Vascular Center, University Hospital, Malmö, Sweden.
Semin Vasc Surg. 2010 Mar;23(1):4-8. doi: 10.1053/j.semvascsurg.2009.12.001.
The overall incidence rate of acute mesenteric ischemia between 1970 and 1982, diagnosed at either autopsy or operation, in the population of Malmö, Sweden was estimated at 12.9/100,000 person-years. Autopsy rate was 87%. Acute superior mesenteric artery (SMA) occlusion (embolus/thrombus ratio = 1.4), mesenteric venous thrombosis (MVT), and nonocclusive mesenteric ischemia (NOMI) were found in approximately 68%, 16%, and 16%, respectively. Acute SMA occlusion was found to be more common than ruptured abdominal aortic aneurysms. The incidence increased exponentially with age, equally distributed among men and women after adjusting for age and gender in the population. Thrombotic occlusions were located more proximally than embolic occlusions and intestinal infarction was more extensive, whereas patients with embolus had a higher frequency of acute myocardial infarction, and had cardiac thrombi in 48% and synchronous emboli in 68% of the patients. The proportion of patients with symptoms inherent with chronic mesenteric ischemia prior to onset of acute thrombotic occlusion has been reported to occur in 73%. Cardiac failure, history of atrial fibrillation, and recent surgery have all been associated with fatal NOMI. MVT is either caused by thrombophilia, direct injury, or local venous congestion or stasis. Multidetector row computed tomography with intravenous contrast enhancement and imaging in the arterial phase for suspicion of acute SMA occlusion and imaging in the venous phase for MVT has become the diagnostic method of choice. In-hospital mortality is highest for NOMI, lower for acute SMA occlusion, and lowest, around 20%, for MVT.
1970 年至 1982 年间，在瑞典马尔默市，通过尸检或手术诊断的急性肠系膜缺血的总发病率估计为 12.9/100,000 人年。尸检率为 87%。急性肠系膜上动脉（SMA）阻塞（栓子/血栓比=1.4）、肠系膜静脉血栓形成（MVT）和非闭塞性肠系膜缺血（NOMI）分别约占 68%、16%和 16%。急性 SMA 阻塞比破裂的腹主动脉瘤更为常见。发病率随年龄呈指数增长，在调整人群中的年龄和性别后，男性和女性的发病率相等。血栓性阻塞比栓塞性阻塞更靠近近端，肠梗死更广泛，而栓塞患者更频繁地发生急性心肌梗死，48%的患者有心房血栓，68%的患者有同步栓塞。急性血栓性闭塞发病前存在慢性肠系膜缺血固有症状的患者比例为 73%。心力衰竭、心房颤动史和近期手术均与致命性 NOMI 相关。MVT 是由血栓形成倾向、直接损伤或局部静脉充血或淤滞引起的。多排螺旋 CT 增强静脉造影并在动脉期进行急性 SMA 阻塞成像，在静脉期进行 MVT 成像已成为首选诊断方法。NOMI 的院内死亡率最高，急性 SMA 阻塞的死亡率较低，约为 20%，MVT 的死亡率最低。
