Published online May 6, 2022. doi: 10.12998/wjcc.v10.i13.4020
Peer-review started: November 2, 2021
First decision: February 14, 2022
Revised: February 25, 2022
Accepted: March 16, 2022
Article in press: March 16, 2022
Published online: May 6, 2022
Processing time: 178 Days and 18.7 Hours
Superior mesenteric artery embolism (SMAE) has acute onset and fast progression, which seriously threatens the life of patients. Multidetector computed tomography (MDCT) is one of the most important diagnostic methods for SMAE, which plays an important role in the diagnosis and prognosis of SMAE.
To evaluate the value of combined clinical data and MDCT findings in the diagnosis of acute SMAE and predict the risk factors for SMAE-related death.
Data from 53 SMAE patients who received abdominal MDCT multi-phase enhancement and superior mesenteric artery digital subtraction angiography examinations were collected. Univariate cox regression and multivariate cox model were used to analyze the correlation between death risk and clinical and computed tomography features in SMAE patients.
Univariate Cox regression model showed that intestinal wall thinning, intestinal wall pneumatosis, blood lactate > 2.1 mmol/L and blood pH < 7.35 increased the risk of death in patients with SMAE. After adjusting for age, sex, embolic involvement length and embolic distribution region, multivariate Cox regression model I showed that blood lactate > 2.1 mmol/L (HR = 5.26, 95%CI: 1.04-26.69, P = 0.045) and intestinal wall thinning (HR = 9.40, 95%CI: 1.05-83.46, P = 0.044) were significantly increases the risk of death in patients with SMAE.
For patients with SAME, increased blood lactate and intestinal wall thinning are the risk factors for death; hence, close monitoring may reduce the mortality rate. Clinical observation combined with MDCT signs can significantly improve SMAE diagnosis.
Core Tip: Acute superior mesenteric artery embolism (SAME) has a rapid onset and progression and lacks specific clinical and biochemical diagnostic indicators, resulting in delayed diagnosis and poor prognosis. Currently, multidetector computed tomography (MDCT) is recommended as the first-line examination method for diagnosing mesenteric vascular diseases. However, when there is no clinical doubt, radiologists can easily miss SMAE with length ≤ 20 mm and in regions III and IV, affecting early treatment of patients. We found that a serum lactate level > 2.1 mmol/L and intestinal wall thinning on MDCT could independently predict the risk factors of death in patients with SMAE.