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Arterial Endovascular Interventions in Acute Mesenteric Ischemia

Acute mesenteric ischemia (AMI) is a true medical emergency and requires a multi-disciplinary treatment approach. AMI occurs when there is a sudden decrease in blood flow resulting in hypoperfusion to the intestines and may lead to bowel infarction. There are many potential etiologies of AMI that include arterial embolus, arterial, or venous thrombosis; traumatic injury; aortic dissection; intestinal obstruction; non-occlusive mesenteric ischemia, and vasculitis. Given mortality rates that approach 90%, rapid diagnosis is essential to decrease risk of bowel infarction. While surgical management has traditionally been the treatment of choice, endovascular management is being used with increasing frequency. Further, utilizing endovascular treatment options together with surgical intervention has shown promising results. The endovascular approach to treatment of AMI will depend on the underlying etiology. In addition, the acuity of patient presentation, presence, or absence of bowel infarction; patient stability; and availability of a hybrid operating room will influence the treatment plan of a patient with AMI. Early diagnosis with advanced cross-sectional imaging along with assessment of the underlying risk factors will optimize chances of early intervention and improve patient outcomes.