Korean Circ J.  2017 Jul;47(4):425-431. 10.4070/kcj.2016.0237.

The Classification and Management Strategy of Spontaneous Isolated Superior Mesenteric Artery Dissection

• Jia Z
• Tu J
• Jiang G

• KMID: 2392876
• DOI: http://doi.org/10.4070/kcj.2016.0237

Abstract

Spontaneous isolated superior mesenteric artery dissection (SISMAD) is an uncommon but potentially catastrophic pathology. Multiple classification schemes have been proposed for this occurrence. Although no consensus has emerged regarding which classification should be used, Li's classification scheme is more precise and complete compared to other classification systems and can be used to guide the treatment of SISMAD. Initial conservative treatment is promising, with favorable early and long-term outcomes for most patients; endovascular treatment is recommended for patients with persistent/recurrent symptoms after conservative treatment; surgical treatment should be performed without delay for patients with arterial rupture, intestinal necrosis, or failed endovascular treatment.

Keyword

Superior mesenteric artery; Dissection; Classification; Treatment

MeSH Terms

Classification*
Consensus
Humans
Mesenteric Artery, Superior*
Necrosis
Pathology
Rupture

Figure

• 

  Fig. 1 Type I: patent false lumen with both entry and re-entry; Type II: ‘cul-de-sac’-shaped false lumen without re-entry; Type III: thrombosed false lumen with an ulcer-like projection, which is defined as a localized blood-filled pouch protruding from the true lumen into the thrombosed false lumen; Type IV: completely thrombosed false lumen with no ulcerlike projection.

• 

  Fig. 2 Type I: patent true and false lumens revealing entry and re-entry sites; Type II: ‘cul-de-sac’-shaped false lumen without re-entry; Type IIa: Visible false lumen but no visible re-entry site (blind pouch of false lumen); Type IIb: No visible false luminal flow (thrombosed false lumen); Type III: SMA dissection with occlusion of SMA. SMA: superior mesenteric artery.

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  Fig. 3 Type I: patent false lumen with both entry and re-entry; Type II: ‘cul-de-sac’-shaped false lumen without re-entry; Type III: thrombosed false lumen with an ulcer-like projection; Type IV: completely thrombosed false lumen with no ulcer-like projection; Type V: aneurismal dissection with stenosis of the distal part of the SMA; Type VI: total (VIa) or partial (VIb) thrombosis of the SMA. SMA: superior mesenteric artery.

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  Fig. 4 Type A: dissection localized to the curved part of the SMA and extended proximally to the SMA ostium; Type B: dissection limited to the curved part of the SMA; Type C: dissection localized to the curved part and extended distally, but the ileocolic artery or distal ileal artery was not involved; Type D: dissection localized to the curved part and extended distally to the ileocolic artery or distal ileal artery. SMA: superior mesenteric artery.

• 

  Fig. 5 Type I: patent false lumen with both entry and re-entry; Type II: ‘cul-de-sac’-shaped false lumen with no re-entry (subdivided into IIa, patent true lumen; IIb, severe stenosis of the true lumen; and IIc, occlusion of the true lumen); Type III: thrombosed false lumen with an ULP (subdivided into IIIa, patent true lumen; IIIb, severe stenosis of the true lumen; and IIIc, occlusion of the true lumen); Type IV: completely thrombosed false lumen with no ULP (subdivided into IVa, patent true lumen; IVb, severe stenosis of the true lumen; and IVc, occlusion of the true lumen); Type V: dissecting aneurysm. ULP: ulcer-like projection.

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  Fig. 6 Two pseudoaneurysms of the superior mesenteric artery main trunk can be seen on digital subtraction angiography. The false lumen was dilated (arrowheads), and an entry point was noted (arrows).

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  Fig. 7 The treatment algorithm for SISMAD. CTA: computed tomography angiography, DSA: digital subtraction angiography, PTA: percutaneous transluminal angioplasty, SISMAD: spontaneous isolated superior mesenteric artery dissection.

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