{"title":"急性和慢性肠系膜上动脉闭塞(SMAO)的临床放射学特征","authors":"Kulumani M. Sivasubramaniyan, Venkateswara Gomathi Shankar, Kramadhari Harshith, Krishnan Nagarajan, Mohan Amuthabharathi, Sekar Sabarish","doi":"10.1007/s12262-024-04149-z","DOIUrl":null,"url":null,"abstract":"<p>Superior mesenteric artery occlusion (SMAO) can present as acute mesenteric ischemia (AMI) with bowel necrosis or as mesenteric vascular narrowing with collateral formation, resulting in chronic mesenteric ischemia (CMI). The diagnosis is often delayed due to a low clinical index of suspicion, leading to a high mortality rate. We aimed to characterize the clinical and radiological features of SMAO. This retrospective study included 39 patients with SMAO reported on CT for 3 years. We compared the clinical features from medical records with imaging and intraoperative findings. The CT features of vessel occlusion, status of collaterals, bowel changes, and other intra-abdominal findings apart from involvement of other vessels (celiac, renal, aortic, neck vessels) were analyzed. Out of 39 patients, 12 had acute SMAO, and the remaining 27 patients had chronic SMAO and were sub-classified into Takayasu (<i>n</i> = 13) and non-Takayasu (<i>n</i> = 14) sub-groups. The acute group had proximal and distal occlusions equally and bowel gangrene changes but without collaterals, whereas chronic group had mainly proximal stenosis/occlusion and no bowel changes with well-formed collaterals. Involvement of other abdominal and peripheral vessels was noted in the chronic group (both Takayasu and non-Takayasu) but less in acute group patients. Early surgery in the acute group was associated with a better prognosis and CT-detected bowel ischemia changes correlated well with intraoperative findings. Acute and chronic SMAO have distinct features in terms of level and type of occlusion, bowel ischemic changes and collaterals. Takayasu arteritis may be a subset of chronic SMAO with associated changes, which warrant further elucidation.</p>","PeriodicalId":13391,"journal":{"name":"Indian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.4000,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Clinico-Radiological Features of Acute and Chronic Superior Mesenteric Artery Occlusion (SMAO)\",\"authors\":\"Kulumani M. Sivasubramaniyan, Venkateswara Gomathi Shankar, Kramadhari Harshith, Krishnan Nagarajan, Mohan Amuthabharathi, Sekar Sabarish\",\"doi\":\"10.1007/s12262-024-04149-z\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p>Superior mesenteric artery occlusion (SMAO) can present as acute mesenteric ischemia (AMI) with bowel necrosis or as mesenteric vascular narrowing with collateral formation, resulting in chronic mesenteric ischemia (CMI). The diagnosis is often delayed due to a low clinical index of suspicion, leading to a high mortality rate. We aimed to characterize the clinical and radiological features of SMAO. This retrospective study included 39 patients with SMAO reported on CT for 3 years. We compared the clinical features from medical records with imaging and intraoperative findings. The CT features of vessel occlusion, status of collaterals, bowel changes, and other intra-abdominal findings apart from involvement of other vessels (celiac, renal, aortic, neck vessels) were analyzed. Out of 39 patients, 12 had acute SMAO, and the remaining 27 patients had chronic SMAO and were sub-classified into Takayasu (<i>n</i> = 13) and non-Takayasu (<i>n</i> = 14) sub-groups. The acute group had proximal and distal occlusions equally and bowel gangrene changes but without collaterals, whereas chronic group had mainly proximal stenosis/occlusion and no bowel changes with well-formed collaterals. Involvement of other abdominal and peripheral vessels was noted in the chronic group (both Takayasu and non-Takayasu) but less in acute group patients. Early surgery in the acute group was associated with a better prognosis and CT-detected bowel ischemia changes correlated well with intraoperative findings. Acute and chronic SMAO have distinct features in terms of level and type of occlusion, bowel ischemic changes and collaterals. Takayasu arteritis may be a subset of chronic SMAO with associated changes, which warrant further elucidation.</p>\",\"PeriodicalId\":13391,\"journal\":{\"name\":\"Indian Journal of Surgery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.4000,\"publicationDate\":\"2024-09-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Indian Journal of Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s12262-024-04149-z\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Indian Journal of Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s12262-024-04149-z","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"SURGERY","Score":null,"Total":0}
Clinico-Radiological Features of Acute and Chronic Superior Mesenteric Artery Occlusion (SMAO)
Superior mesenteric artery occlusion (SMAO) can present as acute mesenteric ischemia (AMI) with bowel necrosis or as mesenteric vascular narrowing with collateral formation, resulting in chronic mesenteric ischemia (CMI). The diagnosis is often delayed due to a low clinical index of suspicion, leading to a high mortality rate. We aimed to characterize the clinical and radiological features of SMAO. This retrospective study included 39 patients with SMAO reported on CT for 3 years. We compared the clinical features from medical records with imaging and intraoperative findings. The CT features of vessel occlusion, status of collaterals, bowel changes, and other intra-abdominal findings apart from involvement of other vessels (celiac, renal, aortic, neck vessels) were analyzed. Out of 39 patients, 12 had acute SMAO, and the remaining 27 patients had chronic SMAO and were sub-classified into Takayasu (n = 13) and non-Takayasu (n = 14) sub-groups. The acute group had proximal and distal occlusions equally and bowel gangrene changes but without collaterals, whereas chronic group had mainly proximal stenosis/occlusion and no bowel changes with well-formed collaterals. Involvement of other abdominal and peripheral vessels was noted in the chronic group (both Takayasu and non-Takayasu) but less in acute group patients. Early surgery in the acute group was associated with a better prognosis and CT-detected bowel ischemia changes correlated well with intraoperative findings. Acute and chronic SMAO have distinct features in terms of level and type of occlusion, bowel ischemic changes and collaterals. Takayasu arteritis may be a subset of chronic SMAO with associated changes, which warrant further elucidation.
期刊介绍:
The Indian Journal of Surgery is the official publication of the Association of Surgeons of India that considers for publication articles in all fields of surgery. Issues are published bimonthly in the months of February, April, June, August, October and December.
The journal publishes Original article, Point of technique, Review article, Case report, Letter to editor, Teachers and surgeons from the past - A short (up to 500 words) bio sketch of a revered teacher or surgeon whom you hold in esteem and Images in surgery, surgical pathology, and surgical radiology.
A trusted resource for peer-reviewed coverage of all types of surgery
Provides a forum for surgeons in India and abroad to exchange ideas and advance the art of surgery
The official publication of the Association of Surgeons of India
92% of authors who answered a survey reported that they would definitely publish or probably publish in the journal again
The Indian Journal of Surgery offers peer-reviewed coverage of all types of surgery. The Journal publishes Original articles, Points of technique, Review articles, Case reports, Letters, Images and brief biographies of influential teachers and surgeons.
The Journal spans General Surgery, Pediatric Surgery, Neurosurgery, Plastic Surgery, Cardiothoracic Surgery, Vascular Surgery, Rural Surgery, Orthopedic Surgery, Urology, Surgical Oncology, Radiology, Anaesthesia, Trauma Services, Minimal Access Surgery, Endocrine Surgery, GI Surgery, ENT, Colorectal Surgery, surgical practice and research.
The Journal provides a forum for surgeons from India and abroad to exchange ideas, to propagate the advancement of science and the art of surgery and to promote friendship among surgeons in India and abroad. This has been a trusted platform for surgons in communicating up-to-date scientific informeation to the community.