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Background <p>Acute arterial mesenteric ischemia (AMI) remains one of the most devastating emergencies in vascular surgery. Despite advances in diagnostic modalities and therapeutic strategies, in-hospital mortality continues to range between 30% and 60%. While retrograde catheter embolectomy and antegrade endovascular revascularization are established first-line treatments both approaches are often technically challenging in the presence of heavily calcified ostial occlusions. Retrograde open mesenteric stenting (ROMS), a&#xa0;hybrid technique, combines the advantages of surgical exploration of the abdominal organs with endovascular revascularization and is gaining increasing relevance in this context.</p> Objective <p>Does ROMS improve outcomes in patients with occlusive AMI due to thrombotic occlusion of the superior mesenteric artery (SMA) compared with conventional treatment strategies?</p> Results <p>Contemporary series, including the largest multicenter cohort to date (Oderich et&#xa0;al.), reported technical success rates of 89–98% for ROMS. The 30-day mortality ranges from 20–35%, comparable to outcomes following mesenteric bypass. Procedural times are significantly shorter. The operation can be performed in standard operating rooms under fluoroscopic guidance; however, a&#xa0;hybrid operating suite represents the optimal environment. Mid-term results demonstrate acceptable primary patency rates of 76–92% at 12&#xa0;months.</p> Conclusion <p>The use of ROMS represents an effective and increasingly adopted therapeutic strategy for occlusive AMI, particularly when antegrade revascularization is not feasible. Structured interdisciplinary management, conceptualized as an “intestinal stroke center,” has been shown to significantly improve mortality; however, the current evidence is largely limited to retrospective series and prospective studies are urgently needed.</p>

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Der akute Mesenterialarterienverschluss – Bringt ROMS einen Paradigmenwechsel?

  • 期刊论文

  • 发表日期：

    2026年7月20日

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  • Farzin Adili,
  • Mahdi Aldaini,
  • Maher Fattoum,
  • Samir Ismail Khan,
  • Abhay Setia

摘要

Background

Acute arterial mesenteric ischemia (AMI) remains one of the most devastating emergencies in vascular surgery. Despite advances in diagnostic modalities and therapeutic strategies, in-hospital mortality continues to range between 30% and 60%. While retrograde catheter embolectomy and antegrade endovascular revascularization are established first-line treatments both approaches are often technically challenging in the presence of heavily calcified ostial occlusions. Retrograde open mesenteric stenting (ROMS), a hybrid technique, combines the advantages of surgical exploration of the abdominal organs with endovascular revascularization and is gaining increasing relevance in this context.

Objective

Does ROMS improve outcomes in patients with occlusive AMI due to thrombotic occlusion of the superior mesenteric artery (SMA) compared with conventional treatment strategies?

Results

Contemporary series, including the largest multicenter cohort to date (Oderich et al.), reported technical success rates of 89–98% for ROMS. The 30-day mortality ranges from 20–35%, comparable to outcomes following mesenteric bypass. Procedural times are significantly shorter. The operation can be performed in standard operating rooms under fluoroscopic guidance; however, a hybrid operating suite represents the optimal environment. Mid-term results demonstrate acceptable primary patency rates of 76–92% at 12 months.

Conclusion

The use of ROMS represents an effective and increasingly adopted therapeutic strategy for occlusive AMI, particularly when antegrade revascularization is not feasible. Structured interdisciplinary management, conceptualized as an “intestinal stroke center,” has been shown to significantly improve mortality; however, the current evidence is largely limited to retrospective series and prospective studies are urgently needed.