Acute Mesenteric Arterial Embolism: What to Do When Catheter-Directed Thrombolysis Has Not Restored Arterial Patency
This protocol addresses acute mesenteric arterial embolism in patients who initially presented with stable haemodynamics and no CTA evidence of transmural necrosis or peritonitis, were managed with catheter-directed thrombolysis as first-line treatment, but did not achieve confirmed patency of the target mesenteric artery.
Clinical Situation
First-line endovascular revascularisation is indicated for patients with stable haemodynamics and no CTA evidence of transmural necrosis or peritonitis. Confirmation of the target mesenteric artery's patency on serial angiograms is the required outcome of this approach.
Previous Line Did Not Succeed
Prior therapy: Catheter-directed thrombolysis.
Goal not achieved: Patency of the target mesenteric artery was not confirmed on serial angiograms performed during follow-up. Failure to meet this endpoint requires escalation to the next protocol step.
Next-Line Approach (Partial Overview)
When catheter-directed thrombolysis has not achieved the required arterial result, a surgical intervention is the next step — the specific operative approach and its indications are detailed in the full protocol.
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.
- First-line endovascular revascularisation for patients with stable haemodynamics and no CTA evidence of transmural necrosis or peritonitis.
- However, in the presence of initial or new clinical or radiological evidence of peritonitis or bowel infarction, immediate laparotomy is required.
- In contrast, when signs of peritonitis or bowel necrosis are evident clinically or radiologically, prompt surgical intervention with laparotomy and resection is required.
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