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      Current Understandings of Spontaneous Isolated Superior Mesenteric Artery Dissection

      review-article
      Author(s):
      Publication date (Electronic):
      Journal: Vascular Specialist International
      Publisher: Vascular Specialist International
      Keywords: Dissection, Superior mesenteric artery, Natural course

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          Abstract

          Spontaneous isolated superior mesenteric artery dissection (SISMAD) has been known as a rare vascular disease. However it is increasingly reported in these days with the development of advanced imaging technology. Underlying etiology, natural course or an optimal management strategy of SISMAD is not exactly known at the moment. During the past 10 years, we have had an interest in this rare vascular disease and collected clinical and image data in 100 or more patients with SISMAD. In this review article, I would like to describe my current understanding of SISMAD on the base of our recent publications in the major vascular surgery journals.

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          Clinical and angiographic follow-up of spontaneous isolated superior mesenteric artery dissection.

          Theresa Kim, Kwang Kim, Susan W Yun … (2009)
          To observe the clinical features and angiographic findings in patients with a spontaneous isolated superior mesenteric artery dissection (SISMAD) and to identify any correlation between them. From a single institution, 32 patients (22 symptomatic patients at presentation; mean age 54years; men 97%) with SISMAD were retrospectively reviewed. All patients were available for clinical follow-up after treatment (conservative, n=28, 88%, open or endovascular superior mesenteric artery (SMA) reconstruction, n=4, 12%), and follow-up CT scans were available in 28 patients (mean 22months, range 1-80months). We found a positive correlation between pain severity and dissection length (p=0.03, rho=0.50, Spearman's partial correlation analysis). After conservative treatment, only one patient (3%) required bowel resection, and there was no difference in outcome between patients who were treated with anticoagulation or anti-platelet therapy and those who were not (p=1.00, Fisher's exact test). No patients had progression of their lesion on the follow-up CT angiography. In SISMAD patients, dissection length is positively associated with more severe clinical symptoms. After conservative treatment, we observed a benign clinical course and no CT progression of the dissection, even without anticoagulation or anti-platelet therapy. Based on our observation, patients with SISMAD can be treated conservatively without anticoagulation therapy.
          Article 0 comments Cited 54 times – based on 0 reviews     Review now
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            Imaging appearances and management of isolated spontaneous dissection of the superior mesenteric artery.

            Ichiro Sakamoto, Yoji Ogawa, Eijun Sueyoshi … (2007)
            The objective of our study was to report the clinical and imaging features of isolated dissection of the superior mesenteric artery (SMA) and describe our imaging classification of this disease entity. We retrospectively analyzed clinical presentation, imaging appearances and outcome of the 12 patients who were diagnosed as having spontaneous dissection of the SMA from 1991 to 2005 in our institution or its affiliated two hospitals. There were 11 males and 1 female with a mean age of 50 years (range, 43-61 years). The diagnosis of isolated dissection was established with CT within 24h of the onset. We categorized SMA dissection into the following four types based on imaging appearances: type I, patent false lumen with both entry and re-entry (four patients), type II, 'cul-de-sac' shaped false lumen without re-entry (one patient), type III, thrombosed false lumen with ulcer like projection (ULP), which is defined as a localized blood-filled pouch protruding from the true lumen into the thrombosed false lumen (five patients) and type IV, completely thrombosed false lumen without ULP (two patients). One patient with type II underwent urgent surgery because of small bowel ischemia. One patient with type III underwent urgent embolotherapy for the treatment of rupture of a branch of the SMA. The remaining 10 patients were initially managed conservatively. In one of the conservatively treated patient, ULP had progressively dilated, and it was treated with stent placement and coil packing 22 months after the onset. The remaining nine patients were conservatively managed without any event during the follow-up period of 7-72 months. Most of the patients with isolated SMA dissection can initially be managed conservatively if there are no clinical and imaging signs indicating ruptured SMA branches or bowel ischemia.
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              Dissecting aneurysm of the aorta; a presentation of 15 cases and a review of the recent literature.

              S R BAUERSFELD (1947)
              Article 0 comments Cited 46 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Vasc Specialist Int
                Journal ID (iso-abbrev): Vasc Specialist Int
                Journal ID (publisher-id): VSI
                Title: Vascular Specialist International
                Publisher: Vascular Specialist International
                ISSN (Print): 2288-7970
                ISSN (Electronic): 2288-7989
                Publication date (Print): June 2016
                Publication date (Electronic): 30 June 2016
                Volume: 32
                Issue: 2
                Pages: 37-43
                Affiliations
                Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
                Author notes
                Corresponding author: Young-Wook Kim, Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea, Tel: 82-2-3410-3461, Fax: 82-2-3410-0040, E-mail: ywkim@ 123456skku.edu
                Article
                Publisher ID: vsi-32-037
                DOI: 10.5758/vsi.2016.32.2.37
                PMC ID: 4928602
                PubMed ID: 27386450
                SO-VID: 0f1f728d-1419-4f14-888a-c2ebc0adbc05
                Copyright © Copyright © 2016, The Korean Society for Vascular Surgery
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 29 February 2016
                Date accepted : 11 March 2016
                Categories
                Subject: Review

                Keywords: dissection,superior mesenteric artery,natural course
                Data availability:
                Keywords: dissection, superior mesenteric artery, natural course

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