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Endovascular stent placement for treatment of spontaneous isolated dissection of the superior mesenteric artery.
Ann Vasc Surg 2014; 28(2):445-51AV

Abstract

BACKGROUND

Spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) is a rare condition often associated with a poor prognosis. The goal of this study is to assess the efficacy of endovascular treatment of SIDSMA with stenting and investigate the possible therapeutic mechanisms involved.

METHODS

This is a retrospective review of all patients undergoing endovascular treatment of SIDSMA from January 2009 to December 2011. Patient demographics, history, clinical presentation, laboratory tests, image characteristics, endovascular treatments, and follow-up outcome were analyzed.

RESULTS

Twenty-four patients with symptoms were treated. All except 1 patient (23 of 24, 96%) underwent successful stent placement (16 with single stent and 7 with overlapping stents). A total of 30 stents (4 balloon-expanded and 26 self-expanding) were placed during the procedures. In the perioperative period and during follow-up, symptom relief was achieved in 20 (83%) patients, and abdominal pain remained unchanged in 4 (17%). No death or serious complications occurred. The median length of hospital stay and follow-up was 3.25 ± 2.23 days (range 2-7 days) and 13.15 ± 8.27 months (range 6-23 months), respectively. Computed tomography angiography (CTA) performed 6 months postoperatively revealed stent patency in 23 cases (100%), false lumen patency in 5 cases (22%), and new development of dissection in the SMA distal to the stent in 1 case (4%). No significant differences were observed in the incidence of false lumen patency between patients treated with a single stent and those treated with overlapping stents, and between patients with and without symptom relief (P > 0.05 for both).

CONCLUSIONS

For symptomatic SIDSMA patients without intra-abdominal hemorrhage and intestinal infarction, endovascular stent placement is a feasible treatment choice with a high success rate and good clinical outcome. Overlapping stenting may be proposed for patients with aneurysmal dilation. False lumen patency may occur in some cases during follow-up, but it does not affect improvement of SIDSMA symptoms.

Authors+Show Affiliations

Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China. Electronic address: vasc065linan@sina.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24070572

Citation

Li, Nan, et al. "Endovascular Stent Placement for Treatment of Spontaneous Isolated Dissection of the Superior Mesenteric Artery." Annals of Vascular Surgery, vol. 28, no. 2, 2014, pp. 445-51.
Li N, Lu QS, Zhou J, et al. Endovascular stent placement for treatment of spontaneous isolated dissection of the superior mesenteric artery. Ann Vasc Surg. 2014;28(2):445-51.
Li, N., Lu, Q. S., Zhou, J., Bao, J. M., Zhao, Z. Q., & Jing, Z. P. (2014). Endovascular stent placement for treatment of spontaneous isolated dissection of the superior mesenteric artery. Annals of Vascular Surgery, 28(2), pp. 445-51. doi:10.1016/j.avsg.2013.01.028.
Li N, et al. Endovascular Stent Placement for Treatment of Spontaneous Isolated Dissection of the Superior Mesenteric Artery. Ann Vasc Surg. 2014;28(2):445-51. PubMed PMID: 24070572.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endovascular stent placement for treatment of spontaneous isolated dissection of the superior mesenteric artery. AU - Li,Nan, AU - Lu,Qing-Sheng, AU - Zhou,Jian, AU - Bao,Jun-Min, AU - Zhao,Zhi-Qing, AU - Jing,Zai-Ping, Y1 - 2013/09/24/ PY - 2012/07/16/received PY - 2013/01/08/revised PY - 2013/01/10/accepted PY - 2013/9/28/entrez PY - 2013/9/28/pubmed PY - 2014/9/30/medline SP - 445 EP - 51 JF - Annals of vascular surgery JO - Ann Vasc Surg VL - 28 IS - 2 N2 - BACKGROUND: Spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) is a rare condition often associated with a poor prognosis. The goal of this study is to assess the efficacy of endovascular treatment of SIDSMA with stenting and investigate the possible therapeutic mechanisms involved. METHODS: This is a retrospective review of all patients undergoing endovascular treatment of SIDSMA from January 2009 to December 2011. Patient demographics, history, clinical presentation, laboratory tests, image characteristics, endovascular treatments, and follow-up outcome were analyzed. RESULTS: Twenty-four patients with symptoms were treated. All except 1 patient (23 of 24, 96%) underwent successful stent placement (16 with single stent and 7 with overlapping stents). A total of 30 stents (4 balloon-expanded and 26 self-expanding) were placed during the procedures. In the perioperative period and during follow-up, symptom relief was achieved in 20 (83%) patients, and abdominal pain remained unchanged in 4 (17%). No death or serious complications occurred. The median length of hospital stay and follow-up was 3.25 ± 2.23 days (range 2-7 days) and 13.15 ± 8.27 months (range 6-23 months), respectively. Computed tomography angiography (CTA) performed 6 months postoperatively revealed stent patency in 23 cases (100%), false lumen patency in 5 cases (22%), and new development of dissection in the SMA distal to the stent in 1 case (4%). No significant differences were observed in the incidence of false lumen patency between patients treated with a single stent and those treated with overlapping stents, and between patients with and without symptom relief (P > 0.05 for both). CONCLUSIONS: For symptomatic SIDSMA patients without intra-abdominal hemorrhage and intestinal infarction, endovascular stent placement is a feasible treatment choice with a high success rate and good clinical outcome. Overlapping stenting may be proposed for patients with aneurysmal dilation. False lumen patency may occur in some cases during follow-up, but it does not affect improvement of SIDSMA symptoms. SN - 1615-5947 UR - https://www.unboundmedicine.com/medline/citation/24070572/Endovascular_stent_placement_for_treatment_of_spontaneous_isolated_dissection_of_the_superior_mesenteric_artery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0890-5096(13)00360-9 DB - PRIME DP - Unbound Medicine ER -