The real-world management of acute mesenteric ischemia in Spain: results from a multicenter national survey

BACKGROUND: Acute mesenteric ischemia (AMI) remains one of the most lethal vascular emergencies, with in-hospital mortality rates frequently exceeding 50%. Although early diagnosis and timely revascularization are critical, clinical practice remains highly variable. This study aimed to evaluate the real-world management of AMI in Spain, identifying gaps in resources, protocols, and interhospital coordination. METHODS: platform. The questionnaire was distributed to general surgeons through national surgical societies and included 27 items covering hospital infrastructure, clinical protocols, diagnostic and therapeutic availability, personal experience, and perceived system-level barriers. RESULTS: A total of 291 surgeons responded. The median age was 40 years (IQR: 17). Most were consultants (76.3%) working in tertiary (42.6%), secondary (33%), or community hospitals (24.4%). While 97.6% reported access to 24/7 multiphasic CT and 90.4% to round-the-clock radiology, only 51.9% had 24/7 interventional radiology and 60.1% vascular surgery. Just 26.8% had institutional AMI protocols. The median distance to a referral center was 25 km (range: 2-250 km), and 68.4% reported difficulty in patient transfers. While 96.9% felt competent managing AMI, only 36.4% were familiar with the term "intestinal stroke." A total of 76.3% expressed interest in joining a national AMI registry. CONCLUSIONS: Spanish surgeons report high self-perceived clinical competence in AMI management, but systemic fragmentation, lack of protocols, and logistical barriers limit optimal care. These findings underscore the urgent need for coordinated regional networks, standardized care pathways, and multidisciplinary collaboration to improve outcomes in acute mesenteric ischemia across European healthcare systems. TRIAL REGISTRATION: Retrospectively registred and recorded in Clinical Trials. NCT06428240, registration date on 20th/05/2024.