Kase Karri, Blaser Annika Reintam, Koitmäe Merli, Talving Peep, Tamme Kadri, Acosta Stefan, Björck Martin, Bala Miklosh, Bodnar Zsolt, Cahenzli Martin, Casian Dumitru, Demetrashvili Zaza, D'Oria Mario, Muñoz-Cruzado Virginia Durán, Forbes Alastair, Vetrhus Morten, Itzhaki Moran Hellerman, Lein Kristoffer, Lindner Matthias, Loudet Cecilia I, Damaskos Dimitrios, Nuzzo Alexandre, Saar Sten, Scheiterle Maximilian, Starkopf Joel, Voomets Anna-Liisa, Voon Kenneth, Yunus Mohammad Alif, Murruste Marko, Castier Yves, Ronot Maxime, Biloslavo Alan, Paiano Lucia, Elke Gunnar, Nagel Denise, Radke David I, Becerra Jacqueline Vilca, Abeleyra María Elina, Hess Benjamin, Kirov Mikhail, Semenkova Tatjana, Nikonov Anton, Smetkin Alexey, Nedredal Geir Ivar, Irtun Øivind, Cohen-Arazi Oded, Keda Asaf, Rojnoveanu Gheorghe, Malcova Tatiana, Ciuró Felipe Pareja, García-Leon Anabel, García-Sánchez Carlos Javier, Hui Lim Jia, Ling Loy Yuan, Kagan Ilya, Singer Pierre, Lipping Edgar, Tvaladze Ana, Mole Damian, Clinch Darja, Qing Too Xiao, Fuglseth Hanne, Martellucci Jacopo, Cerino Giulia, Hong Donghuang, Liu Jinsheng, Ong Ernest, Kundogan Kursat, Talih Tutkun, Bains Lovenish, Visconti Diego, Gibello Lorenzo, Jailani Ruhi Fadzlyana, Ashra Muhammad Amirul, Zakaria Andee Dzulkarnaen, Mohd Ghazi Ahmad Faiz Najmuddin, Abd Ghani Nur Suriyana, Ab Rahim Mohd Fadliyazid, Augustin Goran, Halužan Damir, Gurjar Mohan, Rahul Rahul, Hayati Firdaus, Mah Jin-Jiun
Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.
Tartu University Hospital, Tartu, Estonia.
World J Emerg Surg. 2025 Jun 2;20(1):46. doi: 10.1186/s13017-025-00616-4.
The optimal strategy for initial treatment of acute occlusion of superior mesenteric artery (SMA) is debated. The aim of the study was to compare the effectiveness, timelines and outcomes of endovascular versus open surgical treatment in patients with acute SMA occlusion. This was a preplanned substudy of the prospective observational multicenter AMESI (Acute MESenteric Ischaemia) study.
Patients with SMA occlusion were divided into surgical and endovascular treatment groups. The surgical group included patients initially subjected to open surgical treatment with surgical or hybrid revascularization or intestinal resection only. The endovascular group included patients initially revascularized endovascularly and was further divided according to treatment effectiveness. Patients were also categorized according to revascularization or no revascularization, and subanalysis performed for different revascularization methods. Baseline and outcome comparisons were made using Fisher and Mann-Whitney U tests. Risk-factors for in-hospital mortality were analysed using a logistic regression model.
Of 158 patients 107 had surgical and 51 endovascular treatment. The surgical group had higher baseline illness severity scores, higher C-reactive protein and lactate values. The mortality in the endovascular effective, endovascular insufficient as monotherapy and surgical groups was 2.9%, 41.2% and 45.8%, respectively. In multivariable analysis surgery was not an independent risk factor for in-hospital mortality. The rate of arterial embolism was higher in the endovascular revascularization as monotherapy insufficient treatment group (10/17) compared to the endovascular revascularization as monotherapy effective (5/34) and surgical (27/107) groups. We could not identify useful best thresholds for discriminating between effective and insufficient endovascular treatment. Analysis comparing the effect of any revascularization versus no revascularization on in-hospital mortality did not show a clear benefit of revascularization and the method of revascularization did not independently influence mortality.
The beneficial effect of endovascular compared to surgical treatment in unadjusted analyses is largely explained by selection of patients. None of the compared management approaches had an independent effect on mortality. The choice between endovascular and surgical treatment should not be based solely on the time elapsed from symptom onset but rather on the patient's general condition and possibly on the cause of SMA occlusion.
肠系膜上动脉（SMA）急性闭塞初始治疗的最佳策略存在争议。本研究旨在比较急性SMA闭塞患者血管内治疗与开放手术治疗的有效性、时间线和结局。这是前瞻性观察性多中心AMESI（急性肠系膜缺血）研究的一项预先计划的子研究。
SMA闭塞患者分为手术治疗组和血管内治疗组。手术组包括最初接受开放手术治疗、采用手术或混合血运重建或仅行肠切除术的患者。血管内治疗组包括最初接受血管内血运重建的患者，并根据治疗效果进一步分组。患者还根据是否进行血运重建进行分类，并对不同的血运重建方法进行亚组分析。使用Fisher检验和Mann-Whitney U检验进行基线和结局比较。使用逻辑回归模型分析院内死亡的危险因素。
158例患者中，107例接受手术治疗，51例接受血管内治疗。手术组的基线疾病严重程度评分、C反应蛋白和乳酸值更高。血管内治疗有效组、血管内单一疗法无效组和手术组的死亡率分别为2.9%、41.2%和45.8%。在多变量分析中，手术不是院内死亡的独立危险因素。与血管内单一疗法有效组（5/34）和手术组（27/107）相比，血管内单一疗法血运重建不足治疗组（10/17）的动脉栓塞发生率更高。我们无法确定区分血管内治疗有效和无效的有用最佳阈值。比较任何血运重建与未进行血运重建对院内死亡率影响的分析未显示血运重建有明显益处，且血运重建方法并未独立影响死亡率。
在未经调整的分析中，血管内治疗与手术治疗相比的有益效果在很大程度上是由患者选择所解释的。所比较的管理方法均对死亡率没有独立影响。血管内治疗和手术治疗之间的选择不应仅基于症状出现后的时间，而应基于患者的一般状况以及可能基于SMA闭塞的原因。
