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Serial Follow-Up Evaluation With Computed Tomography After Conservative Medical Treatment in Patients With Symptomatic Spontaneous Isolated Superior Mesenteric Artery Dissection.
Vasc Endovascular Surg 2017; 51(8):538-544VE

Abstract

OBJECTIVE

There is no detailed information available about trend in the morphological change after conservative medical treatment in patients with symptomatic spontaneous isolated superior mesenteric artery dissection (SISMAD).

METHODS

We enrolled 27 consecutive patients with symptomatic SISMAD who underwent conservative medical treatment between 2006 and 2015. The long-term prognosis, natural history, and serial follow-up computed tomography (CT) findings of risk factors of rupture such as arterial diameter and false lumen enhancement were retrospectively assessed.

RESULTS

Spontaneous isolated superior mesenteric artery dissection usually developed in middle-aged men around 50 years old who had a history of smoking. Follow-up CT was performed at 1 to 6 months, 7 to 12 months, and after 12 months. Superior mesenteric artery (SMA) maximum diameter was 10.3 mm (quartile 9.5-11.3) on initial CT and expanded in 47.1% patients during 1- to 6-month follow-up, which decreased over time (P < .001 at 7- to 12-month follow-up, P = .001 after 12-month follow-up). On the other hand, false lumen enhancements were revealed in 9 (33.3%) patients on initial CT. The size of false lumen enhancement was expanded in the longest diameter in 35.3% patients and in shortest diameter in 29.4% during 1- to 6-month follow-up. However, the size of false lumen decreased in all patients after 12-month follow-up. All patients were alive without arterial aneurysm rupture and hospital readmission during the median of 523 days (170-799) study period.

CONCLUSION

We demonstrated that both SMA maximum diameter and false lumen enhancement were transiently expanded in some patients during 6-month follow-up, but no longer expanded after 12-month follow-up. Patients with symptomatic SISMAD could be treated medically with scheduled careful follow-up CT evaluations.

Authors+Show Affiliations

1 Department of Emergency Medicine, Hiroshima City Hospital, Hiroshima-shi, Hiroshima, Japan.2 Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.3 Department of Cardiovascular Surgery, Hiroshima City Hospital, Hiroshima-shi, Hiroshima, Japan.4 Department of Radiology, Hiroshima City Hospital, Hiroshima-shi, Hiroshima, Japan.1 Department of Emergency Medicine, Hiroshima City Hospital, Hiroshima-shi, Hiroshima, Japan.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

28969500

Citation

Ichiba, Toshihisa, et al. "Serial Follow-Up Evaluation With Computed Tomography After Conservative Medical Treatment in Patients With Symptomatic Spontaneous Isolated Superior Mesenteric Artery Dissection." Vascular and Endovascular Surgery, vol. 51, no. 8, 2017, pp. 538-544.
Ichiba T, Hara M, Yunoki K, et al. Serial Follow-Up Evaluation With Computed Tomography After Conservative Medical Treatment in Patients With Symptomatic Spontaneous Isolated Superior Mesenteric Artery Dissection. Vasc Endovascular Surg. 2017;51(8):538-544.
Ichiba, T., Hara, M., Yunoki, K., Urashima, M., & Naitou, H. (2017). Serial Follow-Up Evaluation With Computed Tomography After Conservative Medical Treatment in Patients With Symptomatic Spontaneous Isolated Superior Mesenteric Artery Dissection. Vascular and Endovascular Surgery, 51(8), pp. 538-544. doi:10.1177/1538574417729271.
Ichiba T, et al. Serial Follow-Up Evaluation With Computed Tomography After Conservative Medical Treatment in Patients With Symptomatic Spontaneous Isolated Superior Mesenteric Artery Dissection. Vasc Endovascular Surg. 2017;51(8):538-544. PubMed PMID: 28969500.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Serial Follow-Up Evaluation With Computed Tomography After Conservative Medical Treatment in Patients With Symptomatic Spontaneous Isolated Superior Mesenteric Artery Dissection. AU - Ichiba,Toshihisa, AU - Hara,Masahiko, AU - Yunoki,Keiji, AU - Urashima,Masaki, AU - Naitou,Hiroshi, Y1 - 2017/10/02/ PY - 2017/10/4/pubmed PY - 2017/11/14/medline PY - 2017/10/4/entrez KW - dissection KW - false lumen enhancement KW - maximum diameter KW - superior mesenteric artery SP - 538 EP - 544 JF - Vascular and endovascular surgery JO - Vasc Endovascular Surg VL - 51 IS - 8 N2 - OBJECTIVE: There is no detailed information available about trend in the morphological change after conservative medical treatment in patients with symptomatic spontaneous isolated superior mesenteric artery dissection (SISMAD). METHODS: We enrolled 27 consecutive patients with symptomatic SISMAD who underwent conservative medical treatment between 2006 and 2015. The long-term prognosis, natural history, and serial follow-up computed tomography (CT) findings of risk factors of rupture such as arterial diameter and false lumen enhancement were retrospectively assessed. RESULTS: Spontaneous isolated superior mesenteric artery dissection usually developed in middle-aged men around 50 years old who had a history of smoking. Follow-up CT was performed at 1 to 6 months, 7 to 12 months, and after 12 months. Superior mesenteric artery (SMA) maximum diameter was 10.3 mm (quartile 9.5-11.3) on initial CT and expanded in 47.1% patients during 1- to 6-month follow-up, which decreased over time (P < .001 at 7- to 12-month follow-up, P = .001 after 12-month follow-up). On the other hand, false lumen enhancements were revealed in 9 (33.3%) patients on initial CT. The size of false lumen enhancement was expanded in the longest diameter in 35.3% patients and in shortest diameter in 29.4% during 1- to 6-month follow-up. However, the size of false lumen decreased in all patients after 12-month follow-up. All patients were alive without arterial aneurysm rupture and hospital readmission during the median of 523 days (170-799) study period. CONCLUSION: We demonstrated that both SMA maximum diameter and false lumen enhancement were transiently expanded in some patients during 6-month follow-up, but no longer expanded after 12-month follow-up. Patients with symptomatic SISMAD could be treated medically with scheduled careful follow-up CT evaluations. SN - 1938-9116 UR - https://www.unboundmedicine.com/medline/citation/28969500/Serial_Follow_Up_Evaluation_With_Computed_Tomography_After_Conservative_Medical_Treatment_in_Patients_With_Symptomatic_Spontaneous_Isolated_Superior_Mesenteric_Artery_Dissection_ L2 - http://journals.sagepub.com/doi/full/10.1177/1538574417729271?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -