Keady C, O’Malley CM, Mohamed SA, Bell J, Crotty C, Patton A, O’Regan D, Keeling A, McGrath A, Given M, Mulholland D, Sheehan M. Endovascular management of acute and chronic arterial mesenteric ischaemia: A narrative review of evidence informing interventional radiology treatment. World J Radiol 2026; 18(10): 125052 [DOI: 10.4329/wjr.125052]
Corresponding Author of This Article
Conor Keady, Department of Diagnostic and Interventional Radiology, Beaumont Hospital, Beaumont Road, Beaumont, Dublin D09 V2N0, Ireland. conor.k4@gmail.com
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Radiology, Nuclear Medicine & Medical Imaging
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review-article
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Keady C, O’Malley CM, Mohamed SA, Bell J, Crotty C, Patton A, O’Regan D, Keeling A, McGrath A, Given M, Mulholland D, Sheehan M. Endovascular management of acute and chronic arterial mesenteric ischaemia: A narrative review of evidence informing interventional radiology treatment. World J Radiol 2026; 18(10): 125052 [DOI: 10.4329/wjr.125052]
World J Radiol. Oct 28, 2026; 18(10): 125052 Published online Oct 28, 2026. doi: 10.4329/wjr.125052
Endovascular management of acute and chronic arterial mesenteric ischaemia: A narrative review of evidence informing interventional radiology treatment
Conor Keady, Conor M O’Malley, Sara Azhari Mohamed, Jack Bell, Caroline Crotty, Andrew Patton, Daniel O’Regan, Aoife Keeling, Andrew McGrath, Mark Given, Douglas Mulholland, Mark Sheehan
Conor Keady, Sara Azhari Mohamed, Jack Bell, Caroline Crotty, Andrew Patton, Daniel O’Regan, Aoife Keeling, Andrew McGrath, Mark Given, Douglas Mulholland, Mark Sheehan, Department of Diagnostic and Interventional Radiology, Beaumont Hospital, Dublin D09 V2N0, Ireland
Conor M O’Malley, Department of Medicine, Sligo University Hospital, Sligo F91 H684, Ireland
Co-first authors: Conor Keady and Conor M O’Malley.
Author contributions: Keady C and O’Malley CM contributed equally to this work and conceived the original idea, conducted the primary literature search and narrative review, synthesised the selected evidence, and drafted the manuscript, thereby qualifying as co-first authors of the paper; Mohamed SA, Crotty C, Bell J, Patton A and O’Regan D performed a secondary literature review and data synthesis, and critically appraised the manuscript; Keeling A, McGrath A, Given M, Mulholland D and Sheehan M were the senior authors and contributed to the study design, manuscript structure and performed a final critical appraisal of the manuscript; all authors read and approved the final manuscript.
AI contribution statement: The authors declare that the manuscript was not prepared using AI tools.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to report.
Corresponding author: Conor Keady, Department of Diagnostic and Interventional Radiology, Beaumont Hospital, Beaumont Road, Beaumont, Dublin D09 V2N0, Ireland. conor.k4@gmail.com
Received: July 1, 2026 Revised: October 8, 2026 Accepted: October 20, 2026 Published online: October 28, 2026 Processing time: 122 Days and 3.9 Hours
Abstract
Mesenteric ischaemia is a potentially life-threatening vascular disorder caused by impaired intestinal perfusion, with treatment selection requiring consideration of clinical presentation, bowel viability and lesion anatomy. This narrative review examines evidence informing interventional radiology decisions in arterial acute mesenteric ischaemia (AMI) and chronic mesenteric ischaemia (CMI). MEDLINE/PubMed was searched from inception to December 31, 2025, supplemented by reference-list screening and targeted guideline searches. Qualitative evidence synthesis considered patient selection, study design, adjunctive treatments, outcomes and follow-up. In AMI, endovascular techniques can restore perfusion, but predominantly retrospective evidence does not establish superiority over surgery in bowel preservation or survival. For CMI requiring revascularisation, European Society for Vascular Surgery guidelines recommend an initial endovascular approach, supported by Cardiovascular and Interventional Radiological Society of Europe consensus-based guidance. Observational comparisons associate endovascular treatment with lower perioperative morbidity, and surgery with less symptom recurrence. By linking individual treatment decisions to society guidance and supporting studies, this review complements existing comprehensive reviews and guidance documents. It distinguishes formal recommendations and consensus-based practice from technical feasibility and demonstrated comparative patient benefit, while identifying unresolved questions concerning AMI reperfusion strategies and device selection, in addition to antithrombotic therapy and restenosis management in CMI.
Core Tip: Mesenteric ischaemia is a potentially life-threatening vascular disorder that remains difficult to diagnose and manage, presenting either as an acute surgical emergency or as a cause of chronic, debilitating abdominal symptoms. Advances in imaging and endovascular therapy have transformed its management, positioning interventional radiology at the centre of diagnosis and treatment. This narrative review examines the evidence informing current interventional radiology practice in the management of both acute and chronic mesenteric ischaemia.
