Acute mesenteric occlusion. Have endovascular techniques improved the prognosis?

The mortality of acute mesenteric ischemia remains very high. Even with a standardized visceral and vascular surgical approach, mortality has not been reduced below 40%. Due to this, further improvements of the diagnostic and therapeutic pathways are necessary. Can the application of endovascular techniques lead to an improved prognosis of acute mesenteric ischemia? We undertook an analysis of the open and endovascular treatment of acute mesenteric ischemia based on our results and the current published data. Endovascular treatment of acute mesenteric ischemia is indicated only in cases of incomplete arterial occlusion without a manifest peritonitis. Although the primary technical success rate is very high, the early and late results are not satisfactory. In most cases, standard open reconstruction of the mesenteric arteries leads to a lower preoperative delay as well as more consistent long-term success. Open mesenteric arterial reconstruction remains the method of choice in acute mesenteric ischemia despite being more invasive. Endovascular treatment could not improve the prognosis of the overall number of patients despite being successful in certain aspects. There is an urgent need for prospective randomized studies in order to better outline the indications for both methods of treatment.