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Immediate and middle term outcome of symptomatic spontaneous isolated dissection of the superior mesenteric artery.
Abdom Imaging 2015; 40(1):151-8AI

Abstract

PURPOSE

Spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) is a rare but fatal condition. Herein, we report the therapeutic outcome of a contemporary series of 12 patients with SIDSMA who were treated with conservative, anticoagulation, or endovascular therapy.

METHODS

Revascularization was measured according to recanalization of the primary arterial occlusive lesion and reperfusion was measured by flow through the occluded vessel. Pain was evaluated by using the visual analog scale (VAS) at admission and at each follow-up visit.

RESULTS

Type I SIDSMA was seen in 3 (25%) patients, type IIa in 4 (33.3%) patients, and type IIb in 5 (41.7%) patients. No patient had type III SIDSMA. The false lumens were patent in 6 (50%) patients. Partial thrombosis in the false lumen was demonstrated in CT scans in 5 (41.7%) patients and total thrombosis in 1 (8.3%) patient. Four (33.3%) patients received conservative therapy, and 2 (16.7%) patients received anticoagulation therapy. All six patients resumed normal blood flow in the SMA. The remaining six patients received endovascular stenting. After stent placement, excellent distal blood flow was restored. Abdominal pain was completely resolved in all patients except in one patient. No complications associated with SMA dissection occurred.

CONCLUSION

If bowel perfusion is not compromised and the SMA aneurysm is not likely to rupture in patients with a symptomatic SIDSMA, conservative, or anticoagulation therapy can be considered. If patient has sustained intestinal ischemic symptoms, and severe compression of the true lumen, or dissecting aneurysm likely to rupture, endovascular therapy, or surgery should be adopted.

Authors+Show Affiliations

Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24981145

Citation

Rong, Jian-Jie, et al. "Immediate and Middle Term Outcome of Symptomatic Spontaneous Isolated Dissection of the Superior Mesenteric Artery." Abdominal Imaging, vol. 40, no. 1, 2015, pp. 151-8.
Rong JJ, Qian AM, Sang HF, et al. Immediate and middle term outcome of symptomatic spontaneous isolated dissection of the superior mesenteric artery. Abdom Imaging. 2015;40(1):151-8.
Rong, J. J., Qian, A. M., Sang, H. F., Meng, Q. Y., Zhao, T. J., & Li, X. Q. (2015). Immediate and middle term outcome of symptomatic spontaneous isolated dissection of the superior mesenteric artery. Abdominal Imaging, 40(1), pp. 151-8. doi:10.1007/s00261-014-0182-1.
Rong JJ, et al. Immediate and Middle Term Outcome of Symptomatic Spontaneous Isolated Dissection of the Superior Mesenteric Artery. Abdom Imaging. 2015;40(1):151-8. PubMed PMID: 24981145.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Immediate and middle term outcome of symptomatic spontaneous isolated dissection of the superior mesenteric artery. AU - Rong,Jian-Jie, AU - Qian,Ai-Min, AU - Sang,Hong-Fei, AU - Meng,Qing-You, AU - Zhao,Tie-Jun, AU - Li,Xiao-Qiang, PY - 2014/7/2/entrez PY - 2014/7/2/pubmed PY - 2015/10/2/medline SP - 151 EP - 8 JF - Abdominal imaging JO - Abdom Imaging VL - 40 IS - 1 N2 - PURPOSE: Spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) is a rare but fatal condition. Herein, we report the therapeutic outcome of a contemporary series of 12 patients with SIDSMA who were treated with conservative, anticoagulation, or endovascular therapy. METHODS: Revascularization was measured according to recanalization of the primary arterial occlusive lesion and reperfusion was measured by flow through the occluded vessel. Pain was evaluated by using the visual analog scale (VAS) at admission and at each follow-up visit. RESULTS: Type I SIDSMA was seen in 3 (25%) patients, type IIa in 4 (33.3%) patients, and type IIb in 5 (41.7%) patients. No patient had type III SIDSMA. The false lumens were patent in 6 (50%) patients. Partial thrombosis in the false lumen was demonstrated in CT scans in 5 (41.7%) patients and total thrombosis in 1 (8.3%) patient. Four (33.3%) patients received conservative therapy, and 2 (16.7%) patients received anticoagulation therapy. All six patients resumed normal blood flow in the SMA. The remaining six patients received endovascular stenting. After stent placement, excellent distal blood flow was restored. Abdominal pain was completely resolved in all patients except in one patient. No complications associated with SMA dissection occurred. CONCLUSION: If bowel perfusion is not compromised and the SMA aneurysm is not likely to rupture in patients with a symptomatic SIDSMA, conservative, or anticoagulation therapy can be considered. If patient has sustained intestinal ischemic symptoms, and severe compression of the true lumen, or dissecting aneurysm likely to rupture, endovascular therapy, or surgery should be adopted. SN - 1432-0509 UR - https://www.unboundmedicine.com/medline/citation/24981145/Immediate_and_middle_term_outcome_of_symptomatic_spontaneous_isolated_dissection_of_the_superior_mesenteric_artery_ L2 - https://dx.doi.org/10.1007/s00261-014-0182-1 DB - PRIME DP - Unbound Medicine ER -