Treatment strategy based on the natural course for patients with spontaneous isolated superior mesenteric artery dissection

Abstract

With conservative treatment, the majority of patients with SISMAD showed clinical improvement and no morphologic changes during long-term follow-up. We thus recommend a conservative management strategy as the first-line treatment for patients with SISMAD, regardless of angiographic type.

Spontaneous Isolated Superior Mesenteric Artery Dissection: A Case Report

“…A retrospective study of 35 patients compared the outcome between symptomatic and asymptomatic groups with findings again leaning towards a more conservative approach [10]. Long term follow up and remodeling rates were found to be negligible on a large retrospective study published in 2017, reinforcing the wait-and-watch role [11]. This was contrary however to another author's finding, where the symptomatic patients that had the best symptomatic response were in fact those who undergone endovascular treatment [13].…”

Visceral Fibromuscular Dysplasia: From asymptomatic disorder to emergency

“…59,60 A retrospective review of 116 patients with SMAD didn't show any benefit on outcome with antithrombotic therapy. 51 Current data comparing anticoagulation and antiplatelet agents after cervical artery dissection warrant future studies. 61 Fibromuscular dysplasia patients who have undergone endovascular interventions are prescribed antiplatelet agents, in keeping with recommendations for atherosclerotic disease.…”

“…In case of a VAD, short‐term (eg, 3‐6 months) anticoagulation is generally proposed, followed by long‐term antiplatelet therapy, whereas others prefer antiplatelet therapy (ie, aspirin alone or in combination with clopidogrel) for the initial treatment . A retrospective review of 116 patients with SMAD didn't show any benefit on outcome with antithrombotic therapy . Current data comparing anticoagulation and antiplatelet agents after cervical artery dissection warrant future studies…”

“…Moreover, a conservative approach may not prevent disease progression. Yet, most patients with SMAD remain asympttomatic and show improvement or no change on FU CT. 50,51 In a recent retrospective single-centre cohort of 77 patients with dissection of the SMA and/or coeliac artery, only 5% required invasive intervention because of persistent abdominal pain or bowel ischaemia. In a mean follow-up of 21 months, no late intervention or recurrence was observed.…”

孤立性総肝動脈解離の1例(Spontaneous isolated common hepatic artery dissection: a case report and literature review)

“…Additional aneurysm of common hepatic artery (arrow). 割が追加治療を必要としている13,14) 。 Follow-up contrast-enhanced CT (A: 1 month after discharge, B: 2 months after discharge, C: 5 months after discharge, D: 8 months after discharge). CT shows gradual improvement of common hepatic artery dissection.…”