Treatment of acute mesenteric arterial thrombosis with stable haemodynamics and no CT evidence of transmural bowel necrosis or peritonitis
Clinical scenario
This first-line protocol applies when a patient presents with acute mesenteric arterial thrombosis in the following specific situation:
- Haemodynamically stable
- No CT angiography evidence of transmural bowel necrosis
- No peritonitis
Indicated approach
In this setting, endovascular revascularisation is the indicated first-line strategy, combined with urgent pre-operative critical care stabilisation — including haemodynamic monitoring, fluid resuscitation, and systemic anticoagulation. Additional revascularisation techniques may be employed depending on the nature of the arterial occlusion. The complete regimen, sequencing, and technical criteria are defined in the full protocol.
Treatment goal
Restored blood flow with adequate patency of the target mesenteric artery and peripheral branches, with no residual stenosis exceeding 30%.
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.
- In the acute setting, numerous revascularisation techniques are available, the choice of which depends chiefly on the cause of arterial occlusion.
- An angiogram is then performed to confirm adequate patency of the target vessel and peripheral branches with no residual stenosis < 30%.
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