Introduction

Acute mesenteric ischemia (AMI), primarily from superior mesenteric artery (SMA) occlusion, is a life-threatening condition with high mortality. While open surgery has been the standard, endovascular techniques are emerging as a less invasive alternative.

Aim

This study evaluated the outcomes of an endovascular-first strategy for AMI.

Material and methods

A single-center, retrospective analysis was conducted on 25 consecutive patients (median age 74) with AMI due to SMA occlusion (23 thrombotic, 2 embolic) treated between 2022 and 2025. All patients underwent endovascular recanalization via antegrade or retrograde techniques, using stents, aspiration thrombectomy, or hybrid procedures as needed. The primary endpoint was a composite of mortality or irreversible bowel ischemia requiring resection.

Results

Technical success was achieved in 24 (96%) patients. The in-hospital mortality rate was 16%. The cumulative 30-day rate of major adverse events was 24%. Serum lactate proved to be a sensitive marker for bowel viability, normalizing only in patients without necrosis. No recurrent stenosis was observed at 3- and 6-month follow-up.

Conclusions

An endovascular-first approach for AMI is feasible, safe, and effective, with high technical success and acceptable mortality. It is applicable to both thrombotic and embolic occlusions. Success requires a multidisciplinary strategy, advanced endovascular tools, and the capability to convert to open surgery. The prognosis ultimately depends on the extent of bowel necrosis, underscoring the critical need for rapid diagnosis and intervention.