Clinical scenario

This protocol addresses patients with acute mesenteric arterial thrombosis who present with stable haemodynamics, no CT angiography evidence of transmural bowel necrosis, and no peritonitis.

In this presentation, first-line endovascular revascularisation is the initial approach. The current protocol governs the next step when that first-line treatment has not achieved its intended goal.

Previous line — failure condition

First-line endovascular revascularisation — stenting of the affected mesenteric artery, combined with pre-operative critical care and haemodynamic stabilisation — was the initial intervention for this scenario.

Escalation to this protocol is triggered when the required outcome is not reached: restored blood flow with adequate patency of the target mesenteric artery and its peripheral branches, and no residual stenosis exceeding 30%.

Next-line approach

When endovascular treatment has failed to restore adequate mesenteric perfusion, this protocol involves open surgical mesenteric revascularisation. The complete structured regimen — including the specific procedural steps, intraoperative decision criteria, and adjuncts — is available via the link below.

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.

Open surgical mesenteric revascularisation is generally reserved for patients in whom endovascular treatment is not considered appropriate due to unfavourable mesenteric lesions, or for whom endovascular treatment has failed, or in cases of in-stent restenosis or occlusion.

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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When Endovascular Revascularisation Fails in Acute Mesenteric Arterial Thrombosis — Stable Haemodynamics, No Bowel Necrosis

References