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Optimal Treatment Strategy and Natural History of Isolated Superior Mesenteric Artery Dissection Based on Long-term Follow-up CT findings.

Abstract

OBJECTIVES

Isolated superior mesenteric artery dissection (ISMAD) was previously considered a rare disorder; however, this condition has been increasingly diagnosed as time progressed. Although treatment regimen and treatment outcomes have become clearer, the optimal treatment strategy has not yet been well established.

MATERIALS AND METHODS

This study included 54 patients diagnosed with ISMAD by computed tomography (CT) between November 2004 and December 2017. Thirteen patients were excluded from the analysis of natural course as six were lost to follow-up and seven underwent endovascular therapy.

RESULTS

Of the 54 patients included in the study, 50 were male and four were female. The mean age of patients was 52.3 years (range 40-74). The mean follow-up duration was 18.5 months (range 1.0-131.0). Thirty-eight patients were symptomatic and 16 were asymptomatic. All aneurysmal changes observed on follow-up CT scans were initially classified as type IIII or IV. Of these patients, seven underwent endovascular therapy. The failure rate of conservative treatment was 13%.

CONCLUSION

Conservative treatment is safe and effective if bowel necrosis or arterial rupture is not present. Symptomatic patients classified as type III or IV on the initial CT scan should be followed up. If there is recurrent pain or aneurysmal progression, endovascular therapy should be performed.

Authors+Show Affiliations

Department of Surgery, Eulji Medical Center, Daejeon, South Korea.Department of Surgery, Eulji Medical Center, Daejeon, South Korea. Electronic address: isunjoe@gmail.com.Eulji University College of Nursing, Daejeon, South Korea.Department of Surgery, Eulji Medical Center, Daejeon, South Korea.Department of Surgery, Eulji Medical Center, Daejeon, South Korea.Department of Surgery, Eulji Medical Center, Daejeon, South Korea.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31626943

Citation

Jang, Je Ho, et al. "Optimal Treatment Strategy and Natural History of Isolated Superior Mesenteric Artery Dissection Based On Long-term Follow-up CT Findings." Annals of Vascular Surgery, 2019.
Jang JH, Cho BS, Ahn HY, et al. Optimal Treatment Strategy and Natural History of Isolated Superior Mesenteric Artery Dissection Based on Long-term Follow-up CT findings. Ann Vasc Surg. 2019.
Jang, J. H., Cho, B. S., Ahn, H. Y., Lee, S., Kim, H., & Kim, C. N. (2019). Optimal Treatment Strategy and Natural History of Isolated Superior Mesenteric Artery Dissection Based on Long-term Follow-up CT findings. Annals of Vascular Surgery, doi:10.1016/j.avsg.2019.08.092.
Jang JH, et al. Optimal Treatment Strategy and Natural History of Isolated Superior Mesenteric Artery Dissection Based On Long-term Follow-up CT Findings. Ann Vasc Surg. 2019 Oct 15; PubMed PMID: 31626943.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Optimal Treatment Strategy and Natural History of Isolated Superior Mesenteric Artery Dissection Based on Long-term Follow-up CT findings. AU - Jang,Je Ho, AU - Cho,Byung Sun, AU - Ahn,Hye Young, AU - Lee,Seulgi, AU - Kim,Hyeyoung, AU - Kim,Chang Nam, Y1 - 2019/10/15/ PY - 2019/05/27/received PY - 2019/08/14/revised PY - 2019/08/15/accepted PY - 2019/10/19/entrez PY - 2019/10/19/pubmed PY - 2019/10/19/medline JF - Annals of vascular surgery JO - Ann Vasc Surg N2 - OBJECTIVES: Isolated superior mesenteric artery dissection (ISMAD) was previously considered a rare disorder; however, this condition has been increasingly diagnosed as time progressed. Although treatment regimen and treatment outcomes have become clearer, the optimal treatment strategy has not yet been well established. MATERIALS AND METHODS: This study included 54 patients diagnosed with ISMAD by computed tomography (CT) between November 2004 and December 2017. Thirteen patients were excluded from the analysis of natural course as six were lost to follow-up and seven underwent endovascular therapy. RESULTS: Of the 54 patients included in the study, 50 were male and four were female. The mean age of patients was 52.3 years (range 40-74). The mean follow-up duration was 18.5 months (range 1.0-131.0). Thirty-eight patients were symptomatic and 16 were asymptomatic. All aneurysmal changes observed on follow-up CT scans were initially classified as type IIII or IV. Of these patients, seven underwent endovascular therapy. The failure rate of conservative treatment was 13%. CONCLUSION: Conservative treatment is safe and effective if bowel necrosis or arterial rupture is not present. Symptomatic patients classified as type III or IV on the initial CT scan should be followed up. If there is recurrent pain or aneurysmal progression, endovascular therapy should be performed. SN - 1615-5947 UR - https://www.unboundmedicine.com/medline/citation/31626943/Optimal_Treatment_Strategy_and_Natural_History_of_Isolated_Superior_Mesenteric_Artery_Dissection_Based_on_Long-term_Follow-up_CT_findings L2 - https://linkinghub.elsevier.com/retrieve/pii/S0890-5096(19)30780-0 DB - PRIME DP - Unbound Medicine ER -