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Clinical course of conservative management for isolated superior mesenteric arterial dissection.
Eur J Radiol Open 2019; 6:192-197EJ

Abstract

Objectives

Isolated superior mesenteric arterial dissection (ISMAD) is an uncommon type of arterial dissection and treated with surgery, stenting, or conservative management. This study aimed to evaluate the criteria for conservative therapy for ISMAD patients based on imaging findings.

Methods

Eighteen consecutive ISMAD patients without peritoneal irritation at onset were retrospectively studied. The decision to perform stenting was based on the emergence of peritoneal irritation, aneurysm, or mesenteric ischemia. Clinical manifestations, follow-up contrast-enhanced computed tomography (CECT) findings, and patient outcome were evaluated.

Results

Most patients (16, 89%) were successfully treated conservatively; two patients (11%) required endovascular stenting because of an aneurysm or ulcer-like projection (ULP) sign. The median duration of fasting and hospital stays was 3 (range, 1-8) and 9 (range, 4-34) days, respectively. On CECT, the median distance from the superior mesenteric artery (SMA) origin to the entry site was 12 mm (range, 5-35 mm), and the median length of dissection was 87.5 mm (range, 20-150 mm). Among 16 patients treated conservatively, serial imaging was obtained in 11 patients (69%), and disappearance of the dissection within 4 months occurred in five patients. Two patients treated with endovascular stent underwent follow-up CECT 1 year after onset, and there were no complications.

Conclusions

ISMAD patients without peritoneal irritation can be treated conservatively if there are no signs of an aneurysm, ULP, or mesenteric ischemia. When an aneurysm or ULP sign exists, endovascular stenting was able to preserve SMA blood flow with the improvement of the dissection.

Authors+Show Affiliations

Department of Radiology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.Center for Gastroenterology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.Department of Radiology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.Department of Radiology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.Center for Gastroenterology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.Center for Gastroenterology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.Center for Gastroenterology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.Department of Surgery, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan. Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.Center for Gastroenterology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31193717

Citation

Sosogi, Sho, et al. "Clinical Course of Conservative Management for Isolated Superior Mesenteric Arterial Dissection." European Journal of Radiology Open, vol. 6, 2019, pp. 192-197.
Sosogi S, Sato R, Wada R, et al. Clinical course of conservative management for isolated superior mesenteric arterial dissection. Eur J Radiol Open. 2019;6:192-197.
Sosogi, S., Sato, R., Wada, R., Saito, H., Takauji, S., Sakamoto, J., ... Ohta, T. (2019). Clinical course of conservative management for isolated superior mesenteric arterial dissection. European Journal of Radiology Open, 6, pp. 192-197. doi:10.1016/j.ejro.2019.05.004.
Sosogi S, et al. Clinical Course of Conservative Management for Isolated Superior Mesenteric Arterial Dissection. Eur J Radiol Open. 2019;6:192-197. PubMed PMID: 31193717.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical course of conservative management for isolated superior mesenteric arterial dissection. AU - Sosogi,Sho, AU - Sato,Ryu, AU - Wada,Reona, AU - Saito,Hiroya, AU - Takauji,Shuhei, AU - Sakamoto,Jun, AU - Kimura,Keisuke, AU - Karasaki,Hidenori, AU - Mizukami,Yusuke, AU - Ohta,Tomoyuki, Y1 - 2019/05/24/ PY - 2019/04/21/received PY - 2019/05/14/accepted PY - 2019/6/14/entrez PY - 2019/6/14/pubmed PY - 2019/6/14/medline KW - CECT, contrast-enhanced computed tomography KW - Dissection KW - ISMAD, isolated superior mesenteric arterial dissection KW - Mesenteric artery KW - SMA, superior mesenteric artery KW - Stents KW - ULP, ulcer-like projection SP - 192 EP - 197 JF - European journal of radiology open JO - Eur J Radiol Open VL - 6 N2 - Objectives: Isolated superior mesenteric arterial dissection (ISMAD) is an uncommon type of arterial dissection and treated with surgery, stenting, or conservative management. This study aimed to evaluate the criteria for conservative therapy for ISMAD patients based on imaging findings. Methods: Eighteen consecutive ISMAD patients without peritoneal irritation at onset were retrospectively studied. The decision to perform stenting was based on the emergence of peritoneal irritation, aneurysm, or mesenteric ischemia. Clinical manifestations, follow-up contrast-enhanced computed tomography (CECT) findings, and patient outcome were evaluated. Results: Most patients (16, 89%) were successfully treated conservatively; two patients (11%) required endovascular stenting because of an aneurysm or ulcer-like projection (ULP) sign. The median duration of fasting and hospital stays was 3 (range, 1-8) and 9 (range, 4-34) days, respectively. On CECT, the median distance from the superior mesenteric artery (SMA) origin to the entry site was 12 mm (range, 5-35 mm), and the median length of dissection was 87.5 mm (range, 20-150 mm). Among 16 patients treated conservatively, serial imaging was obtained in 11 patients (69%), and disappearance of the dissection within 4 months occurred in five patients. Two patients treated with endovascular stent underwent follow-up CECT 1 year after onset, and there were no complications. Conclusions: ISMAD patients without peritoneal irritation can be treated conservatively if there are no signs of an aneurysm, ULP, or mesenteric ischemia. When an aneurysm or ULP sign exists, endovascular stenting was able to preserve SMA blood flow with the improvement of the dissection. SN - 2352-0477 UR - https://www.unboundmedicine.com/medline/citation/31193717/Clinical_course_of_conservative_management_for_isolated_superior_mesenteric_arterial_dissection_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2352-0477(19)30027-9 DB - PRIME DP - Unbound Medicine ER -