Tags

Type your tag names separated by a space and hit enter

Management strategy for spontaneous isolated dissection of the superior mesenteric artery based on morphologic classification.
J Vasc Surg. 2014 Jan; 59(1):165-72.JV

Abstract

OBJECTIVE

To explore a therapy strategy for the spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) based on morphologic classification.

METHODS

Forty-two symptomatic patients with SIDSMA presenting with abdominal pain between January 2007 and December 2012 were enrolled in this retrospective study. We proposed a new morphologic classification with subtypes depending on the patency of the true lumen and reviewed the patients' clinical features, risk factors, computed tomography images (morphologic classification, location of entry site, dissection length, and true lumen residual diameter), treatment modalities, and follow-up results.

RESULTS

Twenty-four patients received only observation treatment, seven received open surgery, and 11 received endovascular therapy. True lumen residual diameter in the observation group (46.6%) was statistically better than that in the surgery group (0%) and the endovascular group (18.3%) (P < .05). There was clinical progression in three and imaging progression in seven of the observation group, of which two patients received endovascular treatment and one patient died of bowel infarction. There were two clinical progressions and one imaging progression in the surgery group, of which two patients received additional surgery and one patient died of bowel infarction. The endovascular group obtained encouraging results with no progressions or complications.

CONCLUSIONS

Symptomatic patients with SIDSMA are at risk of progression. We suggested a morphologic classification to guide the treatment. We recommend observation treatment with close follow-up for patients with patent true lumen flow and endovascular intervention for high-risk patients with true lumen stenosis or occlusion. Surgery is indicated for patients with suspected bowel infarction or arterial rupture.

Authors+Show Affiliations

Department of Vascular Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.Department of Vascular Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.Department of Vascular Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.Department of Vascular Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.Department of Vascular Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.Department of Vascular Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.Department of Vascular Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China. Electronic address: doczhk@yahoo.com.cn.Department of Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China. Electronic address: liangtingbo@zju.edu.cn.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23992995

Citation

Li, Dong-lin, et al. "Management Strategy for Spontaneous Isolated Dissection of the Superior Mesenteric Artery Based On Morphologic Classification." Journal of Vascular Surgery, vol. 59, no. 1, 2014, pp. 165-72.
Li DL, He YY, Alkalei AM, et al. Management strategy for spontaneous isolated dissection of the superior mesenteric artery based on morphologic classification. J Vasc Surg. 2014;59(1):165-72.
Li, D. L., He, Y. Y., Alkalei, A. M., Chen, X. D., Jin, W., Li, M., Zhang, H. K., & Liang, T. B. (2014). Management strategy for spontaneous isolated dissection of the superior mesenteric artery based on morphologic classification. Journal of Vascular Surgery, 59(1), 165-72. https://doi.org/10.1016/j.jvs.2013.07.014
Li DL, et al. Management Strategy for Spontaneous Isolated Dissection of the Superior Mesenteric Artery Based On Morphologic Classification. J Vasc Surg. 2014;59(1):165-72. PubMed PMID: 23992995.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management strategy for spontaneous isolated dissection of the superior mesenteric artery based on morphologic classification. AU - Li,Dong-lin, AU - He,Yang-yan, AU - Alkalei,Adel M, AU - Chen,Xu-dong, AU - Jin,Wei, AU - Li,Ming, AU - Zhang,Hong-kun, AU - Liang,Ting-bo, Y1 - 2013/08/28/ PY - 2013/04/23/received PY - 2013/07/01/revised PY - 2013/07/03/accepted PY - 2013/9/3/entrez PY - 2013/9/3/pubmed PY - 2014/2/22/medline SP - 165 EP - 72 JF - Journal of vascular surgery JO - J Vasc Surg VL - 59 IS - 1 N2 - OBJECTIVE: To explore a therapy strategy for the spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) based on morphologic classification. METHODS: Forty-two symptomatic patients with SIDSMA presenting with abdominal pain between January 2007 and December 2012 were enrolled in this retrospective study. We proposed a new morphologic classification with subtypes depending on the patency of the true lumen and reviewed the patients' clinical features, risk factors, computed tomography images (morphologic classification, location of entry site, dissection length, and true lumen residual diameter), treatment modalities, and follow-up results. RESULTS: Twenty-four patients received only observation treatment, seven received open surgery, and 11 received endovascular therapy. True lumen residual diameter in the observation group (46.6%) was statistically better than that in the surgery group (0%) and the endovascular group (18.3%) (P < .05). There was clinical progression in three and imaging progression in seven of the observation group, of which two patients received endovascular treatment and one patient died of bowel infarction. There were two clinical progressions and one imaging progression in the surgery group, of which two patients received additional surgery and one patient died of bowel infarction. The endovascular group obtained encouraging results with no progressions or complications. CONCLUSIONS: Symptomatic patients with SIDSMA are at risk of progression. We suggested a morphologic classification to guide the treatment. We recommend observation treatment with close follow-up for patients with patent true lumen flow and endovascular intervention for high-risk patients with true lumen stenosis or occlusion. Surgery is indicated for patients with suspected bowel infarction or arterial rupture. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/23992995/Management_strategy_for_spontaneous_isolated_dissection_of_the_superior_mesenteric_artery_based_on_morphologic_classification_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(13)01324-4 DB - PRIME DP - Unbound Medicine ER -