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Management of the Diseases of Mesenteric Arteries and Veins

Management of the Diseases of Mesenteric Arteries and Veins Clinical Practice Guidelines of the European Society of Vascular Surgery (ESVS) https://esvs.org/wp-content/uploads/2... #MesentericIschemia #VascularSurgery #ESVSGuidelines #CTA #Endovascular #OpenSurgery #BowelIschemia #VascularMedicine #WoundCare #criticalcaremedicine This video summarises the 2017 European Society for Vascular Surgery guidelines on mesenteric arterial and venous diseases. It covers the definition, epidemiology, and anatomy of conditions including acute arterial ischemia (AMI), chronic arterial ischemia (CMI), non-occlusive mesenteric ischemia (NOMI), mesenteric venous thrombosis (MVT), arterial aneurysms, and isolated dissections. Key diagnostic tools are highlighted, particularly CT Angiography (CTA) for AMI and MVT, and Duplex Ultrasound (DUS) for CMI, followed by CTA. The limitations of laboratory tests for early diagnosis are noted. Management principles include prompt diagnosis, individualised patient care based on guidelines, and treatment at specialised centres offering both open and endovascular options. For AMI, revascularisation before bowel resection is preferred. Open surgery techniques include embolectomy and bypass. Endovascular options include aspiration, thrombolysis, angioplasty, and stenting. Endovascular treatment may have lower short-term mortality but requires follow-up. For CMI, revascularisation is recommended for symptomatic multivessel disease. Open surgery offers better long-term patency, while endovascular approaches may have lower periprocedural morbidity. Stenting is preferred over angioplasty alone. NOMI management focuses on addressing the underlying cause, managing intra-abdominal hypertension, and potentially using intra-arterial vasodilators. MVT treatment is primarily anticoagulation, with endovascular options for selected cases and surgery for peritonitis. Mesenteric aneurysms and dissections are also discussed, with treatment guided by size, type, symptoms, and location. The need for collaborative future research is emphasised due to limited high-level evidence.