DOI: 10.25881/BPNMSC.2019.80.36.019


Darvin V.V., Mazajshvili K.V., Klimova N.V., Vasilev V.V., Gustelyov Yu.A.

Surgut state university, Surgut


The aging population in developed countries and Russia affects the structure of emergency surgical pathology and is accompanied by an increase of patients with acute mesenteric ischemia. In half of the patients, it is caused by cardiac thromboembolic events, in a quarter of the target population mesenteric thrombosis occurs by an atherosclerotic process in the intestinal arteries, and in 5-10% of cases, venous thrombosis is observed. The lack of evidence for the lab detection and the wide range of instrumental examinations, such as CT angiography, MRI angiography, duplex ultrasound, and X-ray contrast angiography demonstrates the absence of a routine diagnostic test. The limitations of the traditional surgery indicate the need for revascularization by embolectomy and/or by-pass surgery that require appropriate equipment and trained staff. X-ray endovascular interventions change the treatment patterns of acute mesenteric thrombosis and include selective catheter-directed thrombolysis, percutaneous rheolytic thrombectomy, balloon angioplasty, and stenting. The hybrid technique with a simultaneous combination of open surgery and X-ray endovascular interventions is very promising and requires long-term study results. Anticoagulant therapy is the treatment of choice for acute mesenteric ischemia caused by thrombosis of the superior mesenteric, inferior mesenteric, splenic and/or portal veins. However, in some ineffectiveness cases of nonsurgical treatment X-ray endovascular interventions are also successfully applied, e.g., direct percutaneous catheter installation into the portal vein system and transjugular intrahepatic portosystemic shunt followed by retrograde catheter insertion into mesenteric veins and mechanical fragmentation with thromboaspiration and/or selective catheter-directed thrombolysis. Thus, including a vascular surgical team in the hospital structure can significantly change the survival rate and quality of life of patients with acute mesenteric ischemia. Good organization of diagnostics, treatment, and prevention of this disease, by analogy with an acute coronary syndrome, will achieve rational improvement of the current situation in Russian healthcare.

Keywords: acute mesenteric ischemia, acute mesenteric thrombosis, selective catheter-directed thrombolysis, percutaneous rheolytic thrombectomy, mesenteric balloon angioplasty and stenting.


1. Belyakin SA, Kohan ЕP, Mironenko DA. Hronicheskaya abdominal’naya ishemiya. – 2014. – 168 c. (In Russ).

2. Brucekallo RG, Arakelyan VS. Hronicheskaya ishemiya organov pishchevareniya: taktika hirurgicheskogo i endovaskulyarnogo lecheniya / // Grudnaya i serdechno-sosudistaya hirurgiya – 2015. – № 4 – S. 22–33. (In Russ).

3. Zvenigorodskaya LA, Samsonova NG, Toporkov AS. Hronicheskaya ishemicheskaya bolezn’ organov pishchevareniya: algoritm diagnostiki i lechenie / // Farmateka – 2010. – № 2 – S. 78–82. (In Russ).

4. Korovin AYA, Andreeva MB, Turkin DV, Trifanov NA. Kompleksnoe lechenie pacientov s ostrym arterial’nym mezenterial’nym trombozom i peritonitom / // Novosti hirurgii – 2018. – T. 26 – № 2. – S. 179–187. (In Russ).

5. Osipenko MF, Livzan MA, Grinevich VB, Sas ЕI, Drapkina OM, SHeptulin AA, Abdulganieva DI, Alekseeva OP, Korochanskaya NV, Mordasova VI, Poluektova ЕA, Prohorova LV, TruhmAS. Klinicheskie rekomendacii Rossijskoj gastroenterologicheskoj associacii po vedeniyu pacientov s abdominal’noj / anov // RZHGGK – 2015. – № 4. – S. 71–80. (In Russ).

6. Hripun A.I., Mironkov A.B., SHurygin S.N., Abashin M.V., Pryamikov A.D. Endovaskulyarnye vmeshatel’stva v lechenii ostroj ishemii kishechnika/ // Hirurgiya (Mosk) – 2015. – № 7, S.62-64. (In Russ).

7. Acosta S. Mesenteric ischemia. Current Opinion in Critical Care. – 2015;21(2): 171-178.

8. Acosta S, Ogren M, Sternby NH, Bergqvist D, Björck M. Incidence of acute thrombo-embolic occlusion of the superior mesenteric artery- А population-based study. European Journal of Vascular and Endovascular Surgery. –2004; 27(2): 145-50.

9. Bala M, Kashuk J, Moore EE, Kluger Y, Biffl W, Gomes CA, Ben-Ishay O, Rubinstein C, Balogh ZJ, Civil I, Coccolini, F., Leppaniemi, A., Peitzman, A., Ansaloni, L., Sugrue, M., Sartelli, M., Di Saverio S, Fraga GP, Catena F. Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery. World Journal of Emergency Surgery. –2017; 12(38):1-11.

10. Björck M, Koelemay M, Acosta S, Bastos Goncalves F, Kölbel T, Kolkman JJ, Lees T, Lefevre JH, Menyhei G, Oderich G, Esvs Guidelines Committee, Kolh P, de Borst GJ, Chakfe N, Debus S, Hinchliffe R, Kakkos S, Koncar I, Sanddal Lindholt J, Vega de Ceniga M, Vermassen F, Verzini F, Document Reviewers, Geelkerken B, Gloviczki P, Huber T, Naylor R. Editor’s Choice - Management of the Diseases of Mesenteric Arteries and Veins: Clinical Practice Guidelines of the European Society of Vascular Surgery (ESVS). European Journal of Vascular and Endovascular Surgery. – 2017;53(4):460-510.

11. Chen Y, Zhu J, Ma Z, Dai X, Fan H, Feng Z, Zhang Y, Luo Y. Hybrid technique to treat superior mesenteric artery occlusion in patients with acute mesenteric ischemia. Experimental and Therapeutic Medicine. – 2015;9(6):2359-2363.

12. Van Dijk LJ, van Petersen AS, Moelker A. Vascular imaging of the mesenteric vasculature. Best Practice & Research Clinical Gastroenterology. – 2017;31(1): 3-14.

13. Dronkers CEА, Srámek A, Huisman MV, Klok FA. Accurate diagnosis of iliac vein thrombosis in pregnancy with magnetic resonance direct thrombus imaging (MRDTI). BMJ Case Reports 2016;2016:bcr2016218091.

14. Furrer J, Grüntzig A, Kugelmeier J, Goebel N. Treatment of abdominal angina with percutaneous dilatation of an arteria mesenterica superior stenosis. Preliminary communication. CardioVascular and Interventional Radiology. –1980;3(1):43-44.

15. Kärkkäinen JM, Lehtimäki TT, Manninen H, Paajanen H. Acute Mesenteric Ischemia Is a More Common Cause than Expected of Acute Abdomen in the Elderly. Journal of Gastrointestinal Surgery. – 2015;19(8):1407-1014.

16. Singh M, Long B, Koyfman A. Mesenteric Ischemia: A Deadly Miss. Emergency Medicine Clinics of North America. –2017;35(4):879-888.

17. Sise MJ. Acute mesenteric ischemia. Surgical Clinics of North America. – 2014; 94(1):165-181.

18. Stone JR, Wilkins LR. Acute mesenteric ischemia. Techniques in Vascular and Interventional Radiology. 2015;18(1):24-30.

19. Thuijls G, van Wijck K, Grootjans J, Derikx JP, van Bijnen AA, Heineman E, Dejong CH, Buurman WA, Poeze M. Early diagnosis of intestinal ischemia using urinary and plasma fatty acid binding proteins. Annals of Surgery. – 2011;253(2):303-308.

20. Tilsed JV, Casamassima A, Kurihara H, Mariani D, Martinez I, Pereira J, Ponchietti L, Shamiyeh A, Al-Ayoubi F, Barco LA, Ceolin M, D’Almeida AJ, Hilario S, Olavarria AL, Ozmen MM, Pinheiro LF, Poeze M, Triantos G, Fuentes FT, Sierra SU, Soreide K, Yanar H. ESTES guidelines: acute mesenteric ischaemia. European Journal of Trauma and Emergency Surgery. – 2016;42(2): 253-270.

21. Wain RA, Hines G. Surgical management of mesenteric occlusive disease: a contemporary review of invasive and minimally invasive techniques. Cardiology in Review. –2008; 16(2): 69-75.

22. Wang MQ, Liu FY, Duan F, Wang ZJ, Song P, Fan Q.S. Acute symptomatic mesenteric venous thrombosis: treatment by catheter-directed thrombolysis with transjugular intrahepatic route. Abdominal Imaging. – 2011; 36(4): 390-398.

For citation

Darvin V.V., Mazajshvili K.V., Klimova N.V., Vasilev V.V., Gustelyov Yu.A. Modern possibilities and perspectives of the organization of angiosurgical emergency care for patients with acute mesenteric ischemia. Bulletin of Pirogov National Medical & Surgical Center. 2019;2(14):89-93. (In Russ.)