Open Access, Peer-reviewed
pISSN 2288-6575
eISSN 2288-6796
    J Korean Surg Soc. 2010 Jul;79(1):64-70. Korean.
    Published online Jun 25, 2010.
    https://doi.org/10.4174/jkss.2010.79.1.64
    Copyright © 2010 The Korean Surgical Society
    Original Article

    Isolated Dissection of Superior Mesenteric Artery: Study on the Treatment Guidelines

    Min Koo Lee, M.D., Byung Sun Cho, M.D., Hyun Young Han, M.D.,1 In Mok Jung, M.D.,2 Sung Hye Park, R.N., Chang Nam Kim, M.D., Young Jin Choi, M.D., Yoon Jung Kang, M.D. and Joo Seung Park, M.D.
      • Department of Surgery, Eulji University Hospital, Daejeon, Korea.
      • 1Department of Radiology, Eulji University Hospital, Daejeon, Korea.
      • 2Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
    • Corresponding author (Email: sunjoe@eulji.ac.kr )
    Received February 17, 2010; Accepted March 26, 2010.

    Abstract

    Purpose

    Isolated superior mesenteric artery (SMA) dissection is a rare, but increasing vascular disorder. However, optimal treatment guidelines are not well established. The purpose of this study is to review a single institutional experience in the management of isolated SMA dissections and establish optimal treatment guidelines.

    Methods

    Between November 2004 and August 2009, 26 patients were diagnosed with isolated SMA dissection at Eulji University Hospital. Diagnosis was confirmed with CT scans in all patients. We retrospectively reviewed the medical records, imaging studies, and the early outcomes of the patients.

    Results

    There were 22 (84.5%) men and 4 women. The mean age was 55.4 (39~74) years. The mean follow-up was 39.1 (4.1~53.3) months. In 15 patients, CT scans were performed for abdominal pain, and in the other 11 patients, the isolated SMA dissections were detected incidentally during workup for other causes. The radiographic findings included an intimal flap with a patent false lumen in 16 and intramural hematoma in 10. The dissection started at a mean of 22.3 (5~46) mm from the origin of the SMA with a mean length was 47.7 (10~150) mm. Treatments included expectant management in 13, anticoagulation in 6, stenting in 6 patients, and surgery in one case of bowel infarction. None required additional intervention. All patients remained asymptomatic during follow-up.

    Conclusion

    Most patients with isolated SMA dissection were successfully managed medically. Surgical or percutaneous intervention should be reserved for those with evidence of bowel necrosis or mesenteric ischemia and failed cases to initial medical treatment.

    Keywords
    Superior mesenteric artery dissection; Treatment guideline; Strategy; Algorithm

    Figures

    Fig. 1
    Classification of CT findings shows double lumen without stenosis (A), intramural thrombosis without stenosis (B), intramural thrombosis with stenosis (C), double lumen with closed false lumen and stenosis (D).

    Fig. 2
    Incidental finding. (A) SMA has intramural thrombosis without stenosis. (B) Double lumen with intimal flap begins from proximal SMA.

    Fig. 3
    CT findings of symptomatic patient. (A) CT scan shows intramural thrombosis and stenosis. (B) SMA has double lumen with patent false lumen without stenosis. (C) Double lumen with closed false lumen and stenosis is present on the CT scan.

    Fig. 4
    Proposed guidelines for the treatment of superior mesenteric artery dissection.

    Tables

    Table 1
    Patients characteristics

    Table 2
    CT findings (n=26)

    Table 3
    Treatments (n=26)

    References

      1. Gobble RM, Brill ER, Rockman CB, Hecht EM, Lamparello PJ, Jacobowitz GR, et al. Endovascular treatment of spontaneous dissections of the superior mesenteric artery. J Vasc Surg 2009;50:1326–1332.
      1. Morris JT, Guerriero J, Sage JG, Mansour MA. Three isolated superior mesenteric artery dissections: update of previous case reports, diagnostics, and treatment options. J Vasc Surg 2008;47:649–653.
      1. Subhas G, Gupta A, Nawalany M, Oppat WF. Spontaneous isolated superior mesenteric artery dissection: a case report and literature review with management algorithm. Ann Vasc Surg 2009;23:788–798.
      1. Sakamoto I, Ogawa Y, Sueyoshi E, Fukui K, Murakami T, Uetani M. Imaging appearances and management of isolated spontaneous dissection of the superior mesenteric artery. Eur J Radiol 2007;64:103–110.
      1. Okada M, Ishiguchi T, Itoh H. Management of spontaneous dissection of the superior mesenteric artery. Intern Med 2004;43:451–452.
      1. Suzuki S, Furui S, Kohtake H, Sakamoto T, Yamasaki M, Furukawa A, et al. Isolated dissection of the superior mesenteric artery: CT findings in six cases. Abdom Imaging 2004;29:153–157.
      1. Yasuhara H, Shigematsu H, Muto T. Self-limited spontaneous dissection of the main trunk of the superior mesenteric artery. J Vasc Surg 1998;27:776–779.
      1. Nakamura K, Nozue M, Sakakibara Y, Kuramoto K, Satoh M, Kobayashi S, et al. Natural history of a spontaneous dissecting aneurysm of the proximal superior mesenteric artery: report of a case. Surg Today 1997;27:272–274.
      1. Kim HK, Kwon TW, Cho YP, Kim GE. Treatment of an isolated superior mesenteric artery dissection. J Korean Soc Vasc Surg 2007;23:159–162.
      1. Ambo T, Noguchi Y, Iwasaki H, Kondo J, Matsumoto A, Suzuki H, et al. An isolated dissecting aneurysm of the superior mesenteric artery: report of a case. Surg Today 1994;24:933–936.
      1. Nagai T, Torishima R, Uchida A, Nakashima H, Takahashi K, Okawara H, et al. Spontaneous dissection of the superior mesenteric artery in four cases treated with anticoagulation therapy. Intern Med 2004;43:473–478.
      1. Sisteron A, Vieville C. Observations personnelles. In: Jausseran JM, Reggi M, Courbier R, editors. Chirurgie des Arteriopathies Digestives. Paris: Expansion Scientifique Francaise; 1975. pp. 197-202.
      1. Picquet J, Abilez O, Penard J, Jousset Y, Rousselet MC, Enon B. Superficial femoral artery transposition repair for isolated superior mesenteric artery dissection. J Vasc Surg 2005;42:788–791.
      1. Leung DA, Schneider E, Kubik-Huch R, Marincek B, Pfammatter T. Acute mesenteric ischemia caused by spontaneous isolated dissection of the superior mesenteric artery: treatment by percutaneous stent placement. Eur Radiol 2000;10:1916–1919.
      1. Froment P, Alerci M, Vandoni RE, Bogen M, Gertsch P, Galeazzi G. Stenting of a spontaneous dissection of the superior mesenteric artery: a new therapeutic approach? Cardiovasc Intervent Radiol 2004;27:529–532.
      1. Kim JH, Roh BS, Lee YH, Choi SS, So BJ. Isolated spontaneous dissection of the superior mesenteric artery: percutaneous stent placement in two patients. Korean J Radiol 2004;5:134–138.
      1. Casella IB, Bosch MA, Sousa WO Jr. Isolated spontaneous dissection of the superior mesenteric artery treated by percutaneous stent placement: case report. J Vasc Surg 2008;47:197–200.
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    MeSH Terms
    Abdominal Pain
    Female
    Follow-Up Studies
    Hematoma
    Humans
    Infarction
    Ischemia
    Male
    Medical Records
    Mesenteric Artery, Superior
    Necrosis
    Retrospective Studies
    Stents
    Metrics
    Share
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