Outcome Comparison of Endovascular and Open Surgery for the Treatment of Acute Superior Mesenteric Artery Embolism: A Retrospective Study.

Wenrui Li,Saisai Cao,Bin Liu,Renming Zhu,Xueming Chen,Hai Feng,Zhiwen Zhang

doi:10.3389/fsurg.2022.833464

Abstract

BackgroundFew centers have adopted endovascular revascularization for the treatment of superior mesenteric artery embolism (SMAE). We sought to evaluate the efficacy of endovascular therapy for the treatment of SMAE and identify post-treatment prognostic factors.MethodsThe clinical data of 41 patients with acute SMA embolism between 2013 and 2021 were retrospectively reviewed. Patients with mesenteric artery thrombosis, mesenteric venous thrombosis, and who had only conservative treatment were excluded.ResultsForty-one consecutive patients were identified with SMAE (median age, [range] 35–86 years). Endovascular therapy was initiated in 14 patients with no clinical evidence of bowel necrosis, with mainly mechanical thrombectomy, and technical success was achieved in 93%. Endovascular therapy had advantages in duration surgery time, blood loss, bowel rest time, ICU time, and ventilator use. There was no difference in bowel necrosis, length of necrotic bowel resected, or in-hospital mortality between the two groups. An initial white blood cell (WBC) count >15 × 103/dl and neutrophil count >13 × 103/dl were associated with an increased risk of bowel necrosis, and an initial WBC count, renal function, American Society of Anesthesiologists (ASA >3) and necrotic bowel >2 m were associated with increased mortality.ConclusionsEndovascular treatment has altered the management of SMAE, and it may be adopted in selected patients who are not at risk for bowel necrosis. Avoidance of bowel necrosis patients and close monitoring for bowel necrosis are important.

Highlights

Few centers have adopted endovascular revascularization for the treatment of superior mesenteric artery embolism (SMAE)
Patients presenting with Acute mesenteric ischemia (AMI) secondary to the following conditions were excluded: mesenteric artery thrombosis, mesenteric venous thrombosis, non-occlusive mesenteric ischemia, aortic dissections complicated by visceral ischemia, and visceral ischemia occurring as part of an investigational device exemption protocol
During the 8-year study period, 41 patients with SMAE were treated with endovascular treatment of open surgery

Summary

Introduction

Few centers have adopted endovascular revascularization for the treatment of superior mesenteric artery embolism (SMAE). We sought to evaluate the efficacy of endovascular therapy for the treatment of SMAE and identify post-treatment prognostic factors. AMI has an insidious onset, rapid progression, and serious consequences. If it cannot be diagnosed and treated on time,the mortality rate can reach 50–70% [1]. Superior mesenteric artery embolism (SMAE) is the most common cause of AMI and usually occurs as an end result of cardiac arrhythmia (e.g., atrial fibrillation), left atrial thrombosis, aortic calcification, previous stenotic lesions, and tumors [2]. With the improvement of modern diagnosis and treatment technology, new breakthroughs and advancements have been brought to the treatment of SMAE, such as percutaneous mechanical thrombectomy, which has been reported for the treatment of SMAE in the form of case reports and case series; these initial studies demonstrate feasibility; whether endovascular therapy should be the primary treatment for SMAE is still controversial [3, 4]

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