Features of Surgical Treatment of Symptomatic Patients with Isolated Superior Mesenteric Artery Dissection (Clinical Cases and Literature Review)

Abstract

Introduction. Isolated superior mesenteric artery dissection (ISMAD) is a rare disease with high variability of clinical manifestations: from incidental findings to the development of acute or chronic mesenteric ischemia and the formation of aneurysms with the probability of their rupture. Despite significant world experience, surgical and conservative treatment of patients with ISMAD remains debatable.
 The aim. Improvement of the diagnosis and surgical treatment of patients with ISMAD.
 Clinical cases.
 In the first clinical observation, a 78-year-old patient with chronic visceral ischemia was diagnosed with an aneurysm of the upper mesenteric artery with signs of dissection and malperfusion. Previous unsuccessful attempts of endovascular treatment at another hospital caused the need for open surgical intervention – resection of the aneurysm and upper mesenteric artery reconstruction.
 
 In the second clinical case, a 61-year-old patient had acute abdominal pain syndrome, and based on clinical examination, laboratory and instrumental examination, the diagnosis of acute mesenteric ischemia with signs of dissection of the superior mesenteric artery was confirmed, which determined immediate indications for surgical treatment – resection of the affected segment of superior mesenteric artery and aorta-superior mesenteric bypass.
 
 The surgical interventions contributed to complete regression of clinical symptoms. Follow-up of the patients showed promising long-term results.
 
 Conclusion. Computed tomography angiography is the method of choice in the diagnosis of ISMAD and makes it possible to provide prompt diagnosis, determine treatment tactics and prevent the development of fatal complications. Open surgical intervention in some cases remains the method of choice in the treatment of ISMAD.