Title : Blocked vessels, ticking clock: How imaging saves lives in gut ischemia
Abstract:
Acute mesenteric ischemia (AMI) is a life-threatening surgical emergency characterized by sudden interruption of blood flow to the intestines, often resulting in bowel necrosis if not promptly diagnosed and treated. Atrial fibrillation (AF), a common cardiac arrhythmia, significantly increases the risk of embolic events that can lead to AMI. This retrospective study, conducted between January 2022 and December 2023, analyzed 100 patients aged 50–80 years with AF who presented with AMI confirmed by CT angiography (CTA). The objective was to evaluate the sensitivity of CTA in diagnosing AMI and to assess surgical outcomes based on the timing of intervention. Inclusion criteria were patients with AF and CTA-confirmed AMI who underwent surgical treatment; patients with chronic ischemia or contraindications to contrast were excluded. CTA demonstrated superior sensitivity in detecting mesenteric arterial occlusions, particularly at the level of the superior mesenteric artery, compared to conventional imaging modalities. Surgical intervention, primarily bowel resection with or without embolectomy, was more successful when performed within 12 hours of symptom onset. Delayed intervention correlated with increased morbidity and mortality. Early CTA (within 6 hours) significantly improved diagnostic accuracy and facilitated timely surgery, leading to better outcomes. The overall 12-month survival rate was 80%, with a recurrence rate of 10%. This study underscores the critical role of CTA in the early diagnosis of AMI in AF patients and highlights the importance of timely radiologic-surgical collaboration. Despite its higher cost, CTA is justified by its diagnostic precision and its ability to guide timely interventions that improve patient survival and reduce complications.
