Observational Study
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World J Gastroenterol. Dec 7, 2014; 20(45): 17179-17184
Published online Dec 7, 2014. doi: 10.3748/wjg.v20.i45.17179
Management of isolated superior mesenteric artery dissection
Peng-Hua Lv, Xi-Cheng Zhang, Li-Fu Wang, Zhao-Lei Chen, Hai-Bin Shi
Peng-Hua Lv, Li-Fu Wang, Department of Interventional Radiology, Northern Jiangsu People’s Hospital, Yangzhou 225001, Jiangsu Province, China
Peng-Hua Lv, Hai-Bin Shi, Department of Radiology, First Hospital Affiliated to Nanjing Medical University, Nanjing 210001, Jiangsu Province, China
Xi-Cheng Zhang, Zhao-Lei Chen, Department of Vascular Surgery, Northern Jiangsu People’s Hospital, Yangzhou 225001, Jiangsu Province, China
Author contributions: Lv PH, Zhang XC, Wang LF, Chen ZL and Shi HB performed the research; Lv PH wrote the paper.
Correspondence to: Dr. Hai-Bin Shi, Department of Radiology, First Hospital Affiliated to Nanjing Medical University, 300 Guangzhou Road, Nanjing 210001, Jiangsu Province, China. shihb@vip.sina.com
Telephone: +86-25-83714511 Fax: +86-25-83718836
Received: May 24, 2014
Revised: July 20, 2014
Accepted: September 29, 2014
Published online: December 7, 2014
Processing time: 200 Days and 4.1 Hours
Abstract

AIM: To evaluate our experience of the clinical management of spontaneous isolated superior mesenteric artery dissection (ISMAD).

METHODS: From January 2008 to July 2013, 18 patients with ISMAD were retrospectively analyzed, including 7 patients who received conservative therapy, 9 patients who received reconstruction with bare stents, and 2 patients who underwent surgical treatment. The decision to intervene was based on anatomic suitability, patient comorbidities and symptoms.

RESULTS: Intestinal ischemia-related symptoms completely resolved in 7 patients who received conservative therapy. Stent placement was successful in 9 patients. Of the 9 patients who received endovascular stenting, abdominal pain was alleviated after the procedure and gradually disappeared within 3 d. Follow-up computed tomography and computed tomography angiography were available in all patients during the first month and the first year after the procedure, which revealed patent stent and patent involved superior mesenteric artery branches with complete obliteration of the dissection lesion. In the 2 patients who underwent surgical treatment, good clinical efficacy was also observed.

CONCLUSION: ISMAD may be managed successfully in a variety of ways based on the clinical symptoms. ISMAD should be treated by conservative management as the first-line option, however, in those with bowel necrosis or imminent arterial rupture during conservative therapy, endovascular or surgical therapy is indicated.

Keywords: Intestine; Superior mesenteric artery; Dissection; Therapy; Endovascular reconstruction

Core tip: Therapeutic options for isolated superior mesenteric artery dissection include conservative management, endovascular treatments or open surgery. In this small series, conservative therapy was indicated for asymptomatic patients or those with short-term symptoms, while endovascular or surgical therapy was recommended for those with clinical or imaging evidence of bowel necrosis or imminent arterial rupture. Percutaneous endovascular reconstruction with bare stent implantation is a feasible treatment choice with a high success rate and good clinical outcome.