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.
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References
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.
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.
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.
Guthrie W, Maclean H. Dissecting aneurysms of arteries other than the aorta. J Pathol. 1972;108:219–35.
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.
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.
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.
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.
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.
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.
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.
Takayama T, Miyata T, Shirakawa M, Nagawa H. Isolated spontaneous dissection of the splanchnic arteries. J Vasc Surg. 2008;48(2):329–33.
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.
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.
Tsai JL, Wu YL, Lin HJ. Spontaneous superior mesenteric artery (SMA) dissection. J Emerg Med. 2008;35(1):81–2.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Drescher R, Koster O, von Rothenburg T. Superior mesenteric artery aneurysm stent graft. Abdom Imaging. 2006;31(1):113–6.
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.
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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
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DOI: https://doi.org/10.1007/s00595-012-0304-8