Endovascular approach for acute-on-chronic mesenteric ischemia: the holy grail for old and frail patients

Acute mesenteric ischemia is a rare but potentially fatal condition, with an estimated mortality rate of 80%. Early diagnosis and intervention are crucial. While laparotomy and open revascularization have traditionally been the standard approach, endovascular techniques are emerging as viable alternatives. We report the case of a frail 76-year-old patient with an acute exacerbation of chronic mesenteric ischemia who underwent successful endovascular revascularization of the superior mesenteric artery with percutaneous thrombectomy, avoiding the need for laparotomy. This case illustrates that an endovascular-first approach can be a feasible option for selected patients, with close monitoring to ensure timely surgical revision if necessary.