Conservative Therapy as a Primary Treatment for Spontaneous Isolated Dissection of the Superior Mesenteric Artery

Okamura, Keizo; Morizumi, Sei; Kawata, Mitsuhiro; Suematsu, Yoshihiro

doi:10.1016/j.avsg.2014.06.062

Cited by 19 publications

(32 citation statements)

References 24 publications

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“…Recently, many studies have proposed treatment strategies for SIDSMA [ 3 – 7 , 9 , 11 , 18 , 22 – 24 ]. There are several treatment modalities for SIDSMA: conservative treatment, endovascular procedure, surgical repair, and bowel resection [ 3 , 4 , 9 , 11 , 13 , 22 , 23 , 25 – 27 ]. Conservative management with or without anticoagulation for symptomatic SIDSMA has been reported to have a high clinical success rate, 90–95%, without recurrence of symptoms [ 15 , 22 , 23 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…Endovascular stenting of the superior mesenteric artery is associated with a higher risk of stent thrombosis than is stenting of other arteries. The long-term stability of stents in patients with SIDSMA has not yet been established [ 3 , 27 ]. Long-term use of antithrombotic agents is essential, but no universally accepted protocol has yet been established [ 3 , 7 , 10 , 23 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…MDCT shows high sensitivity and specificity for the diagnosis of intestinal ischemia [ 2 , 36 , 37 ]. If there is no bowel ischemia or rupture or enlargement of the aneurysm on MDCT, and no peritoneal irritation sign suggesting bowel ischemia, conservative management may be continued [ 3 , 18 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…Spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) has recently been discovered more frequently because of the development of multidetector computed tomography (MDCT) [ 1 , 2 ]. However, the natural clinical and morphological course of SIDSMA has yet not been established nor has a treatment method [ 3 – 11 ]. As a result, there is no established consensus treatment for the management of SIDSMA [ 4 , 7 , 9 , 11 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Conservative Management of Spontaneous Isolated Dissection of the Superior Mesenteric Artery

Kwon

Han

2017

Gastroenterology Research and Practice

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Purpose We report the clinical outcomes of patients with spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) who were treated conservatively. Materials and Methods A retrospective review was performed in 14 patients from 2006 to 2016 with SIDSMA. Their clinical features and computed tomographic angiography (CTA) characteristics, treatment methods, and clinical outcomes were analyzed. The mean age was 53.6 (range, 41–73) years, and the mean follow-up duration was 20.6 (range, 1–54) months. Conservative management was the primary treatment if no bowel ischemia or arterial rupture was noted. Results The mean initial abdominal visual analog pain score was 7 (range, 5–9) in seven patients. The mean total duration of abdominal pain was 10.2 days (range, 2–42 days) in 10 patients. The mean percentage stenosis of the dissected SMA at the initial presentation was 78.8% in 14 patients. Complete obstruction of the SMA at the initial presentation was evident in 4 of the 14 patients (28.6%). Conservative management was successful in all 14 patients. None of the 14 patients developed bowel ischemia or an infarction. Abdominal pain did not recur in any patient during follow-up (mean, 20.6 months; range, 1–54 months). Conclusion Conservative management was successful for all SIDSMA patients, even those with severe compression of the true lumen or complete obstruction of the dissected SMA.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Conservative Management of Spontaneous Isolated Dissection of the Superior Mesenteric Artery

Kwon

Han

2017

Gastroenterology Research and Practice

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“…Multiple algorithms for treatment have been published, but none include all aspects of pathology and treatment. 2) 6) 19) 20) 21) 22) 23) 24) 25) 26) 27) 28) 29) 30) Our suggested treatment algorithm for SISMAD is outlined in Fig. 7…”

Section: Management Algorithm Of Sismadmentioning

confidence: 99%

The Classification and Management Strategy of Spontaneous Isolated Superior Mesenteric Artery Dissection

Jia

Jiang

2017

Korean Circ J

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Spontaneous isolated superior mesenteric artery dissection (SISMAD) is an uncommon but potentially catastrophic pathology. Multiple classification schemes have been proposed for this occurrence. Although no consensus has emerged regarding which classification should be used, Li's classification scheme is more precise and complete compared to other classification systems and can be used to guide the treatment of SISMAD. Initial conservative treatment is promising, with favorable early and long-term outcomes for most patients; endovascular treatment is recommended for patients with persistent/recurrent symptoms after conservative treatment; surgical treatment should be performed without delay for patients with arterial rupture, intestinal necrosis, or failed endovascular treatment.

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Dissections des artères périphériques

Calanca

Depairon

Mazzolai

2016

Maladies Artérielles

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Conservative Therapy as a Primary Treatment for Spontaneous Isolated Dissection of the Superior Mesenteric Artery

Cited by 19 publications

References 24 publications

Conservative Management of Spontaneous Isolated Dissection of the Superior Mesenteric Artery

Conservative Management of Spontaneous Isolated Dissection of the Superior Mesenteric Artery

The Classification and Management Strategy of Spontaneous Isolated Superior Mesenteric Artery Dissection

Dissections des artères périphériques

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