Key result
Colonic necrosis is linked to ~6.1-fold higher mortality in acute superior mesenteric artery embolism.
Why the study?
Acute superior mesenteric artery embolism (ASME) is the most lethal form of acute mesenteric ischemia, prompting an evaluation of its clinical characteristics, open surgical management, and prognostic risk factors.
What are the clinical characteristics, open surgical management outcomes, and prognostic risk factors for all-cause mortality in patients with acute superior mesenteric artery embolism?
Cohort (n=78)
No
What are the clinical characteristics, open surgical management outcomes, and prognostic risk factors for all-cause mortality in patients with acute superior mesenteric artery embolism?
In patients with acute superior mesenteric artery embolism, overall mortality is high (60.3%) and increases stepwise with surgical delay, with colonic necrosis independently predicting higher mortality.
Answers are grounded in this paper and cite their sources.
Colonic necrosis identifies high-risk acute superior mesenteric artery embolism patients; leaves open whether earlier surgery improves survival in prospective studies.
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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Liu et al. (2026) conducted a cohort in Acute superior mesenteric artery embolism (ASME) (n=78). Open surgical management and prognostic risk factors (colonic necrosis, diabetes mellitus, surgical delay) vs. Early surgery (<12 h) or absence of risk factors was evaluated on All-cause mortality (HR 6.098, 95% CI 1.411-26.347, p=0.015). In acute superior mesenteric artery embolism, overall mortality was 60.3% (27.3% with surgery <12h vs 71.1% >24h) and colonic necrosis independently increased mortality (HR 6.098; P=0.015).
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