Endovascular Treatment vs. Open Surgery for Acute Mesenteric Ischemia: A Systematic Review and Meta-Analysis

Background: Acute mesenteric ischaemia (AMI) is a surgical emergency with mortality reaching 40 – 80 %. Endovascular techniques have expanded rapidly, but their comparative effectiveness versus conventional open revascularisation remains uncertain. Objective: To evaluate the benefits and harms of endovascular revascularisation compared with open surgical revascularisation for acute arterial AMI in adults. Methods: This protocol follows PRISMA‑P guidance and is registered in PROSPERO (CRD42023454389). We will search CENTRAL, MEDLINE, Embase, Scopus and Web of Science, without language or date limits, last updated 8 August 2024. Eligible designs are prospective and retrospective comparative cohort studies enrolling adults (≥ 18 years) with arterial AMI. Primary outcome is all‑cause mortality (in‑hospital or ≤ 30 days). Secondary outcomes include bowel‑resection rate, second‑look laparotomy, need for re‑intervention, length of hospital stay, major procedure‑related complications and direct hospital costs. Two reviewers will independently screen studies, extract data and assess risk of bias with ROBINS‑I. Random‑effects meta‑analyses will use DerSimonian–Laird models; narrative synthesis will be applied when pooling is inappropriate. Certainty of evidence will be graded with GRADE. Expected output: A peer‑reviewed systematic review and meta‑analysis clarifying whether endovascular approaches confer survival or organ‑sparing advantages over open surgery, and identifying knowledge gaps for future research. Funding: No external funding.