Treatment-acute mesenteric ischemia

• IVF, NPO, optimize hemodynamics (minimize pressors), broad-spectrum abx, anticoagulation w/ heparin ± tPA (for occlusive disease), IV papaverine (vasodilator; for non-occlusive mesenteric ischemia)

• If evidence of peritonitis: to OR for surgical endovascular therapies & bowel resection

• SMA thrombosis: percutaneous (stenting) or surgical revascularization

• SMA embolism: embolectomy (catheter-based aspiration vs. surgical)

• Nonocclusive: correct underlying cause (esp. cardiac)

• Mesenteric venous thrombosis: 3–6 mo anticoag after initial heparinization. Fibrinolysis or thrombectomy typically reserved for Pts w/ hemodynamic instability or refractory sx.

• Focal segmental ischemia: typically surgical resection