DOI: 10.4103/vit.vit-d-26-00018 ISSN: 2589-9686

Open surgical treatment of acute superior mesenteric artery embolism

Chong Liu, Haidi Hu
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PURPOSE:

Acute superior mesenteric artery embolism (ASME) is the most lethal form of acute mesenteric ischemia. This study evaluated the clinical characteristics, open surgical management, and prognostic risk factors of ASME in a retrospective single-center cohort.

METHODS:

Clinical data of 78 patients with ASME admitted to Shengjing Hospital of China Medical University from January 2020 to December 2024 were retrospectively analyzed. Baseline characteristics, laboratory findings, and outcomes were compared between the survival ( n = 31) and death ( n = 47) groups. Univariate and multivariate Cox regression analyses were performed to identify independent risk factors for all-cause mortality.

RESULTS:

The mean patient age was 65.8 years; 39 patients (50.0%) had atrial fibrillation and 12 (15.4%) were initially misdiagnosed. The median interval from symptom onset to admission was 59.0 h. Forty-six patients (59.0%) underwent surgical treatment, including 41 open surgeries. The overall mortality was 60.3% (47/78), and it increased stepwise with surgical delay (27.3% when surgery was performed within 12 h vs. 71.1% beyond 24 h). Colonic necrosis (hazard ratio [HR] = 6.098, 95% confidence interval [CI]: 1.411–26.347, P = 0.015), and diabetes mellitus (HR = 3.738, 95% CI: 0.938–14.885, P = 0.061) were associated with increased mortality, whereas male gender was protective (HR = 0.232, 95% CI: 0.074–0.730, P = 0.013).

CONCLUSION:

In this single-center retrospective cohort, delayed presentation, initial misdiagnosis, colonic necrosis, and diabetes mellitus were associated with increased mortality. Open surgery remains an essential treatment option for ASME patients with peritonitis or bowel necrosis; prospective studies comparing open surgery with endovascular therapy are warranted.

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