Conservative management of symptomatic spontaneous isolated dissection of the superior mesenteric artery

Abstract

In patients with symptomatic spontaneous isolated dissection of the SMA, conservative management is feasible if there is no evidence of bowel infarction or bleeding.

Current strategy for the treatment of symptomatic spontaneous isolated dissection of superior mesenteric artery

“…27 Recently, however, SIDSMA has been reported more frequently. [1][2][3][5][6][7][8][9][10][11][12][15][16][17][18][19][20][21][22] SIDSMA can be detected as an incidental finding, but may also cause drastic complications such as bowel infarction and severe hemorrhage. Although four approaches -conservative management, anticoagulation, endovascular stenting, and open surgery -have been previously reported, given the paucity of the SMA dissections, the optimal treatment for SIDSMA remains a matter of some controversy.…”

“…Some authors insist that anticoagulation therapy is valid and should be a mainstay for the conservative management of SIDSMA after the first successful treatment with intravenous heparin (Ambo et al). 14,21,23 This opinion has been strengthened by the experience with treatment of spontaneous dissection of the carotid artery, where anticoagulation is effective in preventing the formation of the thrombus. 28 Considering the aforementioned treatment objectives of the SIDSMA and the previous reports 3,10 that have described the progression of disease and aneurysmal dilatation in some cases despite the administration of chronic anticoagulation therapy, anticoagulation or antiplatelet therapy could not be the optimal treatment for SIDSMA.…”

Natural history of spontaneous isolated superior mesenteric artery dissection derived from follow-up after conservative treatment

“…During follow-up examination, the SMA stent was found to be occluded at 18 months, but the patient remained without abdominal symptoms. Some authors suggest a SMA stent if an intimal flap or a short SMA stenosis is present, 16 but SMA stent is known to have a higher risk of stent thrombosis than other site arteries in the long term. To prevent acute or subacute thrombosis after SMA stenting, a stent used for SMA needs to have minimal shortening and good flexibility, and it must not change location as a result of the continuous movement of the mesentery.…”

Isolated dissection of the superior mesenteric artery treated using open emergency surgery

“…Thus, asymptomatic patients should be treated conservatively [7]. The controversial discussion concerning whether asymptomatic patients should be treated to prevent a potential intestinal infarction remains unresolved [28,30,34,35]. Another algorithm was published by Garrett Jr. et al [6].…”