Dufay Raphael, Garzelli Lorenzo, Ben Abdallah Iannis, Tual Arnaud, Cazals-Hatem Dominique, Corcos Olivier, Vilgrain Valérie, Weiss Emmanuel, Nuzzo Alexandre, Ronot Maxime
Université Paris Cité, France & Service de Radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France.
Service d'Imagerie Médicale et Interventionnelle, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
Insights Imaging. 2025 May 8;16(1):97. doi: 10.1186/s13244-025-01986-8.
To describe the characteristics and outcomes of patients with an incomplete occlusion of the superior mesenteric artery (SMA) (persistence of contrast-enhanced vessel lumen) and compare them to those with a complete occlusion of the SMA (complete interruption of the contrast-enhanced vessel lumen) in arterial acute mesenteric ischaemia (AMI).
Retrospective study of arterial AMI patients (2006-2022). Demographics, laboratory tests, clinical characteristics, CT, treatments and outcomes were compared between patients with complete or incomplete SMA obstruction after adjusting for aetiology (embolic or atherosclerotic). The primary outcome was 30-day mortality, and the secondary outcome was 6-month gastrointestinal disability-free survival (no short bowel syndrome or parenteral nutritional support or permanent stoma).
151 patients (65 women, mean age 69) were included, 62 (41%) with incomplete and 89 (59%) with occlusive SMA occlusion. After adjusting for aetiology, chronic kidney failure (p = 0.03) and normal bowel enhancement on CT (p < 0.01) were associated with incomplete SMA occlusion. Patients with incomplete SMA occlusion were more frequently treated by endovascular revascularisation (p < 0.01) and stenting (p < 0.01), while patients with complete SMA occlusion were treated by open revascularisation. The 30-day mortality rate was 13% with no difference between incomplete (11%) and complete SMA occlusion (15%; p = 0.89). Nevertheless, complete SMA occlusion patients had a lower 6-month gastrointestinal disability-free survival rate (p = 0.01), more transmural necrosis (p < 0.01) and a higher risk of gastrointestinal disability (p = 0.02).
Incomplete SMA occlusion can cause AMI with a similar 30-day mortality rate to completely occlusive forms. However, it is associated with poorer gastrointestinal outcomes, regardless of aetiology.
Acute arterial mesenteric ischaemia caused by incomplete occlusion of the superior mesenteric artery demonstrates similar 30-day mortality to complete occlusion but distinctively better gastrointestinal outcomes, emphasising nuanced imaging evaluation for targeted management strategies in these patients.
Occlusive acute mesenteric ischaemia can be caused by incomplete superior mesenteric artery (SMA) occlusion. Acute mesenteric ischaemia caused by incomplete SMA occlusion has a similar 30-day mortality rate to complete SMA occlusion. A complete occlusion of the SMA is associated with poorer gastrointestinal outcomes.
描述肠系膜上动脉（SMA）不完全闭塞（对比增强血管腔持续存在）患者的特征和预后，并将其与动脉性急性肠系膜缺血（AMI）中SMA完全闭塞（对比增强血管腔完全中断）的患者进行比较。
对动脉性AMI患者（2006 - 2022年）进行回顾性研究。在对病因（栓塞性或动脉粥样硬化性）进行校正后，比较完全或不完全SMA梗阻患者的人口统计学、实验室检查、临床特征、CT、治疗方法及预后。主要结局为30天死亡率，次要结局为6个月无胃肠道功能障碍生存率（无短肠综合征、无肠外营养支持或永久性造口）。
纳入151例患者（65例女性，平均年龄69岁），62例（41%）为SMA不完全闭塞，89例（59%）为闭塞性SMA闭塞。校正病因后，慢性肾衰竭（p = 0.03）和CT上肠管强化正常（p < 0.01）与SMA不完全闭塞相关。SMA不完全闭塞的患者更常接受血管内血运重建治疗（p < 0.01）和支架置入术（p < 0.01），而SMA完全闭塞的患者接受开放性血运重建治疗。30天死亡率为13%，SMA不完全闭塞组（11%）和完全闭塞组（15%）之间无差异（p = 0.89）。然而，SMA完全闭塞的患者6个月无胃肠道功能障碍生存率较低（p = 0.01），透壁坏死更多（p < 0.01），胃肠道功能障碍风险更高（p = 0.02）。
SMA不完全闭塞可导致AMI，其30天死亡率与完全闭塞形式相似。然而，无论病因如何，它都与较差的胃肠道预后相关。
由肠系膜上动脉不完全闭塞引起的急性动脉性肠系膜缺血，其30天死亡率与完全闭塞相似，但胃肠道预后明显更好，这强调了对这些患者进行细致的影像学评估以制定针对性管理策略的重要性。
闭塞性急性肠系膜缺血可由肠系膜上动脉（SMA）不完全闭塞引起。由SMA不完全闭塞引起的急性肠系膜缺血，其30天死亡率与SMA完全闭塞相似。SMA完全闭塞与较差的胃肠道预后相关。
