Endovascular Recanalisation in Combination with Surgical Revision in Arterial Occlusion of the Superior Mesenteric Artery: a Prospective Study

Abstract Background Acute mesenteric ischaemia is an acute abdominal event resulting mainly from acute occlusion of the superior mesenteric artery (SMA). Primary endovascular revascularisation is opted for in patients who are stable without signs of acute peritonitis. Surgical revision depends on the outcome of revascularization and clinical condition. Method A total of 30 patients with acute mesenteric ischaemia due to arterial embolism were treated during the 2021–2024 period. Endovascular therapy was successful in 28 (93.3%) patients. Aspiration thrombectomy was performed in 23 (76.6%) patients, and a stent was implanted into the SMA in 5 (21.7%) patients. Surgical revision was performed in all patients. Results In 10 (33.3%) cases, sole exploratory laparotomy was performed due to favourable intraoperative findings in the small intestine after successful endovascular revascularisation. In 20 (66.7%) cases, bowel resection of small intestinal loops was necessary, with a second-look procedure subsequently performed in 16 patients. The overall mortality of the cohort was 53.5%. Conclusion Acute mesenteric ischaemia is a disease of older age associated with high mortality. Early diagnosis with CTA is essential. Treatment should be a combination of endovascular and surgical therapy performed by a multidisciplinary team available 24/7.