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. 2023 Jul 26;96(1151):20230232. doi: 10.1259/bjr.20230232

Table 3.

Typical clinical presentation and recanalisation options depending on the type of acute mesenteric ischaemia.

Typical clinical presentation Recanalisation options
(Laparoscopic bowel evaluation is driven by the prediction of transmural necrosis)
Atherosclerotic AMI Possible history of chronic mesenteric ischaemia
Sudden abdominal pain in a patient with multi-arterial disease
Endovascular revascularisation:
  • Stenting


Open revascularisation:
  • Retrograde open mesenteric stenting

  • Antegrade or retrograde by-pass

Embolic AMI Sudden marked pain in a patient with a history of atrial fibrillation Endovascular revascularisation:
  • Thrombus-aspiration

  • Catheter-directed thrombolysis


Open revascularisation:
  • Open thrombectomy with patch repair

Isolated SMA dissection Sudden marked abdominal pain (epigastric) in middle-aged males without known atherosclerosis Revascularisation only if bowel ischaemia (low evidence):
  • Endovascular: catheter directed thrombolysis

  • Open: intimal repair

Venous AMI Abdominal pain and inflammatory syndrome in females with history of venous thrombosis Anticoagulation therapy.
If worsening despite adequate anticoagulation:
  • Transhepatic/transjugular thrombus-aspiration+catheter-directed thrombolysis (low evidence)

Non-occlusive mesenteric ischaemia Intensive care unit patient with shock and abdominal pain/distension Intensive resuscitation.
Local intra-arterial vasodilator infusion (low evidence)
Ischaemic colitis Abdominal guarding with inflammatory syndrome mimicking infectious colitis. No revascularisation.

AMI, acute mesenteric ischaemia.