Endovascular versus open revascularization for acute arterial occlusive mesenteric ischemia: a retrospective single center analysis

Abstract Purpose Acute arterial occlusive mesenteric ischemia (AAOMI) is a life-threatening emergency associated with high mortality rates. Revascularization is a key component of multimodal therapy; however, the optimal initial treatment strategy, open surgical (OR) versus endovascular revascularization (ER), remains a subject of ongoing debate. This study aimed to compare outcomes between open and endovascular revascularization in patients with AAOMI. Methods This retrospective single-center cohort study included all patients with AAOMI who underwent urgent revascularization between January 2004 and July 2024. Based on the initial revascularization method, patients were divided into two treatment groups: open surgical and endovascular. Outcomes included in-hospital mortality, bowel resection rate and extent, incidence of short bowel syndrome, and length of hospital and intensive care unit (ICU) stay. Results Of the 100 patients included, 79 were initially treated with open revascularization and 21 with endovascular revascularization. In-hospital mortality was 48.1% (38/79) of OR patients and 33.3% (7/21) of ER patients ( p  = 0.227). 42 patients (53.2%) with open surgical treatment required bowel resection, compared to 10 patients (47.6%) with endovascular-first revascularization ( p  = 0.651). The median extent of bowel resection was 69 cm in the OR group and 71 cm in the ER group ( p  = 0.350). No differences could be detected regarding short bowel syndrome. Median hospital stay was 15 days in the open surgical cohort vs. 11 days in the endovascular cohort ( p  = 0.484). Median ICU stay was 5 days in the OR group and 4 days in the ER group ( p  = 0.172). Conclusion Open surgical and endovascular revascularization resulted in comparable outcomes regarding in-hospital mortality, bowel resection, short bowel syndrome, and length of hospital and ICU stay in this retrospective cohort. Treatment decisions should be individualized based on occlusion type, patient condition, and institutional expertise. Prospective multicenter studies are warranted to further refine optimal management strategies for AAOMI.