Liao Guanyi, Chen Siyang, Cao Haoyang, Wang Wuwan, Gao Qing
Department of Gastroenterology.
Department of Cardiology, the First Affiliated Hospital, Chongqing Medical University, Chongqing, China.
Medicine (Baltimore). 2019 Feb;98(6):e14446. doi: 10.1097/MD.0000000000014446.
Acute mesenteric ischemia (AMI) is a life-threatening medical condition that occurs when a sudden decreased perfusion to the intestines which leads to bowel infarction, and acute superior mesenteric artery embolism (ASMAE) is the main cause of AMI. Unfortunately, with the improvement of diagnosis and treatment technology, the mortality remains high due to less frequent clinical suspicion resulted from the unclear clinical manifestation and non-specific laboratory findings.
Relevant studies published were identified by searching the PubMed, Embase and Cochrane Library databases. This review presented the literatures to introduce the research progress of ASMAE in recent years.
Patients with the history of atrial fibrillation, heart valve disease and atherosclerosis should be considered as ASMAE. Laboratory findings are insensitive and unspecific, however, angiography and Computed tomography angiography (CTA) can provide a clear diagnosis sensitively and specifically. Endovascular approaches have been increasingly reported in multiple case series. The key to successful treatment of AMI involves early clinical recognition and early intervention to move the embolus, which can reduce the rate of misdiagnosis and save the precious time and lives of patients.
Loss of time eventually leads to progression of ischemia to transmural bowel necrosis with peritonitis and septicemia, which may further worsen patients' outcomes. It is important for physicians to make a timely and accurate diagnosis, which can save precious time and reduce the mortality.
急性肠系膜缺血（AMI）是一种危及生命的疾病，当肠道灌注突然减少导致肠梗死时发生，急性肠系膜上动脉栓塞（ASMAE）是AMI的主要原因。不幸的是，随着诊断和治疗技术的提高，由于临床表现不明确和实验室检查结果不特异导致临床怀疑较少，死亡率仍然很高。
通过检索PubMed、Embase和Cochrane图书馆数据库确定已发表的相关研究。本综述介绍了近年来ASMAE的研究进展。
有房颤、心脏瓣膜病和动脉粥样硬化病史的患者应考虑为ASMAE。实验室检查结果不敏感且不特异，然而，血管造影和计算机断层血管造影（CTA）可以敏感且特异的做出明确诊断。多个病例系列中越来越多地报道了血管内治疗方法。成功治疗AMI的关键在于早期临床识别和早期干预以清除栓子，这可以降低误诊率并挽救患者的宝贵时间和生命。
时间的延误最终会导致缺血进展为透壁性肠坏死并伴有腹膜炎和败血症，这可能会进一步恶化患者的预后。医生及时准确的诊断很重要，这可以节省宝贵的时间并降低死亡率。
