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. 2005 Mar;241(3):516-22.
doi: 10.1097/01.sla.0000154269.52294.57.

Clinical implications for the management of acute thromboembolic occlusion of the superior mesenteric artery: autopsy findings in 213 patients

Stefan Acosta  1 , Mats Ogren, Nils-Herman Sternby, David Bergqvist, Martin Björck
Affiliations

Clinical implications for the management of acute thromboembolic occlusion of the superior mesenteric artery: autopsy findings in 213 patients

Stefan Acosta et al. Ann Surg. 2005 Mar.

Abstract

Objective: To study findings at autopsy in patients with fatal acute thromboembolic occlusion of the superior mesenteric artery (SMA).

Summary background data: Acute occlusion of the SMA is difficult to diagnose and mortality remains high. In Malmo, Sweden, the autopsy rate between 1970 and 1982 was 87%, creating possibilities for a population-based study.

Methods: Among 23,496 clinical autopsies and 7569 forensic autopsies, 213 cases with acute thromboembolic occlusion of the SMA and intestinal infarction were identified.

Results: A clinical suspicion of intestinal infarction was documented in 32% of the patients, only 35% being in the care of surgeons. The embolus/thrombus ratio was 1.4 to 1. Thrombotic occlusions were located more proximally than embolic occlusions (P < 0.001), intestinal infarction was more extensive (P = 0.025) and thrombotic occlusions were associated with old brain infarction (P = 0.048), aortic wall thrombosis (P = 0.080), and disseminated cancer (P = 0.079). Patients with embolic occlusions (n = 122) had a higher frequency of acute myocardial infarction (AMI) than patients with thrombotic occlusions (P = 0.049). The embolic source was identified in 80%. In 115 (94%), synchronous embolism and/or source of embolus were present. There were findings of remaining cardiac thrombi in 58 (48%) and synchronous emboli affected 273 other arterial segments in 83 (68%).

Conclusions: Early recognition and revascularization would have been a prerequisite for survival in at least half of the patients, since the jejunum, ileum, and colon were affected by infarction. A minority of all patients were under surgical care. AMI, cardiac thrombi, and synchronous emboli were common findings among patients with embolic occlusions.

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Figures

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FIGURE 1. Extent of intestinal infarction in 208 patients with acute thromboembolic occlusion of the SMA.
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FIGURE 2. Concurrent acute thromboembolic disease. Occurrence of acute myocardial infarction (AMI), ischemic stroke, and synchronous embolism in 213 patients with acute thromboembolic occlusion of the SMA.
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FIGURE 3. Number of synchronous emboli among 122 patients with an embolus to the SMA.
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