric ischemia (Part II) - Vascular and endovascular surgical approaches.

    • Jussi M Kärkkäinen and Stefan Acosta.
    • Heart Center, Kuopio University Hospital, P.O. Box 100, 70029 Kuopio, Finland. Electronic address: jkarkkai@gmail.com.
    • Best Pract Res Clin Gastroenterol. 2017 Feb 1; 31 (1): 27-38.

    AbstractThe 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.Copyright © 2016 Elsevier Ltd. All rights reserved.

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