Management of isolated spontaneous dissection of superior mesenteric artery

Zerbib, Philippe; Perot, Céline; Lambert, Marc; Seblini, M.; Pruvot, F.R.; Chambón, J. P.

doi:10.1007/s00423-009-0537-1

Cited by 77 publications

(64 citation statements)

References 23 publications

(40 reference statements)

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“…The SMA dissection morphology was classified as described above by Sakamoto, et al 2) and Zerbib, et al 3) Yun, et al 10) classified the morphology into type I (the same as that classified by Sakamoto, et al), type II (cases with no re-entry, the false lumen is patent [IIa] and occluded [IIb]), and type III (occluded). We adopted the more detailed classification established by Sakamoto, et al and Zerbib, et al It is considered desirable to perform active treatment, such as surgical and endovascular treatments, when the diameter is 2 cm or greater or stenosis is 70% or more in cases of types II, III, V and VI of this classification.…”

Section: Discussionmentioning

confidence: 99%

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Management Strategy of Isolated Spontaneous Dissection of the Superior Mesenteric Artery

Satokawa

Takase

Seto

et al. 2014

Annals of Vascular Diseases

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Objective: Isolated spontaneous dissection of the superior mesenteric artery (SMA) is very rare among of the visceral artery dissection and its treatment is not established. In this paper we present our experiences and consider the treatment of isolated SMA dissection. Methods: A retrospective review of our cases from 2005 was performed. Clinical symptoms, radiologic findings and results were evaluated. There were 14 cases of visceral artery dissection, in which all cases were with SMA dissection. There were 12 males and 2 females with a mean age of 57 years (range 41-78 years). Results: We categorized SMA dissection into the six types according to the Sakamoto's and Zerbib's classification. One patient with type VI underwent emergent endovascular surgery with stent. One patient with type VI received thrombectomy and intimectomy with open surgery. One patient with type II underwent aneurysmectomy due to enlarged dissected SMA 3 months later from onset. The other eleven patients were managed conservatively. At follow-up, the diameter of SMA did not enlarged and the length of the dissection significantly decreased to 20.7 ± 15.7 mm from 38.0 ± 15.1 mm at onset (p <0.01). After treatment, imaging indicated the following changes in classification: type I, one patient; type II, 4 patients; type IV, 4 patients; complete remodeling, one patient, all without any event during the follow-up period of 5-82 months. Conclusion: Most patients with isolated visceral artery dissection occurred in superior mesenteric artery and can be treated conservatively; however, endovascular or surgical procedures including laparotomy are indicated when there is suspicion of severe mesenteric ischemia. Because the dissection configuration will change, long term follow-up is necessary.

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Section: Discussionmentioning

confidence: 99%

“…Zerbib, et al 3) added type V accompanied by dissection and stenosis of the SMA and type VI with partial or complete occlusion (Fig. 1).…”

Section: Methodsmentioning

confidence: 99%

Management Strategy of Isolated Spontaneous Dissection of the Superior Mesenteric Artery

Satokawa

Takase

Seto

et al. 2014

Annals of Vascular Diseases

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“…[18][19] Endovascular or surgical treatment should be performed in cases after failure of conservative treatment, presenting persistent abdominal symptoms, and intestinal ischemia and rupture of the artery. [20][21] In our study, most patients accepted conservative treatment and obtained a favorable outcome except 5 who underwent endovascular intervention. The true lumen stenosis degree was more than 75%…”

Section: Discussionmentioning

confidence: 62%

Value of Multi-detector CT in Detection of Isolated Spontaneous Superior Mesenteric Artery Dissection

Zhao

et al. 2017

cmsj

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Objective To investigate the role of multi-detector computed tomography (CT) in the diagnosis and classification of isolated spontaneous superior mesenteric artery dissection (ISSMAD).Methods From July 2012 to December 2016, 30 consecutive patients with ISSMAD underwent CT scan at least two times. We retrospectively summarized the clinical characteristics and CT findings of them. The stenosis ratio of true lumen was compared between the patients without bowel ischemia and ones with bowel ischemia.Results There were 5 cases of type I ISSMAD, 14 cases of type Ⅱ, 1 case of type Ⅲ, 7 cases of type Ⅳ and 3 cases of type V. Intestinal ischemia occurred in 5 patients. The stenosis ratio of true lumen in the patients without bowel ischemia was lower than that with bowel ischemia (45.6% vs. 76.0%, t=-14.5, P=0.000). Five patients with intestinal ischemia underwent superior mesenteric artery stenting and others received conservative therapy. The abdominal pain was alleviated for all the patients after treatment.

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“…8) Sakamoto reported that one patient with type II needed urgent surgery because of small bowel ischemia and 11 other patients were treated conservatively. Zerbib et al 9) proposed a modified classification: type I − IV of Sakamoto's classification; type V, aneurysmal dissection with stenosis of the distal part of the SMA; and type VI, total [VIa] or partial [VIb] thrombosis of the SMA. Most patients of type I respond to conservative treatment but need long time follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…9) We experienced ten patients with SMA dissection during the past 7 years. Among the ten there was no intervention due to risk of rupture at acute or subacute onset periods.…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Aneuysmectomy after Thrombo-Intimectomy for Spontaneous Isolated Superior Mesenteric Artery Dissection

Satokawa

Seto

Yamamoto

et al. 2012

Annals of Vascular Diseases

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A 53 year-old man was admitted with acute onset of severe abdominal pain, and we performed emergent thrombectomy and intimectomy for acute, complete occlusion of superior mesenteric artery (SMA) due to its spontaneous dissection. However, 4 months later the operated part of the SMA enlarged due to aneurysm and the patient was treated by aneuysmectomy and iliac-mesenteric bypass using a saphenous vein. Aggressive treatment such as surgical or endovascular procedure is necessary for severe ischemia due to SMA dissection.

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Management of isolated spontaneous dissection of superior mesenteric artery

Abstract: Patients with symptoms lasting for more than 1 week, aneurysmal dilatation more than 2 cm in diameter, and SMA stenosis are suitable candidates for surgical management.

Cited by 77 publications

References 23 publications

Management Strategy of Isolated Spontaneous Dissection of the Superior Mesenteric Artery

Management Strategy of Isolated Spontaneous Dissection of the Superior Mesenteric Artery

Value of Multi-detector CT in Detection of Isolated Spontaneous Superior Mesenteric Artery Dissection

A Case Report of Aneuysmectomy after Thrombo-Intimectomy for Spontaneous Isolated Superior Mesenteric Artery Dissection

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