Single-centre experience in the endovascular treatment of acute superior mesenteric artery occlusion: an observational analytical 3-year study

Introduction
To retrospectively evaluate single-centre experience in endovascular therapy (EVT) of acute superior mesenteric artery (SMA) occlusion by assessing technical success, mortality, and its dependence on the level and aetiology of occlusion.

Material and methods
Eighty patients presented with acute SMA occlusion and underwent EVT at our centre from 2018 to 2020. Clinical diagnosis was confirmed by computed tomography angiography (CTA). Based on findings of CTA and digital subtraction angiography, we classified all cases by the number of SMA large branches that remained non-occluded (ostial, proximal, distal occlusion), as well as according to aetiology (embolic, thrombotic). Technical success was evaluated according to restoration of blood flow to the SMA stem and all large branches (successful, partially successful, failure).

Results
Thrombotic aetiology was identified in 25.0% and embolic in 75.0% of patients. We distinguished 3 occlusion level types: ostial occlusion (23.8%), proximal occlusion (47.5%), and distal occlusion (28.7%). 67.5% of cases were technically successful, 12.5% were partially successful, and 20.0% resulted in technical failure. The 30-day mortality rate was 55.0%. EVT technical success did not statistically depend on the aetiology or on the level of occlusion. The aetiology of occlusion had no statistical significance regarding intrahospital mortality. In the group with EVT failure, fewer non-occluded large branches meant more fatal cases, and vice versa.

Conclusions
Despite EVT technical success rates being adequate, mortality rates remain extremely high. While the occlusion level appeared to have no influence over EVT technical success rates, it may be a potentially useful prognostic factor in the case of failed recanalization. Aetiology of the occlusion seemed to have no impact on technical success or mortality.