ACR Appropriateness Criteria® radiologic management of mesenteric ischemia: 2022 update
Open accessAbstract
Mesenteric ischemia is a serious medical condition characterized by insufficient vascular supply to the small bowel. In the acute setting, endovascular interventions, including embolectomy, transcatheter thrombolysis, and angioplasty with or without stent placement, are recommended as initial therapeutic options. For nonocclusive mesenteric ischemia, transarterial infusion of vasodilators, such as papaverine or prostaglandin E1, is the recommended initial treatment. In the chronic setting, endovascular means of revascularization, including angioplasty and stent placement, are generally recommend, with surgical options, such as bypass or endarterectomy, considered alternative options. Although the diagnosis of median arcuate ligament syndrome remains controversial, diagnostic angiography can be helpful in rendering a diagnosis, with the preferred treatment option being a surgical release. Systemic anticoagulation is recommended as initial therapy for venous mesenteric ischemia with acceptable rates of recanalization. If anticoagulation fails, transcatheter thrombolytic infusion can be considered with possible adjunctive placement of a transjugular intrahepatic portosystemic shunt to augment antegrade flow. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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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 [7]
The Surgical Embolectomy section (page not provided) says randomized prospective trials comparing open surgery with endovascular interventions are lacking and describes multiple small retrospective studies. It does not say those studies are predominantly single-centre or that they constitute most of the available literature; it also discusses larger cohort studies. (LLM, conf=0.85)
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- Authors
- Lam, A., Kim, Y.-J., Fidelman, N., Higgins, M., Cash, B. D., Charalel, R. A., Guimaraes, M. S., Kwan, S. W., Patel, P. J., Plett, S., Scali, S. T., Stadtlander, K. S., Stoner, M., Tong, R., & Kapoor, B. S.
- Affiliations
- University of California, San Francisco (US)
- Boston University (US)
- American Gastroenterological Association (US)
- Weill Cornell Medicine (US)
- Medical University of South Carolina (US)
- University of Utah (US)
- Froedtert Hospital (US)
- Society for Vascular Surgery (US)
- Cleveland Clinic Florida (US)
- Main Line Health (US)
- Cleveland Clinic (US)
- Corresponding author
- Lam, Alexander
- ORCID
- Venue
- Journal of the American College of Radiology
- Publisher
- Elsevier BV
- Published
- 2022-11
- Volume
- 19
- Issue
- 11
- Pages
- S433-S444
- ISSN
- 1546-1440 (ISSN-L)
- OpenAlex
- W4310065253
- Cited by
- 29
- References
- 48
- Citations by year
- 2026: 8 · 2025: 6 · 2024: 5 · 2023: 10
- FWCI
- 5.01
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the American College of Radiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Emergency Medicine › Appendicitis Diagnosis and Management
- Health Sciences › Medicine › Surgery › Vascular anomalies and interventions
- Keywords
- mesenteric ischemia, nonocclusive mesenteric ischemia, endovascular treatment, embolectomy, catheter-directed thrombolysis, angioplasty, stenting, papaverine, prostaglandin E1, median arcuate ligament syndrome, anticoagulation, transjugular intrahepatic portosystemic shunt, small bowel ischemia
- MeSH terms
- Anticoagulants, Humans, Radiology, Societies, Medical, Evidence-Based Medicine, 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 ›
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