Skip to main content

Advertisement

Log in

Conservative treatment for isolated superior mesenteric artery dissection

Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

The treatment guidelines for isolated superior mesenteric artery (SMA) dissection have not been established. We assessed 14 cases of SMA dissection and reviewed the literature on this entity.

Methods

The subjects were 11 men and 3 women (average age 64 years), with SMA dissection diagnosed by computed tomography (CT) scan or digital subtraction angiography, between 2001 and 2009, at our institution. Eight patients presented with symptoms such as abdominal pain, but SMA dissection was diagnosed incidentally during investigations of another illness in six patients. Thirteen patients were treated conservatively with anticoagulation and/or antiplatelet drugs, but one underwent exploratory laparotomy. The median follow-up period was 22 months.

Result

The symptoms did not worsen, and ultimately resolved in the eight patients who had symptoms. Isolated dissection improved dramatically in two of the six patients with obstruction of the false lumen and was not seen on computed tomography (CT) scans 1 and 3 months after its onset.

Conclusion

We recommend conservative treatment as the first choice for isolated SMA dissection, even if the patient has abdominal pain and tenderness, given that there are no signs of peritonitis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bauersfeld SR. Dissecting aneurysm of the aorta: a presentation of fifteen cases and a review of recent literature. Ann Intern Med. 1947;26:73–89.

    Google Scholar 

  2. 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(1):103–10.

    Article  PubMed  Google Scholar 

  3. Yasuhara H, Shigematsu H, Muto T. Self-limited spontaneous dissection of the main trunk of the superior mesenteric artery. J Vasc Surg. 1998;27:777–9.

    Article  Google Scholar 

  4. Guthrie W, Maclean H. Dissecting aneurysms of arteries other than the aorta. J Pathol. 1972;108:219–35.

    Article  PubMed  CAS  Google Scholar 

  5. Vignati PV, Welch JP, Ellison L, Cohen JL. Acute mesenteric ischemia caused by isolated superior mesenteric artery dissection. J Vasc Surg. 1992;16:109–12.

    Article  PubMed  CAS  Google Scholar 

  6. Picquet J, Abilez O, Penard J, Jousset Y, Rouosselet MC, Enon B. Superficial femoral artery transposition repair for isolated superior mesenteric artery dissection. J Vasc Surg. 2005;42:788–91.

    Article  PubMed  Google Scholar 

  7. Solis MM, Ranval TJ, Mcfarland DR, Eidt JF. Surgical treatment of superior mesenteric artery dissecting aneurysm and simultaneous celiac artery compression. Ann Vasc Surg. 1993;7:457–62.

    Article  PubMed  CAS  Google Scholar 

  8. 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(3):649–53.

    Article  PubMed  Google Scholar 

  9. Hirai S, Hamanaka Y, Mitsui N, Isaka M, Kobayashi T. Spontaneous and isolated dissection of the main trunk of the superior mesenteric artery. Ann Thorac Cardiovasc Surg. 2002;8(4):236–40.

    PubMed  Google Scholar 

  10. Miyamoto N, Sakurai Y, Hirokami M, Takahashi K, Nishimori H, Tsuji K, et al. Endovascular stent placement for isolated spontaneous dissection of the superior mesenteric artery: report of a case. Radiat Med. 2005;23(7):520–4.

    PubMed  Google Scholar 

  11. Ozaki T, Kimura M, Yoshimura N, Hori Y, Takano T, Kamura T, et al. Endovascular treatment of spontaneous isolated dissecting aneurysm of the superior mesenteric artery using stent-assisted coil embolization. Cardiovasc Intervent Radiol. 2006;29(3):435–7.

    Article  PubMed  Google Scholar 

  12. Takayama T, Miyata T, Shirakawa M, Nagawa H. Isolated spontaneous dissection of the splanchnic arteries. J Vasc Surg. 2008;48(2):329–33.

    Article  PubMed  Google Scholar 

  13. 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(1):197–200.

    Article  PubMed  Google Scholar 

  14. 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(6):473–8.

    Article  PubMed  Google Scholar 

  15. Tsai JL, Wu YL, Lin HJ. Spontaneous superior mesenteric artery (SMA) dissection. J Emerg Med. 2008;35(1):81–2.

    Article  PubMed  Google Scholar 

  16. Tsai HY, Yang TL, Wann SR, Yen MY, Chang HT. Successful angiographic stent-graft treatment for spontaneously dissecting broad-base pseudoaneurysm of the superior mesenteric artery. J Chin Med Assoc. 2005;68(8):397–400.

    Article  PubMed  Google Scholar 

  17. Ando M, Ito M, Mishima Y. Spontaneous dissecting aneurysm of the main trunk of the superior mesenteric artery: report of a case. Surg Today. 1995;25(5):468–70.

    Article  PubMed  CAS  Google Scholar 

  18. Javerliat I, Becquemin JP, d’Audiffret A. Spontaneous isolated dissection of the superior mesenteric artery. Eur J Vasc Endovasc Surg. 2003;25(2):180–4.

    Article  PubMed  CAS  Google Scholar 

  19. 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(2):153–7.

    Article  PubMed  CAS  Google Scholar 

  20. Tsuji Y, Hino Y, Sugimoto K, Matsuda H, Okita Y. Surgical intervention for isolated dissecting aneurysm of the superior mesenteric artery—a case report. Vasc Endovascular Surg. 2004;38(5):469–72.

    Article  PubMed  Google Scholar 

  21. Kochi K, Orihashi K, Murakami Y, Sueda T. Revascularization using arterial conduits for abdominal angina due to isolated and spontaneous dissection of the superior mesenteric artery. Ann Vasc Surg. 2005;19(3):418–20.

    Article  PubMed  Google Scholar 

  22. Sparks SR, Vasquez JC, Bergan JJ, Owens EL. Failure of nonoperative management of isolated superior mesenteric artery dissection. Ann Vasc Surg. 2000;14(2):105–9.

    Article  PubMed  CAS  Google Scholar 

  23. 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;5:134–8.

    Article  PubMed  Google Scholar 

  24. Wu XM, Wang TD, Chen MF. Percutaneous endovascular treatment for isolated spontaneous superior mesenteric artery dissection: report of two cases and literature review. Catheter Cardiovasc Interv. 2009;73(2):145–51.

    Article  PubMed  Google Scholar 

  25. Ishida M, Kato N, Hirano T, Suzuki T, Shomura Y, Yada I, et al. Dissecting aneurysm of the superior mesenteric artery successfully treated by endovascular stent-graft placement. Cardiovasc Intervent Radiol. 2003;26(4):403–6.

    Article  PubMed  Google Scholar 

  26. Drescher R, Koster O, von Rothenburg T. Superior mesenteric artery aneurysm stent graft. Abdom Imaging. 2006;31(1):113–6.

    Article  PubMed  CAS  Google Scholar 

  27. Iwase K, Sando K, Ito T, Mikata S, Mizushima T, Kainuma S, et al. Isolated dissecting aneurysm of the superior mesenteric artery: intravascular ultrasound (IVUS) images. Hepatogastroenterology. 2007;54(76):1161–3.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Masatoshi Jibiki.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jibiki, M., Inoue, Y. & Kudo, T. Conservative treatment for isolated superior mesenteric artery dissection. Surg Today 43, 260–263 (2013). https://doi.org/10.1007/s00595-012-0304-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-012-0304-8

Keywords

Navigation