This protocol covers what to do when initial endovascular aspiration embolectomy of the superior mesenteric artery has not achieved its required goals in a patient who remains haemodynamically stable with no CT evidence of transmural bowel necrosis or peritonitis.
Acute mesenteric arterial embolism with stable haemodynamics and no CTA evidence of transmural necrosis or peritonitis. In this setting, endovascular revascularisation is the indicated first-line approach.
Multidisciplinary critical care combined with endovascular aspiration embolectomy of the superior mesenteric artery did not achieve the required procedural targets: adequate anticoagulation control during the procedure, complete embolus removal with restored superior mesenteric artery patency, and correction of electrolyte and pH abnormalities. This protocol represents the next step following that failure.
When residual thromboembolic material or inadequate flow persists — or when the embolus is lodged in a distal vessel segment — catheter-directed thrombolysis, with the catheter positioned at or proximal to the embolus, may be performed. If an underlying vessel abnormality is uncovered, stenting may also be considered. The complete agent selection, dosages, and procedural algorithm are available in the full protocol.
Confirmed patency of the target mesenteric artery, assessed by serial angiography performed once or twice daily during treatment.
DOI: 10.1007/s00270-025-04080-0