Early consultation with interventional radiology and surgery is necessary for definitive management.

Endovascular interventions in hemodynamically stable patients include angioplasty, arterial stenting, aspiration embolectomy, and directed SMA thrombolysis.

Vasodilators are employed to reduce vasospasm. Specific agents include papaverine (a phosphodiesterase inhibitor) and glucagon. Papaverine’s standard dose is 30-60 mg/h via direct angiography catheter. Patients with peritoneal signs or concern for perforated bowel should prompt immediate surgical consultation. However, attempts at revascularization should precede surgical intervention when the clinical situation allows.⁸

Laparotomy is required for all patients who have evidence of any threatened bowel.¹⁵

Other surgical approaches include open embolectomy, thromboendarterectomy, and mesenteric artery bypass.

Acute mesenteric ischemia is a difficult clinical problem in part because of varying underlying etiologies and difficulty establishing the diagnosis.

A high index of suspicion is required, given the notable lack of simple, noninvasive testing available to confirm or exclude the diagnosis.

Early recognition and initiation of management are especially important given the high morbidity and mortality related to delay in diagnosis.

Suspect AMI in the elderly patient with a history of cardiac disease who presents with abdominal pain.

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