Welcome to part 2 of the Q&A series of the 2025 ESVS Clinical Practice Guidelines on the Management of Diseases of the Mesenteric and Renal Arteries and Veins. In this podcast, we will highlight the new, complex and most controversial recommendations in this guideline. In episode two, the discussion moves to Median Arcuate Ligament Syndrome (MALS), acute mesenteric ischaemia (AMI), and non-occlusive mesenteric ischaemia (NOMI)—three challenging and clinically relevant conditions.

The experts explore patient selection and diagnostic criteria for MALS, ongoing controversies in treatment, and current research. The episode also covers the clinical presentation, imaging findings, and updated diagnostic approach to acute mesenteric ischaemia, including why biomarkers such as lactate and D-dimer are no longer recommended for diagnosis. Finally, management strategies for NOMI, including multidisciplinary care and intra-arterial vasodilator therapy, are discussed.

Guests:

Dr. Mark Koelemay

Professor Dr. Bob Geelkerken

Dr. Nicola Leone

Dr. Jussi Kärkkäinen (Part 2)

Shownotes:

https://www.ejves.com/article/S1078-5884(25)00516-7/fulltext

https://open.spotify.com/episode/45Hk77hIyikYNcWklAyVMA

https://open.spotify.com/episode/58yEYHdIdh7IgVQY13gcmk