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Current strategy for the treatment of symptomatic spontaneous isolated dissection of superior mesenteric artery.
J Vasc Surg 2011; 54(2):461-6JV

Abstract

OBJECTIVE

Spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) is extremely rare. Various treatment options are currently available, including conservative management, anticoagulation, endovascular stenting, and surgical repair. Herein, we present our experience in the treatment of symptomatic SIDSMA.

METHODS

A retrospective study was conducted on 14 consecutive patients with symptomatic SIDSMA between January 2000 and January 2010. All patients had acute onset abdominal pain. The decision to intervene was based on patient symptoms and signs, as well as the morphologic characteristics of superior mesenteric artery (SMA) dissection on computed tomography (CT) angiography. Endovascular stenting (ES) was indicated in patients with severe compression of the true lumen or dissecting aneurysm likely to rupture. Self-expandable stents were placed via a right common femoral approach. None of the patients underwent anticoagulation, and patients who underwent ES were maintained on antiplatelet therapy for 3 months postoperatively.

RESULTS

The median age of the study subjects was 59 years (range, 50-75 years). The median follow-up time was 27.5 months (range, 2-64 months). Treatment included conservative management without the use of anticoagulation in seven patients, ES in six, and necrotic bowel resection in one. Four patients with severe compression of the true lumen or large dissecting aneurysm underwent ES as a primary treatment. ES was additionally performed in two patients in whom initial conservative treatment failed (increasing dissecting aneurysm at 7-day follow-up CT scan in one and a reappearance of abdominal pain after resuming diet in the other). The median fasting time was significantly shorter in patients with primary ES (2.5 days) than in those managed conservatively (8.0 days). No complications associated with the SIDSMA or ES were developed. The patency of stents was demonstrated on follow-up CT scans up to 60 months (range, 1-60 months).

CONCLUSIONS

Conservative management without anticoagulation can be applied successfully to the patients with symptomatic SIDSMA. Primary endovascular stenting is indicated if patients have suspected bowel ischemia, compression of the true lumen of the SMA >80%, or SMA aneurysm of >2.0 cm in diameter on initial CT scan. Endovascular stenting can also be provided to the patients in whom initial conservative treatment failed, as a rescue therapy.

Authors+Show Affiliations

Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21571493

Citation

Min, Sang-Il, et al. "Current Strategy for the Treatment of Symptomatic Spontaneous Isolated Dissection of Superior Mesenteric Artery." Journal of Vascular Surgery, vol. 54, no. 2, 2011, pp. 461-6.
Min SI, Yoon KC, Min SK, et al. Current strategy for the treatment of symptomatic spontaneous isolated dissection of superior mesenteric artery. J Vasc Surg. 2011;54(2):461-6.
Min, S. I., Yoon, K. C., Min, S. K., Ahn, S. H., Jae, H. J., Chung, J. W., ... Kim, S. J. (2011). Current strategy for the treatment of symptomatic spontaneous isolated dissection of superior mesenteric artery. Journal of Vascular Surgery, 54(2), pp. 461-6. doi:10.1016/j.jvs.2011.03.001.
Min SI, et al. Current Strategy for the Treatment of Symptomatic Spontaneous Isolated Dissection of Superior Mesenteric Artery. J Vasc Surg. 2011;54(2):461-6. PubMed PMID: 21571493.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Current strategy for the treatment of symptomatic spontaneous isolated dissection of superior mesenteric artery. AU - Min,Sang-Il, AU - Yoon,Kyung-Chul, AU - Min,Seung-Kee, AU - Ahn,Sang Hyun, AU - Jae,Hwan Joon, AU - Chung,Jin Wook, AU - Ha,Jongwon, AU - Kim,Sang Joon, Y1 - 2011/05/14/ PY - 2011/01/10/received PY - 2011/02/28/revised PY - 2011/03/01/accepted PY - 2011/5/17/entrez PY - 2011/5/17/pubmed PY - 2011/10/25/medline SP - 461 EP - 6 JF - Journal of vascular surgery JO - J. Vasc. Surg. VL - 54 IS - 2 N2 - OBJECTIVE: Spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) is extremely rare. Various treatment options are currently available, including conservative management, anticoagulation, endovascular stenting, and surgical repair. Herein, we present our experience in the treatment of symptomatic SIDSMA. METHODS: A retrospective study was conducted on 14 consecutive patients with symptomatic SIDSMA between January 2000 and January 2010. All patients had acute onset abdominal pain. The decision to intervene was based on patient symptoms and signs, as well as the morphologic characteristics of superior mesenteric artery (SMA) dissection on computed tomography (CT) angiography. Endovascular stenting (ES) was indicated in patients with severe compression of the true lumen or dissecting aneurysm likely to rupture. Self-expandable stents were placed via a right common femoral approach. None of the patients underwent anticoagulation, and patients who underwent ES were maintained on antiplatelet therapy for 3 months postoperatively. RESULTS: The median age of the study subjects was 59 years (range, 50-75 years). The median follow-up time was 27.5 months (range, 2-64 months). Treatment included conservative management without the use of anticoagulation in seven patients, ES in six, and necrotic bowel resection in one. Four patients with severe compression of the true lumen or large dissecting aneurysm underwent ES as a primary treatment. ES was additionally performed in two patients in whom initial conservative treatment failed (increasing dissecting aneurysm at 7-day follow-up CT scan in one and a reappearance of abdominal pain after resuming diet in the other). The median fasting time was significantly shorter in patients with primary ES (2.5 days) than in those managed conservatively (8.0 days). No complications associated with the SIDSMA or ES were developed. The patency of stents was demonstrated on follow-up CT scans up to 60 months (range, 1-60 months). CONCLUSIONS: Conservative management without anticoagulation can be applied successfully to the patients with symptomatic SIDSMA. Primary endovascular stenting is indicated if patients have suspected bowel ischemia, compression of the true lumen of the SMA >80%, or SMA aneurysm of >2.0 cm in diameter on initial CT scan. Endovascular stenting can also be provided to the patients in whom initial conservative treatment failed, as a rescue therapy. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/21571493/Current_strategy_for_the_treatment_of_symptomatic_spontaneous_isolated_dissection_of_superior_mesenteric_artery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(11)00428-9 DB - PRIME DP - Unbound Medicine ER -