Open and endovascular management of acute mesenteric ischaemia: a systematic review
Abstract
BACKGROUND: Acute mesenteric ischaemia (AMI) is a life-threatening surgical emergency resulting from thromboembolic occlusion of the mesenteric vasculature. Traditional management of AMI has been open revascularisation with or without bowel resection-a procedure which carries considerable morbidity and mortality in an already unwell, compromised patient. Endovascular and more minimally invasive management approaches to AMI have been reported. Proponents of endovascular management suggest this approach may be associated with reduced morbidity and mortality compared with open surgery. OBJECTIVES: To assess the impact of endovascular approach for AMI on mortality and need for subsequent laparotomy and/or bowel resection. DATA SOURCES: The search bodies PubMed and Medline were interrogated. ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS: All studies in English with greater than 10 patients examining outcomes for patients undergoing endovascular intervention for acute mesenteric ischaemia were included. All patients over 18 years presenting with a diagnosis of acute mesenteric ischaemia secondary to an arterial thromboembolic source were included. Studies examining endovascular intervention alone or endovascular and open intervention were selected. RESULTS: The 30-day mortality for endovascular approach from all 13 studies was 16-42%. Of the 7 comparative studies including results of open revascularisation, the 30-day mortality for patient treated with an endovascular approach was 15-39% versus 33-50% for open revascularisation. Laparotomy rates post-initial endovascular intervention ranged from 13 to 73%. Bowel resection post-endovascular therapy ranged from 14 to 40% among studies. Concerning 7 comparative studies for open versus endovascular revascularisation, the rate of bowel resection in the endovascular group ranged 14-28% and 33-63% in the open cohort. Endovascular intervention also demonstrated lower median length (s) of bowel resected. LIMITATIONS: Heterogeneity of studies and patient populations studied including selection bias. CONCLUSIONS AND IMPLICATIONS OF FINDINGS: Endovascular management may be associated with reduced mortality and need for/length of bowel resection compared with the traditional open approach, but there remains a paucity of robust data to support this. The available literature illustrates that a subgroup of patients without haemodynamic compromise and more insidious onset may garner benefit from endovascular intervention.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Whether to treat AMI by endovascular or open surgery has not been examined in RCTs, and most of the available literature is based on small, retrospective single-centre studies.
“Whether to treat AMI by endovascular or open surgery has not been examined in RCTs, and most of the available literature is based on small, retrospective single-centre studies5–7,20,21.”
From Acute mesenteric ischaemia (2023) · cites this paper as [21]
Laparotomy rates ranged from 13-73% after endovascular revascularisation, and bowel resection rates from 14-40%.
“Laparotomy rates ranged from 13 e 73% after endovascular revascularisation, and bowel resection rates from 14 e 40%. 158”
In the same seven studies, the 30 day mortality rate ranged from 15-39% after endovascular revascularisation and from 33-50% after open revascularisation.
“In the same seven studies, the 30 day mortality rate ranged from 15 e 39% after endovascular revascularisation and from 33 e 50% after open revascularisation.”
The rate of bowel resection in the endovascular group ranged from 14-28% compared with 33-63% in the open cohort.
“The rate of bowel resection in the endovascular group ranged from 14 e 28% compared with 33 e 63% in the open cohort.”
In a systematic review of 13 observational studies, the 30 day mortality rate was 15-39% after endovascular and 33-50% after open revascularisation.
“In a systematic review of 13 observational studies, the 30 day mortality rate was 15 e 39% after endovascular and 33 e 50% after open revascularisation. 158”
Cites
Clair, D. G., & Beach, J. M. (2016) · New England Journal of Medicine · doi:10.1056/nejmra1503884 · Cited by 589 · see citing works
Systematic review of survival after acute mesenteric ischaemia according to disease aetiology
Schoots, I. G., Koffeman, G. I., Legemate, D. A., Levi, M., & van Gulik, T. M. (2004) · Journal of British Surgery · doi:10.1002/bjs.4459 · Cited by 502 · see citing works
Contemporary management of acute mesenteric ischemia: Factors associated with survival
Park, W. M., Gloviczki, P., Cherry, K. J., Hallett, J. W., Bower, T. C., Panneton, J. M., Schleck, C., Ilstrup, D., Harmsen, W. S., & Noel, A. A. (2002) · Journal of Vascular Surgery · doi:10.1067/mva.2002.120373 · Cited by 463 · see citing works
Non-occlusive mesenteric ischemia: etiology, diagnosis, and interventional therapy
Trompeter, M., Brazda, T., Remy, C. T., Vestring, T., & Reimer, P. (2002) · European Radiology · doi:10.1007/s00330-001-1220-2 · Cited by 378 · see citing works
Epidemiology of Mesenteric Vascular Disease: Clinical Implications
Acosta, S. (2010) · Seminars in Vascular Surgery · doi:10.1053/j.semvascsurg.2009.12.001 · Cited by 340 · see citing works
Mesenteric revascularization: management and outcomes in the United States, 1988-2006
Schermerhorn, M. L., Giles, K. A., Hamdan, A. D., Wyers, M. C., & Pomposelli, F. B. (2009) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2009.03.004 · Cited by 311 · see citing works
Arthurs, Z. M., Titus, J., Bannazadeh, M., Eagleton, M. J., Srivastava, S., Sarac, T. P., & Clair, D. G. (2011) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2010.09.049 · Cited by 285 · cited 9× · see citing works
“Supporting this, Arthurs et al. [9] found that patients who underwent open surgery trended towards a higher serum lactate measurement than the endovascular group.”
BackgroundResultInfluentialChronic mesenteric ischemia: open surgery versus percutaneous angioplasty and stenting
Kasirajan, K., O'Hara, P. J., Gray, B. H., Hertzer, N. R., Clair, D. G., Greenberg, R. K., Krajewski, L. P., Beven, E. G., & Ouriel, K. (2001) · Journal of Vascular Surgery · doi:10.1067/mva.2001.111808 · Cited by 275 · see citing works
Comparison of open and endovascular treatment of acute mesenteric ischemia
Beaulieu, R. J., Arnaoutakis, K. D., Abularrage, C. J., Efron, D. T., Schneider, E., & Black, J. H. (2014) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2013.06.084 · Cited by 222 · see citing works
Atkins, M. D., Kwolek, C. J., LaMuraglia, G. M., Brewster, D. C., Chung, T. K., & Cambria, R. P. (2007) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2007.01.067 · Cited by 217 · see citing works
Current results of open revascularization for chronic mesenteric ischemia: a standard for comparison
Park, W. M., Cherry, K. J., Chua, H. K., Clark, R. C., Jenkins, G., Harmsen, W. S., Noel, A. A., Panneton, J. M., Bower, T. C., Hallett, J. W., et al. (2002) · Journal of Vascular Surgery · doi:10.1067/mva.2002.123753 · Cited by 203 · see citing works
Revascularization for acute mesenteric ischemia
Ryer, E. J., Kalra, M., Oderich, G. S., Duncan, A. A., Gloviczki, P., Cha, S., & Bower, T. C. (2012) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2011.12.017 · Cited by 188 · cited 2× · see citing works
“Means of addressing this include a hybrid operating theatre with immediate access to CT imaging, interventional radiology and laparoscopy to facilitate synchronous bowel inspection ± resection [23].”
BackgroundGrootjans, J., Lenaerts, K., Buurman, W. A., Dejong, C. H. C., & Derikx, J. P. M. (2016) · World Journal of Gastroenterology · doi:10.3748/wjg.v22.i9.2760 · Cited by 157 · see citing works
Self-citationQuinn, A. D. (1993) · Critical Care Nursing Clinics of North America · doi:10.1016/s0899-5885(18)30596-3 · Cited by 156 · see citing works
Thrombolytic therapy for acute superior mesenteric artery occlusion
Schoots, I. G., Levi, M. M., Reekers, J. A., Lameris, J. S., & van Gulik, T. M. (2005) · Journal of Vascular and Interventional Radiology · doi:10.1097/01.rvi.0000141719.24321.0b · Cited by 152 · see citing works
Endovascular and open surgery for acute occlusion of the superior mesenteric artery
Block, T. A., Acosta, S., & Björck, M. (2010) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2010.05.084 · Cited by 150 · see citing works
Acosta, S. (2015) · Current Opinion in Critical Care · doi:10.1097/mcc.0000000000000189 · Cited by 111 · see citing works
Liu, F., Wang, M., Fan, Q., Duan, F., Wang, Z. K., & Song, P. (2009) · World Journal of Gastroenterology · doi:10.3748/wjg.15.5028 · Cited by 85 · see citing works
Endovascular Therapy as a Primary Revascularization Modality in Acute Mesenteric Ischemia
Kärkkäinen, J. M., Lehtimäki, T. T., Saari, P., Hartikainen, J., Rantanen, T., Paajanen, H., & Manninen, H. (2015) · CardioVascular and Interventional Radiology · doi:10.1007/s00270-015-1064-9 · Cited by 77 · see citing works
Thrombophilia and Venous Thromboembolism: Implications for Testing
Cohn, D., Roshani, S., & Middeldorp, S. (2007) · Seminars in Thrombosis and Hemostasis · doi:10.1055/s-2007-985753 · Cited by 75 · see citing works
Raupach, J., Lojík, M., Chovanec, V., Renc, O., Strýček, M., Dvorak, P., Hoffmann, P., Guňka, I., Ferko, A., Ryška, P., et al. (2015) · CardioVascular and Interventional Radiology · doi:10.1007/s00270-015-1156-6 · Cited by 71 · see citing works
Imaging in Intestinal Ischemic Disorders
Gore, R. M., Yaghmai, V., Thakrar, K. H., Berlin, J. W., Mehta, U. K., Newmark, G. M., & Miller, F. H. (2008) · Radiologic Clinics of North America · doi:10.1016/j.rcl.2008.05.004 · Cited by 71 · see citing works
Early Endovascular Treatment of Superior Mesenteric Occlusion Secondary to Thromboemboli
Jia, Z., Jiang, G., Tian, F., Zhao, J., Li, S., Wang, K., Wang, Y., Jiang, L., & Wang, W. (2013) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2013.09.025 · Cited by 69 · see citing works
Harper, D., & Chandler, B. (2015) · BJA Education · doi:10.1093/bjaceaccp/mkv017 · Cited by 69 · see citing works
(1993) · PubMed · Cited by 65 · see citing works
Stone, J. R., & Wilkins, L. R. (2014) · Techniques in vascular and interventional radiology · doi:10.1053/j.tvir.2014.12.004 · Cited by 63 · see citing works
Die akute mesenteriale Ischämie: Resektion oder Rekonstruktion?
Eckstein, H.-H. (2003) · Der Chirurg · doi:10.1007/s00104-003-0630-x · Cited by 54 · see citing works
Bulut, T., Oosterhof-Berktas, R., Geelkerken, R. H., Brusse-Keizer, M., Stassen, E. J., & Kolkman, J. J. (2017) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2016.12.036 · Cited by 46 · see citing works
Operative Management of Chronic Mesenteric Ischemia
Kazmers, A. (1998) · Annals of Vascular Surgery · doi:10.1007/s100169900158 · Cited by 41 · see citing works
Erben, Y., Protack, C. D., Jean, R. A., Sumpio, B. J., Miller, S. M., Liu, S., Trejo, G., & Sumpio, B. E. (2018) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2017.11.078 · Cited by 40 · see citing works
Zhang, Z., Wang, D., Li, G., Wang, X., Wang, Y., Li, G., & Jiang, T. (2017) · BioMed Research International · doi:10.1155/2017/1964765 · Cited by 39 · see citing works
Treatment Outcome in Patients With Acute Superior Mesenteric Artery Embolism
Yun, W., Lee, K. K., Cho, J., Kim, H.-K., & Huh, S. (2013) · Annals of Vascular Surgery · doi:10.1016/j.avsg.2012.07.022 · Cited by 37 · see citing works
Die akute mesenteriale Ischmie Resektion oder Rekonstruktion
Eckstein, H. (2003) · Cited by 29 · see citing works
Kim, H.-K., Hwang, D., Park, S., Lee, J. M., & Huh, S. (2017) · Journal of Vascular Surgery Venous and Lymphatic Disorders · doi:10.1016/j.jvsv.2017.04.011 · Cited by 28 · see citing works
Puippe, G. D., Suesstrunk, J., Nocito, A., Pfiffner, R., Glenck, M., & Pfammatter, T. (2015) · VASA · doi:10.1024/0301-1526/a000455 · Cited by 24 · see citing works
Endovascular treatment of mesenteric ischemia
Hawkins, B. M., Khan, Z., Abu-Fadel, M. S., EXAIRE, J. E., Saucedo, J. F., & Hennebry, T. A. (2011) · Catheterization and Cardiovascular Interventions · doi:10.1002/ccd.23098 · Cited by 21 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Koelemay, M. J., Geelkerken, R. H., Kärkkäinen, J., Leone, N., Antoniou, G. A., de Bruin, J. L., Gombert, A., Gottsätter, A., Iborra, E., Ronchey, S., et al. (2025) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2025.06.010 · Cited by 123 · see citing works
Tolonen, M., Lemma, A., Vikatmaa, P., Peltola, E., Mentula, P., Björkman, P., Leppäniemi, A., & Sallinen, V. (2021) · Journal of Trauma and Acute Care Surgery · doi:10.1097/ta.0000000000003305 · Cited by 46 · see citing works
Li, W., Cao, S., Zhang, Z., Zhu, R., Chen, X., Liu, B., & Feng, H. (2022) · Frontiers in Surgery · doi:10.3389/fsurg.2022.833464 · Cited by 25 · see citing works
Fuglseth, H., Søreide, K., & Vetrhus, M. (2023) · British Journal of Surgery · doi:10.1093/bjs/znad021 · Cited by 20 · see citing works
Pengermä, P., Venesmaa, S., Karjalainen, J., Ukkonen, M., Saari, P., & Kärkkäinen, J. M. (2023) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2023.08.100 · Cited by 19 · see citing works
Treatment outcomes in patients with acute thromboembolic occlusion of the superior mesenteric artery
Li, W., Liu, M., Jin, L., Feng, H., Chen, X., & Zhang, Z. (2024) · Journal of Cardiothoracic Surgery · doi:10.1186/s13019-024-02745-4 · Cited by 11 · see citing works
Reintam Blaser, A., Forbes, A., & Björck, M. (2022) · Current Opinion in Critical Care · doi:10.1097/mcc.0000000000000972 · Cited by 9 · see citing works
Management of acute mesenteric ischaemia in adult patients: a systematic review and meta-analysis
Blaser, A. R., Koitmäe, M., Bachmann, K. F., Gaetano, P. D., Kiisk, E., Laisaar, K.-T., Piva, S., Stahl, K., Tamme, K., & Acosta, S. (2025) · World Journal of Emergency Surgery · doi:10.1186/s13017-025-00614-6 · Cited by 11 · see citing works
Kase, K., Blaser, A. R., Koitmäe, M., Talving, P., Tamme, K., Acosta, S., Björck, M., Bala, M., Bodnár, Z., Cahenzli, M., et al. (2025) · World Journal of Emergency Surgery · doi:10.1186/s13017-025-00616-4 · Cited by 8 · see citing works
A decade's experience with retrograde open mesenteric stenting for acute mesenteric ischemia
Habib, S. G., Semaan, D. B., Andraska, E., Madigan, M. C., Al-Khoury, G. E., Chaer, R. A., & Eslami, M. H. (2024) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2024.05.010 · Cited by 7 · see citing works
Ennab, R. M., Al-Omari, M., Jaradat, I., & Aljabali, A. A. A. (2020) · International Journal of Surgery Case Reports · doi:10.1016/j.ijscr.2020.09.180 · Cited by 5 · see citing works
Tricky acute mesenteric ischemia: what can we do?
Cui, X.-Y., Chen, Y., Guan, G., Luo, F., & Zhang, Z. (2025) · Gastroenterology Report · doi:10.1093/gastro/goaf067 · Cited by 2 · see citing works
Ratlarda Oluşturulan Mezenterik Arter İskemisinin Erken Belirteçleri
AYDIN, F., & Aslan, B. (2020) · Kafkas Universitesi Veteriner Fakultesi Dergisi · doi:10.9775/kvfd.2020.24393 · Cited by 2 · see citing works
Mesenteriale Ischämie in der Intensivmedizin
Junginger, A., & Braun, G. (2021) · Intensivmedizin up2date · doi:10.1055/a-1171-5020 · Cited by 1 · see citing works
Delmotte, P.-R., Fron, C., & Monsel, A. (2023) · EMC - Anestesia-Reanimación · doi:10.1016/s1280-4703(23)47652-9 · Cited by 1 · see citing works
Gamé, V., Yugueros, X., Mestres, G., Turrado-Rodriguez, V., Morales, X., & Riambau, V. A. (2024) · Angiología · doi:10.20960/angiologia.00555 · Cited by 1 · see citing works
Akute mesenteriale (intestinale) Ischämie
Debus, E. S., & Grundmann, R. T. (2022) · Evidenzbasierte Chirurgie · doi:10.1007/978-3-662-66422-3_8
Delmotte, P.-R., Fron, C., & Monsel, A. (2023) · EMC - Anestesia-Rianimazione · doi:10.1016/s1283-0771(23)47674-8
Acute Mesenteric (Intestinal) Ischaemia
Debus, E. S., & Grundmann, R. T. (2023) · Springer eBooks · doi:10.1007/978-3-031-47397-5_8
Successful Recanalization of the Superior Mesenteric Artery in Acute Mesenteric Ischemia
Kochetkov, F. D., Kalinin, R. E., Suchkov, I. A., Antonenko, A. O., Krymov, O. V., Khabibulin, V. V., & Faber, M. I. (2024) · Russian Sklifosovsky Journal Emergency Medical Care · doi:10.23934/2223-9022-2024-13-2-305-311
Etiology is a Factor when Choosing Endovascular or Open Treatment for Acute Mesenteric Ischemia
Nandurkar, T. S., Millay, O. H., & Endean, E. D. (2025) · Vascular and Endovascular Surgery · doi:10.1177/15385744251375257
Refining patient stratification and treatment decision-making in acute SMA occlusion
Ye, Y., Hu, Y. Q., Ji, X., Zhang, J., Xu, H., & An, P. (2025) · World Journal of Emergency Surgery · doi:10.1186/s13017-025-00653-z
Intestinal failure after acute mesenteric ischaemia
Blaser, A. R., Irtun, Ø., Bezmarević, M., & Gabe, S. M. (2026) · Clinical Nutrition Open Science · doi:10.1016/j.nutos.2026.100683
How I do it - Diagnostik und interventionelle Therapie der akuten mesenterialen Ischämie
Mayr, V., & Stroszczynski, C. (2026) · Radiologie up2date · doi:10.1055/a-2762-6037
National analysis of open and endovascular revascularization for acute mesenteric ischemia
Wong, J., Lai, O., Gao, Z., Rossi, C. S., Leung, P., Rahmani, J., Tran, D., Mehta, D., Mendes, B. C., de Virgilio, C., et al. (2026) · JVS-Vascular Insights · doi:10.1016/j.jvsvi.2026.100533
Interventionelle Therapie des akuten Mesenterialarterienverschlusses – Zeit ist Darm
Mostafa, K., Andersson, J., Gottschalk, H., Trentmann, J., Backhauß, J., Hajabo, M., Schuwerk, R., Kruse, J., Kapahnke, S., Bürger, M., et al. (2026) · Gefässchirurgie · doi:10.1007/s00772-026-01385-3
Mamadaliyeva, M. (2026) · Eurasian Journal of Academic Research · doi:10.70413/ejar-v06-i08-p1-008
- Authors
- Murphy, B., Dejong, C. H. C., & Winter, D. C.
- Affiliations
- St. Vincent's University Hospital (IE)
- Maastricht University (NL)
- Corresponding author
- Murphy, B.
- Venue
- World Journal of Surgery
- Publisher
- Wiley
- Published
- 2019-09-03
- Volume
- 43
- Issue
- 12
- Pages
- 3224-3231
- ISSN
- 0364-2313 (ISSN-L)
- 1432-2323
- OpenAlex
- W2971863293
- Cited by
- 27
- References
- 36
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 4 · 2023: 5 · 2022: 3 · 2021: 2 · 2020: 2
- FWCI
- 0.36
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- World Journal of Surgery (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Emergency Medicine › Appendicitis Diagnosis and Management
- Health Sciences › Medicine › Surgery › Intestinal and Peritoneal Adhesions
- Keywords
- acute mesenteric ischemia, endovascular revascularization, bowel resection, 30-day mortality, laparotomy, minimally invasive surgery, surgical outcomes comparison, hemodynamic instability
- MeSH terms
- Acute Disease, Humans, Endovascular Procedures, Mesenteric Ischemia
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
