Clinical implications for the management of acute thromboembolic occlusion of the superior mesenteric artery: autopsy findings in 213 patients.
OBJECTIVE
To study findings at autopsy in patients with fatal acute thromboembolic occlusion of the superior mesenteric artery (SMA).


BACKGROUND
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.
Acosta
Stefan
S
Department of Vascular Surgery, Uppsala University Hospital, Sweden. stefan.acosta@telia.com
Ogren
Mats
M
Sternby
Nils-Herman
NH
Bergqvist
David
D
Björck
Martin
M
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D005260:Female; D006801:Humans; D007238:Infarction / Q000175:diagnosis / Q000209:etiology / Q000473:pathology; D007422:Intestines / Q000098:blood supply / Q000473:pathology; D008297:Male; D017538:Mesenteric Artery, Superior / Q000473:pathology; D008641:Mesenteric Vascular Occlusion / Q000175:diagnosis* / Q000473:pathology; D013923:Thromboembolism / Q000175:diagnosis* / Q000473:pathology
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