Management Strategy of Isolated Spontaneous Dissection of the Superior Mesenteric Artery

Abstract

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.

Long-Term Outcomes of Spontaneous Isolated Superior Mesenteric Artery Dissection

“…Majority of patients with SMAD are males in their 50s, 6) and the disease often manifests as sudden abdominal pain. 5) In most patients, administration of conservative treatment results in symptom improvement; however, owing to the dissection of the superior mesenteric artery, in severe cases, there is a risk of intestinal ischemia and ruptures due to dissection. 2,7,8) In patients who visited our department, endovascular treatment was performed because of severe abdominal symptoms associated with acute disease and the possibility of intestinal ischemia in one patient, and surgical blood flow reconstruction was performed in one patient.…”

“…1). [3][4][5] The following items were evaluated: (1) the pathophysiology of and treatments for acute disease as well as treatment outcomes; (2) evaluation of the dissection morphology of isolated disease using contrast-enhanced computed tomography (CT) as well as the changes caused by dissection; and (3) retrospective chart review of long-term outcomes of isolated disease as well as the collection and review of data from other institutions. ©2019 The Editorial Committee of Annals of Vascular Diseases.…”

“…One patient with Type II disease underwent resection of a segment with aneurysm and a bypass with autologous veins owing to the enlargement of the dissected segment 3 months after the onset of Type II disease ( Table 2). 5) Among the 13 patients with mild abdominal symptoms, follow-up was performed with fasting and fluid management, and 2 patients with Type I and 3 patients with Type IV disease were treated with aspirin-based antiplatelet therapy, with all patients experiencing improvement in their symptoms. Fourteen patients were asymptomatic and were only followed through observation.…”

Baseline disease is a more important predictor of intestinal necrosis than CT findings in patients with acute mesenteric ischemia

“…Because intestinal ischemia and necrosis are associated with a high mortality rate, delay in the diagnosis of intestinal ischemia or necrosis should be avoided as much as possible [4,5]. There are several choices for assessment of the intestinal condition in such patients such as invasive exploratory laparotomy for laparoscopic vision and exploratory surgery for direct vision [6,7]. On the other hand, it has been reported that the use of computed tomography (CT) with or without contrast medium enhancement has the potential to evaluate the presence or absence of intestinal ischemia and necrosis less invasively than exploratory surgery [8][9][10][11].…”

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

“…[6][7][8][9] Although there were some reports on the role of multi-detector CT in the diagnosis of ISSMAD, the number of cases was limited, and few was more than 20. The case number of the present study was relatively large, and there were 30 cases included.…”