Overview
Superior mesenteric artery thrombosis (SMAT) is a life-threatening condition characterized by occlusion of the superior mesenteric artery, leading to acute mesenteric ischemia and potentially severe bowel necrosis if not promptly treated 1.Diagnosis
Clinical Presentation: Sudden onset of severe abdominal pain 1.
Imaging: Contrast-enhanced CT scan is crucial for diagnosis, revealing thrombosis in the superior mesenteric artery 1.
Laboratory Tests: Elevated lactate levels may indicate ischemia 1.Management
First-Line Treatment: Preoperative interventional radiology procedures, such as thrombus aspiration 1.
Surgical Intervention: Emergency surgery indicated if radiological interventions fail to restore adequate blood flow 1.
Fluorescence Guidance: Use of indocyanine green fluorescence to assess and guide resection of ischemic bowel segments 1.Special Populations
Elderly: Case report suggests effective multidisciplinary approach in elderly patients 1.Key Recommendations
Initiate Interventional Radiology Early: Perform preoperative thrombus aspiration to minimize ischemic damage 1 (Evidence: Moderate).
Utilize Fluorescence Imaging: Employ indocyanine green fluorescence during surgery to accurately identify and resect ischemic bowel segments 1 (Evidence: Weak).
Combine Radiological and Surgical Approaches: Collaborate between interventional radiology and surgery for optimal outcomes in SMAT 1 (Evidence: Expert opinion).References
1 Imai T, Tanaka Y, Sato Y, Mase J, Suetsugu T, Fukada M et al.. Successful treatment of superior mesenteric artery thrombosis via preoperative interventional radiology and surgery using indocyanine green fluorescence. Clinical journal of gastroenterology 2021. link