Acute mesenteric arterial embolism
ICD-10 K55.0 · ICD-11 DD30.0.1

Treatment of Acute Mesenteric Arterial Embolism with Stable Haemodynamics and No Peritonitis

Clinical scenario

This protocol applies to patients presenting with acute mesenteric arterial embolism who have stable haemodynamics and in whom CT angiography shows no evidence of transmural bowel necrosis or peritonitis. This combination defines the window in which endovascular revascularisation is the indicated first-line approach.

Specific patient criteria

First-line endovascular revascularisation is currently indicated for patients with stable haemodynamics and no CTA evidence of transmural necrosis or peritonitis. When either criterion is absent — haemodynamic instability or imaging signs of bowel necrosis or peritoneal involvement — a different pathway applies.

Approach overview

Management combines immediate multidisciplinary critical care — including intravenous fluid resuscitation, anticoagulation, and supportive measures — with endovascular revascularisation targeting the embolus in the superior mesenteric artery.

Full regimen, procedural detail, and sequencing available via the structured protocol below.

Key clinical goals

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1007/s00270-025-04080-0

First-line endovascular revascularisation is currently indicated for patients with stable haemodynamics and no CT evidence of transmural necrosis or peritonitis.

Intra-vascular volume expansion with crystalloids and blood products must be started immediately to improve visceral perfusion.

Aggressive fluid resuscitation may be required, potentially exceeding 10 L of IV fluids in the first 24 h of treatment, taking care to avoid volume overload.

Intravenous full-dose anticoagulation, preferably with unfractionated heparin, should be initiated unless contra-indicated.

Early, broad-spectrum antibiotic therapy is required due to the high risk of infection secondary to bacterial translocation.

Although no specific recommendations exist regarding anticoagulation targets in acute arterial mesenteric ischaemia, an activated clotting time (ACT) between 250 and 300 s should be targeted by analogy with most peripheral intra-arterial endovascular procedures.

The risk of severe metabolic acidosis and hyperkalaemia after bowel infarction and reperfusion requires close monitoring of electrolyte and pH values and correction of any abnormalities.

View source ↗