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The Significance of the Angle between Superior Mesenteric Artery and Aorta in Spontaneous Isolated Superior Mesenteric Artery Dissection.
Ann Vasc Surg. 2017 Nov; 45:117-126.AV

Abstract

BACKGROUND

The aim of this study is to assess the significance of the angle between superior mesenteric artery (SMA) and distal aorta in spontaneous isolated superior mesenteric artery dissection (SISMAD) by clinical and biomechanical analyses.

METHODS

Thirty-seven patients with SISMAD (1 asymptomatic) and 148 controls (1:4 matched for age [mean 50.2 years], gender [92% male], and body mass index, and being ruled out for arterial disease) underwent aortic computed tomography angiography. SMA-distal aorta angle, measured on sagittal plane, was compared along with baseline characteristics (body mass index, smoking history, and comorbidities) between groups, and assessed as tool to evaluate SISMAD risk after stratification into 4 angle-interval categories. Flow analysis and fluid-structure interaction study were conducted based on patient-specific models with ultrasound-measured boundary conditions to further reveal the flow pattern and loading distribution in the 4 angle-interval categories.

RESULTS

SISMAD patients versus controls had larger mean SMA-distal aorta angle (73 ± 19.8° vs. 50 ± 18.81°, P < 0.001), and more frequently smoking history (62% vs. 40%, P = 0.02) and hypertension (59% vs. 34%, P < 0.001), all multivariate predictors of no SISMAD (odds ratio 0.946 [95% confidence interval 0.927-0.966]; 0.415 [0.198-0.87]; and 0.252 [0.117-0.544], respectively). Odds ratio for SISMAD increased with increasing SMA-distal aorta angle (1, 10, 57, and 73 for <50°, 50-69°, 70-90°, and >90°, respectively; P < 0.05 for >70°). In silico study confirmed that larger angle is associated with higher stress in the arterial wall and higher oscillatory shear index in the vessel lumen at the SMA superior convex, where dissection commonly occurs.

CONCLUSIONS

Besides smoking history and hypertension, SISMAD was positively associated with a morphological parameter, the SMA-distal aorta angle. This might be due to the greater wall stress and oscillatory stress index in the arterial convex with a larger angle.

Authors+Show Affiliations

Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China; Department of Vascular Surgery, Affiliated Hospital of Chengde Medical College, Chengde, People's Republic of China.Department of Biomedical Engineering, School of Life Science, Beijing Institute of Technology, Beijing, People's Republic of China.Department of Biomedical Engineering, School of Life Science, Beijing Institute of Technology, Beijing, People's Republic of China.Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China.Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China.Department of Biomedical Engineering, School of Life Science, Beijing Institute of Technology, Beijing, People's Republic of China; Key Laboratory of Convergence Medical Engineering System and Healthcare Technology, The Ministry of Industry and Information Technology, Beijing Institute of Technology, Beijing, People's Republic of China.Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China. Electronic address: xiongjiangdoc@126.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28689953

Citation

Wu, Zhongyin, et al. "The Significance of the Angle Between Superior Mesenteric Artery and Aorta in Spontaneous Isolated Superior Mesenteric Artery Dissection." Annals of Vascular Surgery, vol. 45, 2017, pp. 117-126.
Wu Z, Yi J, Xu H, et al. The Significance of the Angle between Superior Mesenteric Artery and Aorta in Spontaneous Isolated Superior Mesenteric Artery Dissection. Ann Vasc Surg. 2017;45:117-126.
Wu, Z., Yi, J., Xu, H., Guo, W., Wang, L., Chen, D., & Xiong, J. (2017). The Significance of the Angle between Superior Mesenteric Artery and Aorta in Spontaneous Isolated Superior Mesenteric Artery Dissection. Annals of Vascular Surgery, 45, 117-126. https://doi.org/10.1016/j.avsg.2017.06.156
Wu Z, et al. The Significance of the Angle Between Superior Mesenteric Artery and Aorta in Spontaneous Isolated Superior Mesenteric Artery Dissection. Ann Vasc Surg. 2017;45:117-126. PubMed PMID: 28689953.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Significance of the Angle between Superior Mesenteric Artery and Aorta in Spontaneous Isolated Superior Mesenteric Artery Dissection. AU - Wu,Zhongyin, AU - Yi,Jie, AU - Xu,Huanming, AU - Guo,Wei, AU - Wang,Lijun, AU - Chen,Duanduan, AU - Xiong,Jiang, Y1 - 2017/07/08/ PY - 2017/03/20/received PY - 2017/06/12/revised PY - 2017/06/16/accepted PY - 2017/7/12/pubmed PY - 2018/6/12/medline PY - 2017/7/11/entrez SP - 117 EP - 126 JF - Annals of vascular surgery JO - Ann Vasc Surg VL - 45 N2 - BACKGROUND: The aim of this study is to assess the significance of the angle between superior mesenteric artery (SMA) and distal aorta in spontaneous isolated superior mesenteric artery dissection (SISMAD) by clinical and biomechanical analyses. METHODS: Thirty-seven patients with SISMAD (1 asymptomatic) and 148 controls (1:4 matched for age [mean 50.2 years], gender [92% male], and body mass index, and being ruled out for arterial disease) underwent aortic computed tomography angiography. SMA-distal aorta angle, measured on sagittal plane, was compared along with baseline characteristics (body mass index, smoking history, and comorbidities) between groups, and assessed as tool to evaluate SISMAD risk after stratification into 4 angle-interval categories. Flow analysis and fluid-structure interaction study were conducted based on patient-specific models with ultrasound-measured boundary conditions to further reveal the flow pattern and loading distribution in the 4 angle-interval categories. RESULTS: SISMAD patients versus controls had larger mean SMA-distal aorta angle (73 ± 19.8° vs. 50 ± 18.81°, P < 0.001), and more frequently smoking history (62% vs. 40%, P = 0.02) and hypertension (59% vs. 34%, P < 0.001), all multivariate predictors of no SISMAD (odds ratio 0.946 [95% confidence interval 0.927-0.966]; 0.415 [0.198-0.87]; and 0.252 [0.117-0.544], respectively). Odds ratio for SISMAD increased with increasing SMA-distal aorta angle (1, 10, 57, and 73 for <50°, 50-69°, 70-90°, and >90°, respectively; P < 0.05 for >70°). In silico study confirmed that larger angle is associated with higher stress in the arterial wall and higher oscillatory shear index in the vessel lumen at the SMA superior convex, where dissection commonly occurs. CONCLUSIONS: Besides smoking history and hypertension, SISMAD was positively associated with a morphological parameter, the SMA-distal aorta angle. This might be due to the greater wall stress and oscillatory stress index in the arterial convex with a larger angle. SN - 1615-5947 UR - https://www.unboundmedicine.com/medline/citation/28689953/The_Significance_of_the_Angle_between_Superior_Mesenteric_Artery_and_Aorta_in_Spontaneous_Isolated_Superior_Mesenteric_Artery_Dissection_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0890-5096(17)30869-5 DB - PRIME DP - Unbound Medicine ER -