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Outcomes and Radiographic Findings of Isolated Spontaneous Superior Mesenteric Artery Dissection.
Eur J Vasc Endovasc Surg. 2017 Feb; 53(2):276-281.EJ

Abstract

OBJECTIVES

This study aimed to investigate the features, treatments, and prognosis of patients with symptomatic and asymptomatic isolated SMA dissection.

METHODS

Data from 35 consecutive patients in whom isolated SMA dissection was diagnosed on computed tomography angiography (CTA) between 2004 and 2015 at two general hospitals in Japan, were collected retrospectively. Nineteen symptomatic patients were compared, and 16 asymptomatic patients with incidentally revealed SMA dissection were also compared. In addition, the vascular remodelling and outcomes during follow-up were evaluated.

RESULTS

The patient characteristics in the symptomatic and incidental groups were comparable except for age; mean ages were 55.9 ± 13.9 and 65.3 ± 10.9 years, respectively. Most of the symptomatic patients were managed conservatively (including antiplatelet therapy, anticoagulants, blood pressure control, or bowel rest). In addition, one patient was initially treated by endovascular intervention because of intestinal ischaemia, and another was switched from conservative to surgical treatment. The in-hospital outcome was good with no mortality. In the incidental group, all 16 patients were observed as outpatients without additional treatment. Complete remodelling of the false lumen was observed in 31% of patients with follow-up CTA, and was associated with the presence of symptoms and the absence of false lumen with blood flow at diagnosis. Neither recurrent or new onset abdominal pain, intervention for SMA dissection, nor SMA related death was observed in either group during the follow-up period (750 ± 779 and 1200 ± 951 days).

CONCLUSIONS

The characteristics of asymptomatic patients with incidentally revealed SMA dissection were comparable with those of symptomatic patients, except for age. During follow-up, factors favouring complete remodelling of false lumens were the presence of symptoms, and the absence of false lumen blood flow at diagnosis.

Authors+Show Affiliations

Cardiovascular Centre, the Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan.Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan. Electronic address: takao-kato@kitano-hp.or.jp.Department of Cardiovascular Centre, Osaka Red Cross Hospital, Osaka, Japan.Cardiovascular Centre, the Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan.Cardiovascular Centre, the Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan.Cardiovascular Centre, the Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan.Department of Cardiovascular Centre, Osaka Red Cross Hospital, Osaka, Japan.Cardiovascular Centre, the Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan.

Pub Type(s)

Journal Article
Multicenter Study
Observational Study

Language

eng

PubMed ID

28012909

Citation

Kimura, Y, et al. "Outcomes and Radiographic Findings of Isolated Spontaneous Superior Mesenteric Artery Dissection." European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery, vol. 53, no. 2, 2017, pp. 276-281.
Kimura Y, Kato T, Nagao K, et al. Outcomes and Radiographic Findings of Isolated Spontaneous Superior Mesenteric Artery Dissection. Eur J Vasc Endovasc Surg. 2017;53(2):276-281.
Kimura, Y., Kato, T., Nagao, K., Izumi, T., Haruna, T., Ueyama, K., Inada, T., & Inoko, M. (2017). Outcomes and Radiographic Findings of Isolated Spontaneous Superior Mesenteric Artery Dissection. European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery, 53(2), 276-281. https://doi.org/10.1016/j.ejvs.2016.11.012
Kimura Y, et al. Outcomes and Radiographic Findings of Isolated Spontaneous Superior Mesenteric Artery Dissection. Eur J Vasc Endovasc Surg. 2017;53(2):276-281. PubMed PMID: 28012909.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes and Radiographic Findings of Isolated Spontaneous Superior Mesenteric Artery Dissection. AU - Kimura,Y, AU - Kato,T, AU - Nagao,K, AU - Izumi,T, AU - Haruna,T, AU - Ueyama,K, AU - Inada,T, AU - Inoko,M, Y1 - 2016/12/21/ PY - 2016/07/12/received PY - 2016/11/09/accepted PY - 2016/12/26/pubmed PY - 2018/1/18/medline PY - 2016/12/26/entrez KW - Asymptomatic KW - Isolated KW - Prognosis KW - Spontaneous KW - Superior mesenteric artery dissection SP - 276 EP - 281 JF - European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery JO - Eur J Vasc Endovasc Surg VL - 53 IS - 2 N2 - OBJECTIVES: This study aimed to investigate the features, treatments, and prognosis of patients with symptomatic and asymptomatic isolated SMA dissection. METHODS: Data from 35 consecutive patients in whom isolated SMA dissection was diagnosed on computed tomography angiography (CTA) between 2004 and 2015 at two general hospitals in Japan, were collected retrospectively. Nineteen symptomatic patients were compared, and 16 asymptomatic patients with incidentally revealed SMA dissection were also compared. In addition, the vascular remodelling and outcomes during follow-up were evaluated. RESULTS: The patient characteristics in the symptomatic and incidental groups were comparable except for age; mean ages were 55.9 ± 13.9 and 65.3 ± 10.9 years, respectively. Most of the symptomatic patients were managed conservatively (including antiplatelet therapy, anticoagulants, blood pressure control, or bowel rest). In addition, one patient was initially treated by endovascular intervention because of intestinal ischaemia, and another was switched from conservative to surgical treatment. The in-hospital outcome was good with no mortality. In the incidental group, all 16 patients were observed as outpatients without additional treatment. Complete remodelling of the false lumen was observed in 31% of patients with follow-up CTA, and was associated with the presence of symptoms and the absence of false lumen with blood flow at diagnosis. Neither recurrent or new onset abdominal pain, intervention for SMA dissection, nor SMA related death was observed in either group during the follow-up period (750 ± 779 and 1200 ± 951 days). CONCLUSIONS: The characteristics of asymptomatic patients with incidentally revealed SMA dissection were comparable with those of symptomatic patients, except for age. During follow-up, factors favouring complete remodelling of false lumens were the presence of symptoms, and the absence of false lumen blood flow at diagnosis. SN - 1532-2165 UR - https://www.unboundmedicine.com/medline/citation/28012909/Outcomes_and_Radiographic_Findings_of_Isolated_Spontaneous_Superior_Mesenteric_Artery_Dissection_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1078-5884(16)30612-8 DB - PRIME DP - Unbound Medicine ER -