Key result
Surgically managed acute SMA embolism carries ~36% post-discharge mortality with high rates of intestinal necrosis.
Why the study?
Acute superior mesenteric artery embolism is a rare, life-threatening systemic embolism associated with cardiogenic risk factors whose clinical features, management, and short-term outcomes required description.
Cohort (n=28)
No
In an elderly cohort with acute superior mesenteric artery embolism and a high prevalence of atrial fibrillation and valvular heart disease, delayed presentation was common and associated with high rates of transmural bowel necrosis (58.3% of operative patients) and post-discharge mortality (35.7%), highlighting the necessity of an open surgical strategy when bowel viability is uncertain.
Answers are grounded in this paper and cite their sources.
High post-discharge mortality after open surgery warrants earlier detection; leaves open optimal revascularization strategies in cardiogenic embolism.
Background Acute superior mesenteric artery embolism (ASMAE) is a rare, life-threatening systemic embolism associated with cardiogenic risk factors. We described its clinical features, management, and outcomes in a single-center cohort. Methods This retrospective cohort study included 28 patients with ASMAE treated between March 2023 and March 2026. Isolated mesenteric venous thrombosis, non-occlusive mesenteric ischemia, and superior mesenteric artery dissection were excluded. All patients underwent computed tomography angiography (CTA), and operative patients had surgical or pathological confirmation. Clinical, treatment, complication, discharge, and available post-discharge follow-up data were collected. Continuous variables are reported as mean ± standard deviation and categorical variables as counts and percentages. Results We included 17 men and 11 women (mean age, 71.04 ± 9.06 years). Atrial fibrillation was present in 22 patients and valvular heart disease in 12. The proximal, middle, and distal superior mesenteric artery was involved in 7, 12, and 9 patients, respectively; 9 had concurrent infarction and 11 had peritonitis. Four patients received conservative treatment and 24 entered an operative pathway. The mean operative duration was 172.04 ± 63.02 minutes. Operations included Fogarty embolectomy alone (12), embolectomy plus bowel resection (9), bowel resection alone (1), laparotomy alone (1), and AcoStream aspiration followed by open surgery (1). Intestinal ischemia occurred in 21 patients, transmural necrosis in 14, and bowel resection with anastomosis in 10. Eleven patients were discharged against medical advice; 1 survived and 10 died after discharge (post-discharge mortality, 35.7%). Seventeen patients improved before discharge, and 1 later recovered, yielding 18 patients with a favorable short-term outcome. Five of 14 operative patients with a favorable outcome were lost to follow-up; one had residual distal embolism at 1 month. Conclusions ASMAE in patients with cardiogenic risk factors was associated with a high burden of intestinal ischemia, bowel necrosis, and post-discharge death. An open revascularization-dominant strategy enabled assessment of bowel viability and resection of nonviable intestine. These findings are descriptive, not comparative; prospective studies with standardized criteria and complete follow-up are needed.
No takes yet. Share an insight, caveat, or question.
Yang et al. (2026) conducted a cohort in Acute superior mesenteric artery embolism (ASMAE) (n=28). Open surgical revascularization-dominant management (24 operative pathway vs 4 conservative treatment) was evaluated on Post-discharge mortality (co-primary with intraoperative intestinal ischemia [87.5%], transmural intestinal necrosis [58.3%], and necrotic bowel resection [41.7%] among operative patients). Acute superior mesenteric artery embolism managed predominantly with open surgery had 87.5% intraoperative ischemia, 58.3% transmural necrosis, and 35.7% post-discharge mortality.
Synapse has enriched 8 closely related papers on similar clinical questions. Consider them for comparative context: