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Management of isolated superior mesenteric artery dissection.
World J Gastroenterol 2014; 20(45):17179-84WJ

Abstract

AIM

To evaluate our experience of the clinical management of spontaneous isolated superior mesenteric artery dissection (ISMAD).

METHODS

From January 2008 to July 2013, 18 patients with ISMAD were retrospectively analyzed, including 7 patients who received conservative therapy, 9 patients who received reconstruction with bare stents, and 2 patients who underwent surgical treatment. The decision to intervene was based on anatomic suitability, patient comorbidities and symptoms.

RESULTS

Intestinal ischemia-related symptoms completely resolved in 7 patients who received conservative therapy. Stent placement was successful in 9 patients. Of the 9 patients who received endovascular stenting, abdominal pain was alleviated after the procedure and gradually disappeared within 3 d. Follow-up computed tomography and computed tomography angiography were available in all patients during the first month and the first year after the procedure, which revealed patent stent and patent involved superior mesenteric artery branches with complete obliteration of the dissection lesion. In the 2 patients who underwent surgical treatment, good clinical efficacy was also observed.

CONCLUSION

ISMAD may be managed successfully in a variety of ways based on the clinical symptoms. ISMAD should be treated by conservative management as the first-line option, however, in those with bowel necrosis or imminent arterial rupture during conservative therapy, endovascular or surgical therapy is indicated.

Authors+Show Affiliations

Peng-Hua Lv, Li-Fu Wang, Department of Interventional Radiology, Northern Jiangsu People's Hospital, Yangzhou 225001, Jiangsu Province, China.Peng-Hua Lv, Li-Fu Wang, Department of Interventional Radiology, Northern Jiangsu People's Hospital, Yangzhou 225001, Jiangsu Province, China.Peng-Hua Lv, Li-Fu Wang, Department of Interventional Radiology, Northern Jiangsu People's Hospital, Yangzhou 225001, Jiangsu Province, China.Peng-Hua Lv, Li-Fu Wang, Department of Interventional Radiology, Northern Jiangsu People's Hospital, Yangzhou 225001, Jiangsu Province, China.Peng-Hua Lv, Li-Fu Wang, Department of Interventional Radiology, Northern Jiangsu People's Hospital, Yangzhou 225001, Jiangsu Province, China.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

25493033

Citation

Lv, Peng-Hua, et al. "Management of Isolated Superior Mesenteric Artery Dissection." World Journal of Gastroenterology, vol. 20, no. 45, 2014, pp. 17179-84.
Lv PH, Zhang XC, Wang LF, et al. Management of isolated superior mesenteric artery dissection. World J Gastroenterol. 2014;20(45):17179-84.
Lv, P. H., Zhang, X. C., Wang, L. F., Chen, Z. L., & Shi, H. B. (2014). Management of isolated superior mesenteric artery dissection. World Journal of Gastroenterology, 20(45), pp. 17179-84. doi:10.3748/wjg.v20.i45.17179.
Lv PH, et al. Management of Isolated Superior Mesenteric Artery Dissection. World J Gastroenterol. 2014 Dec 7;20(45):17179-84. PubMed PMID: 25493033.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of isolated superior mesenteric artery dissection. AU - Lv,Peng-Hua, AU - Zhang,Xi-Cheng, AU - Wang,Li-Fu, AU - Chen,Zhao-Lei, AU - Shi,Hai-Bin, PY - 2014/05/24/received PY - 2014/07/20/revised PY - 2014/09/29/accepted PY - 2014/12/11/entrez PY - 2014/12/11/pubmed PY - 2015/9/4/medline KW - Dissection KW - Endovascular reconstruction KW - Intestine KW - Superior mesenteric artery KW - Therapy SP - 17179 EP - 84 JF - World journal of gastroenterology JO - World J. Gastroenterol. VL - 20 IS - 45 N2 - AIM: To evaluate our experience of the clinical management of spontaneous isolated superior mesenteric artery dissection (ISMAD). METHODS: From January 2008 to July 2013, 18 patients with ISMAD were retrospectively analyzed, including 7 patients who received conservative therapy, 9 patients who received reconstruction with bare stents, and 2 patients who underwent surgical treatment. The decision to intervene was based on anatomic suitability, patient comorbidities and symptoms. RESULTS: Intestinal ischemia-related symptoms completely resolved in 7 patients who received conservative therapy. Stent placement was successful in 9 patients. Of the 9 patients who received endovascular stenting, abdominal pain was alleviated after the procedure and gradually disappeared within 3 d. Follow-up computed tomography and computed tomography angiography were available in all patients during the first month and the first year after the procedure, which revealed patent stent and patent involved superior mesenteric artery branches with complete obliteration of the dissection lesion. In the 2 patients who underwent surgical treatment, good clinical efficacy was also observed. CONCLUSION: ISMAD may be managed successfully in a variety of ways based on the clinical symptoms. ISMAD should be treated by conservative management as the first-line option, however, in those with bowel necrosis or imminent arterial rupture during conservative therapy, endovascular or surgical therapy is indicated. SN - 2219-2840 UR - https://www.unboundmedicine.com/medline/citation/25493033/Management_of_isolated_superior_mesenteric_artery_dissection_ L2 - http://www.wjgnet.com/1007-9327/full/v20/i45/17179.htm DB - PRIME DP - Unbound Medicine ER -