MESENTERIC ISCHEMIA: CURRENT THERAPEUTIC APPROACHES AND EARLY INTERVENTION STRATEGIES

Abstract

Mesenteric ischemia (MI) is a serious vascular emergency associated with high morbidity and mortality. Late diagnosis often results in intestinal necrosis and death. This narrative literature review aims to synthesize early intervention strategies and current therapeutic approaches for Acute Mesenteric Ischemia (AMI) and Chronic Mesenteric Ischemia (CMI). The methodology was based on a search in the PubMed database, using the descriptors 'Mesenteric Ischemia', 'therapy', and 'surgery', focusing on publications from the last five years. The results indicate that computed tomography angiography (CTA) is the indispensable gold standard for the rapid diagnosis of AMI. The management of AMI requires immediate fluid resuscitation, broad-spectrum antibiotic therapy, and urgent revascularization. Endovascular therapy has become the first option in patients without peritonitis, being associated with lower mortality and lower rates of intestinal resection. Open surgery (embolectomy or bypass) remains mandatory in the presence of intestinal necrosis, with damage control surgery being a crucial strategy in critically ill patients. In contrast, mesenteric ischemia (MI), usually of atherosclerotic origin, presents with postprandial pain and weight loss. Current guidelines recommend an "endovascular-first" approach for MI, preferably with covered stents, reserving open surgery for complex cases or therapeutic failures. Mortality from mesenteric ischemia (MI) remains high (29.5% to 63%), while mortality from electively treated MI is close to zero. It is concluded that early diagnosis by CTA in MI and prioritization of endovascular techniques in MI are fundamental to improving outcomes.