Clinical course of conservative management for isolated superior mesenteric arterial dissection

Sosogi, Sho; Sato, Ryu; Wada, Reona; Saito, Hiroya; Takauji, Shuhei; Sakamoto, Jun; Kimura, Kazuhiro; Karasaki, Hidenori; Mizukami, Yusuke; Ohta, Takao

doi:10.1016/j.ejro.2019.05.004

Cited by 9 publications

(11 citation statements)

References 24 publications

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“…Two case series analyzed the median distance from SMA origin and the initial dissection point and its subsequent length [6,7]. In both was found a median between 15 and 30mm primary tear from ostium, similarly, found in our case report (30mm).…”

Section: Case Reportsupporting

confidence: 83%

Spontaneous Isolated Superior Mesenteric Artery Dissection: A Case Report

Deshpande¹,

Machado²

2019

IJSCR

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Section: Case Reportsupporting

confidence: 83%

Spontaneous Isolated Superior Mesenteric Artery Dissection: A Case Report

Deshpande¹,

Machado²

2019

IJSCR

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“…This suggests that SIVAD is rare, and consensus regarding the pathology and optimal therapy is lacking. However, some recent papers have advocated treatment strategies [2,6].…”

Section: Discussionmentioning

confidence: 99%

“…Presumed risk factors include atherosclerotic disease, hypertension, bromuscular dysplasia, cystic medial necrosis, and connective tissue disorders [2,3]. Treatment options for SIVAD include nonoperative, endovascular, and surgical interventions [2,[4][5][6][7]. Recently, appropriate treatment strategies have been proposed [2,6].…”

Section: Introductionmentioning

confidence: 99%

“…Treatment options for SIVAD include nonoperative, endovascular, and surgical interventions [2,[4][5][6][7]. Recently, appropriate treatment strategies have been proposed [2,6]. Endovascular intervention with good outcomes has become popular for patients with persistent symptoms or developing ischemia because of comparable outcomes with surgical intervention [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

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New technique for false lumen coiling of spontaneous isolated superior mesenteric artery dissection

Yamaguchi

Murata

Ueda

et al. 2021

Preprint

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Background: Spontaneous isolated visceral artery dissection is rarely encountered. Endovascular intervention with good outcomes has become popular for patients with persistent symptoms or developing ischemia. We could perform life-saving treatment for a spontaneous isolated superior mesenteric artery dissection with a unique endovascular intervention.Case presentation: We describe the case of an 80-year-old man who presented with acute abdominal pain and a spontaneous isolated superior mesenteric artery dissection measuring 35 mm in major diameter and 6.6 mm in minor diameter on abdominal contrast-enhanced computed tomography. After admission, abdominal pain was progressive, and a repeated scan revealed progression of the dissection. As an endovascular intervention, via the bilateral femoral approach, detachable coils were placed in the false lumen of the superior mesenteric artery dissection through the false lumen under the micro-balloon occlusion at the point of re-entry and entry through the true lumen to prevent coil migration. Technical and clinical success was achieved without serious adverse events.Conclusion: Coil embolization using micro-balloon assistance combined with the double-catheter technique for a large entry and re-entry false lumen of a spontaneous isolated superior mesenteric artery dissection was useful and feasible.

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“…Visceral artery aneurysms are aneurysms affecting the celiac, superior or inferior mesenteric arteries and their branches. In true visceral artery aneurysms, all three layers of the arterial wall are bulging, whereas in visceral artery pseudoaneurysms (VAPA), there is a tear in the vessel wall and only the adventitial layer of the vascular wall is bulging [1].VAPA are typically the result of inflammation, peptic ulcer disease, dissection or trauma including iatrogenic causes such as surgery or interventional procedures [2][3][4][5]. Another rare cause of pseudoaneurysm formation is segmental arterial mediolysis (SAM), where a tear separates the outer medial muscle from the adventitia [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Frequency and causes of delayed diagnosis of visceral artery pseudoaneurysms with CT: Lessons learned

Martini

Pfammatter

Puippe

et al. 2020

European Journal of Radiology Open

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Visceral artery pseudoaneurysms (VAPA) are associated with a high morbidity and mortality, but sometimes are missed in initial computed tomography (CT) examinations. The aims of this study were to determine the frequency and causes of misdiagnoses of VAPA with CT. Materials and Methods: We retrospectively identified 77 patients with VAPA in our database who underwent contrast-enhanced CT. The frequency of delayed diagnosis was determined and the reasons were noted. We identified the etiology of VAPA, measured size, and noted the affected vessels. Results: Forty-five of the 77 patients (58 %) had a delayed diagnosis of VAPA. There was no difference in the rate of missed VAPA in symptomatic compared to asymptomatic patients (p = 0.255). The majority of VAPA were associated with previous surgery or interventions (n = 48/62 %). The major affected vessel was the hepatic (n = 31) followed by the splenic artery (n = 17). The main reasons for misdiagnosis were a missed arterial phase in CT (n = 16/36 %), artifacts masking the aneurysm (n = 9/20 %), overlooked pseudoaneurysm (n = 19/42 %), and misinterpretation by attending radiologists (n = 1/2 %). Missed VAPA were smaller (median 8 mm) than those VAPA that were initially diagnosed (median 13 mm, p < 0.01), but occurred with a similar frequency in larger and smaller visceral arteries (p = 0.601). Conclusions: Our study showed that 58 % of VAPA were diagnosed with delay, with the following four reasons for misdiagnosis: Lack of an arterial contrast phase in CT, no techniques for artifact reduction, and lack of awareness of the radiologists. Avoiding delayed diagnosis will most probably improve outcome of patients with VAPA.

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Clinical course of conservative management for isolated superior mesenteric arterial dissection

Cited by 9 publications

References 24 publications

Spontaneous Isolated Superior Mesenteric Artery Dissection: A Case Report

Spontaneous Isolated Superior Mesenteric Artery Dissection: A Case Report

New technique for false lumen coiling of spontaneous isolated superior mesenteric artery dissection

Frequency and causes of delayed diagnosis of visceral artery pseudoaneurysms with CT: Lessons learned

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