Stenting of a Spontaneous Dissection of the Superior Mesenteric Artery: A New Therapeutic Approach?

Abstract

Spontaneous dissection of the superior mesenteric artery (SMA) is rare and has been reported only sporadically. Therapeutic options are either a surgical approach, which is the more frequently adopted, or a simple observation. We report a case of spontaneous dissection of the SMA with a review of the literature and present a new therapeutic approach.

Evolution of Computed Tomographic Characteristics of Spontaneous Isolated Superior Mesenteric Artery Dissection During Conservative Management

“…Concerning treatment of spontaneous isolated SMA dissection, a relatively high proportion of patients requiring surgical intervention has been previously reported. 21 However, several recent reports have indicated a high success rate with conservative management alone, 7,11,22 and our study showed that conservative treatment was successful in 96.6% of patients. Failure of conservative management during the follow-up period has been reported in previous studies, 23-25 and surgical interventions were required 10 days to 1 year after diagnosis, because of symptom recurrence.…”

Percutaneous endovascular treatment for isolated spontaneous superior mesenteric artery dissection: Report of two cases and literature review

“…Reviewing the literature, there have been eight reported cases of SMA dissection treated by stent placement [4,5,10,[16][17][18][19] and all of them were treated successfully (Table I). It is still not certain that when is the optimal timing to perform endovascular therapy for patients with isolated SMA dissection.…”

Management of isolated spontaneous dissection of superior mesenteric artery

“…In a case reported by Sparks [7], the patient underwent surgery 11 months after the initial diagnosis of DSMA for recurrent abdominal pain with extension of the dissection and aneurysmal dilatation of the artery. Among 28 cases described since 1975 and treated conservatively, Froment [9] noted a failure rate of 38.5% increasing to 50% in symptomatic patients. These cases indicated that medical treatment required close clinical and radiological follow-up for at least 12 months [3,21].…”

“…The false lumen may thrombose [17]. The natural history of DMSA is not predictable and the optimal treatment may involve conservative management with [18] or without [12] anticoagulation, surgery [4,8], or percutaneous stent placement [9,19,20]. However, DSMA is a hazardous condition which may worsen [4].…”

“…In recent years, an increasing number of case reports have been published. In 1992, 12 cases were collected in a literature review [6], 29 cases in 2000 [7], 36 cases in 2002 [8], and 29 cases in 2004 [9]. In 2008, a meta-analysis by Morris et al reported 71 cases of DSMA [3].…”