Tags

Type your tag names separated by a space and hit enter

Vasodilator and endovascular therapy for isolated superior mesenteric artery dissection.
J Vasc Surg 2013; 57(6):1612-20JV

Abstract

OBJECTIVE

We report our experience in the treatment of isolated superior mesenteric artery dissection and review the clinical and imaging features reported in the literature.

METHODS

A retrospective study was conducted of 18 consecutive patients with isolated superior mesenteric artery dissection who presented at the Peking University Third Hospital between September 2008 and May 2012. Their clinical characteristics, including age, sex, medical history, risk factors, symptoms, diagnostic imaging modality, and treatment, were analyzed. Also reviewed were 278 patients with isolated superior mesenteric artery dissection reported in the English language literature. The epidemiology, mechanism, clinical presentation, imaging features, and treatment were discussed.

RESULTS

There were 14 men and four women with a mean age of 55.6 years (range, 41-84 years). Four patients were asymptomatic, and 14 presented with acute-onset abdominal pain. The diagnosis was established by contrast-enhanced computed tomography in 17 patients and ultrasound imaging in one patient. All dissections were located at the anterior wall and around the convex curvature of the superior mesenteric artery. The decision to intervene was based on symptoms. Three asymptomatic patients underwent successful conservative management, and one asymptomatic patient with an aneurysmal dilated false lumen underwent endovascular stent placement. For the 14 symptomatic patients, definitive treatment included catheter-directed infusion of a vasodilator in four and stent placement combined with catheter-directed infusion of a vasodilator in 10, of whom one patient underwent hybrid stent placement. No complications or deaths occurred. During the mean 14.9-month (range, 1-40 month) follow-up period, all patients were asymptomatic, and patency of the superior mesenteric artery was demonstrated by contrast-enhanced computed tomography scan.

CONCLUSIONS

Conservative management can be applied to asymptomatic patients with isolated superior mesenteric artery dissection. For symptomatic patients, stent placement is the definitive treatment if there is no arterial rupture or intestinal necrosis. Self-expanding bare stents that completely cover the curvature of the superior mesenteric artery are recommended. Catheter-directed infusion of a vasodilator can be an effective accessional process after stent placement.

Authors+Show Affiliations

Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23538008

Citation

Luan, Jing Yuan, et al. "Vasodilator and Endovascular Therapy for Isolated Superior Mesenteric Artery Dissection." Journal of Vascular Surgery, vol. 57, no. 6, 2013, pp. 1612-20.
Luan JY, Li X, Li TR, et al. Vasodilator and endovascular therapy for isolated superior mesenteric artery dissection. J Vasc Surg. 2013;57(6):1612-20.
Luan, J. Y., Li, X., Li, T. R., Zhai, G. J., & Han, J. T. (2013). Vasodilator and endovascular therapy for isolated superior mesenteric artery dissection. Journal of Vascular Surgery, 57(6), pp. 1612-20. doi:10.1016/j.jvs.2012.11.121.
Luan JY, et al. Vasodilator and Endovascular Therapy for Isolated Superior Mesenteric Artery Dissection. J Vasc Surg. 2013;57(6):1612-20. PubMed PMID: 23538008.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vasodilator and endovascular therapy for isolated superior mesenteric artery dissection. AU - Luan,Jing Yuan, AU - Li,Xuan, AU - Li,Tian Run, AU - Zhai,Guo Jun, AU - Han,Jin Tao, Y1 - 2013/03/26/ PY - 2012/09/19/received PY - 2012/11/27/revised PY - 2012/11/27/accepted PY - 2013/3/30/entrez PY - 2013/3/30/pubmed PY - 2013/7/31/medline SP - 1612 EP - 20 JF - Journal of vascular surgery JO - J. Vasc. Surg. VL - 57 IS - 6 N2 - OBJECTIVE: We report our experience in the treatment of isolated superior mesenteric artery dissection and review the clinical and imaging features reported in the literature. METHODS: A retrospective study was conducted of 18 consecutive patients with isolated superior mesenteric artery dissection who presented at the Peking University Third Hospital between September 2008 and May 2012. Their clinical characteristics, including age, sex, medical history, risk factors, symptoms, diagnostic imaging modality, and treatment, were analyzed. Also reviewed were 278 patients with isolated superior mesenteric artery dissection reported in the English language literature. The epidemiology, mechanism, clinical presentation, imaging features, and treatment were discussed. RESULTS: There were 14 men and four women with a mean age of 55.6 years (range, 41-84 years). Four patients were asymptomatic, and 14 presented with acute-onset abdominal pain. The diagnosis was established by contrast-enhanced computed tomography in 17 patients and ultrasound imaging in one patient. All dissections were located at the anterior wall and around the convex curvature of the superior mesenteric artery. The decision to intervene was based on symptoms. Three asymptomatic patients underwent successful conservative management, and one asymptomatic patient with an aneurysmal dilated false lumen underwent endovascular stent placement. For the 14 symptomatic patients, definitive treatment included catheter-directed infusion of a vasodilator in four and stent placement combined with catheter-directed infusion of a vasodilator in 10, of whom one patient underwent hybrid stent placement. No complications or deaths occurred. During the mean 14.9-month (range, 1-40 month) follow-up period, all patients were asymptomatic, and patency of the superior mesenteric artery was demonstrated by contrast-enhanced computed tomography scan. CONCLUSIONS: Conservative management can be applied to asymptomatic patients with isolated superior mesenteric artery dissection. For symptomatic patients, stent placement is the definitive treatment if there is no arterial rupture or intestinal necrosis. Self-expanding bare stents that completely cover the curvature of the superior mesenteric artery are recommended. Catheter-directed infusion of a vasodilator can be an effective accessional process after stent placement. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/23538008/Vasodilator_and_endovascular_therapy_for_isolated_superior_mesenteric_artery_dissection_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(12)02720-6 DB - PRIME DP - Unbound Medicine ER -