Surgical and medical management of mesenteric ischemia

Opinion statement

Acute mesenteric ischemia frequently results in bowel necrosis, which necessitates laparotomy to assess bowel viability. Reduction in mortality requires a high index of suspicion and prompt diagnosis. Bowel resection should be preceded by visceral artery revascularization. Medical management includes the use of anticoagulation, vasodilators, and the use of inhibitors of reperfusion injury. The management of chronic mesenteric ischemia largely depends on the general condition of the patient, who is often affected by malnutrition and dehydration. Surgery, although associated with greater morbidity and mortality, is more durable and effective in relieving the symptoms of chronic mesenteric ischemia. Endovascular treatment options for chronic mesenteric ischemia include percutaneous balloon angioplasty and stenting. This treatment is more likely to be successful in dealing with stenotic rather than occlusive lesions and offers a minimal invasive approach but is associated with a smaller primary success rate and a higher recurrence rate.