Acute mesenteric ischemia is a deadly process with overall mortality rate of 40％.1 Acute thrombosis of an atherosclerotic lesion with previous partial occlusion is one of the common causes.Peri-operative mortality of superior mesenteric artery (SMA) thrombosis is higher because of the difficulty in diagnosis,the extensive nature of the bowel ischemia infarction,and the complex surgical revascularization.2 We described a hybrid approach employing fluoroscopically assisted embolectomy and balloon angioplasty,followed by intra-arterial catheter-directed thrombolysis during laparotomy in patients suffering from acute SMA thrombosis.rnMETHODSrnPatientsrnThe hybrid technique was used in a total of four patients with acute mesenteric ischemia in the last 2 years.The clinical records of all patients were retrospectively reviewed.Only patients with acute SMA thrombosis were included.Patients suffering from acute SMA embolism with a history of atrial tachyarrhytmias were excluded.Co-morbid medical conditions,radiologic findings,complete peri-operative data,and follow-up information were obtained for all patients.