J Korean Surg Soc.  2010 Jul;79(1):64-70. 10.4174/jkss.2010.79.1.64.

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

• Lee MK
• Cho BS
• Han HY
• Jung IM
• Park SH
• Kim CN
• Choi YJ
• Kang YJ
• Park JS

• KMID: 1455489
• DOI: http://doi.org/10.4174/jkss.2010.79.1.64

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.

Keyword

Superior mesenteric artery dissection; Treatment guideline; Strategy; Algorithm

MeSH Terms

Abdominal Pain
Female
Follow-Up Studies
Hematoma
Humans
Infarction
Ischemia
Male
Medical Records
Mesenteric Artery, Superior
Necrosis
Retrospective Studies
Stents

Figure

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  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).

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

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  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.

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

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