scholarly journals Long-term Outcomes of Conservative Treatment and Endovascular Treatment in Patients with Symptomatic Spontaneous Isolated Superior Mesenteric Artery Dissection: A Single-center Experience

2020 ◽  
Author(s):  
Leyin Xu ◽  
Jiang Shao ◽  
Daming Zhang ◽  
Chenyang Qiu ◽  
Jingjing Wang ◽  
...  
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Artery Dissection ◽  
Single Center ◽  
Long Term Outcomes ◽  
Conservative Group ◽  
Superior Mesenteric Artery Dissection ◽  
Symptom Recurrence

Abstract Background: Spontaneous isolated superior mesenteric artery dissection (SISMAD) is a rare vascular disorder, and the treatment strategies remain controversial. This study aimed to compare outcomes of conservative and endovascular treatments in symptomatic patients with SISMAD. Methods: Forty-two consecutive SISMAD patients who were admitted to a single center between October 2009 and May 2018 were enrolled in this study. Based on their symptoms, 15 had conservative treatment, and 27 had endovascular treatment. The baseline characteristics, treatments, and follow-up results of the conservative group and endovascular group were analysed. Results: The rates of symptom relief were 93.3% in the conservative group and 96.3% in the endovascular group. The procedure-related complications in the endovascular group included one case of pseudoaneurysm formation in the left brachial artery. During the follow-up period (median 28.5 months), a higher proportion of patients in the conservative group had symptom recurrence (42.9% in the conservative group versus 4.8% in the endovascular group, p < 0.001). Four patients in the conservative group and one patient in the endovascular group had additional endovascular intervention during follow-up. Compared with the conservative group, patients in the endovascular group had statistically significantly longer symptom-free survival ( p = 0.014) and a higher rate of superior mesenteric artery (SMA) remodeling ( p < 0.001). Conclusions: For symptomatic SISMAD, endovascularly treated patients had a lower rate of symptom recurrence and a higher rate of SMA remodeling in the long term. Prospective, multi-center studies are needed to confirm the long-term outcomes of both treatments.

scholarly journals Long-term Outcomes of Conservative Treatment and Endovascular Treatment in Patients with Symptomatic Spontaneous Isolated Superior Mesenteric Artery Dissection: A Single-center Experience

2019 ◽  
Author(s):  
Leyin Xu ◽  
Daming Zhang ◽  
Chenyang Qiu ◽  
Jingjing Wang ◽  
Kang Li ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Artery Dissection ◽  
Single Center ◽  
Conservative Group ◽  
Superior Mesenteric Artery Dissection ◽  
Symptom Recurrence

Abstract Background: Spontaneous isolated superior mesenteric artery dissection (SISMAD) is a rare vascular disorder and the treatment strategies remain controversial. This study aimed to compare outcomes of conservative and endovascular treatments in symptomatic patients with SISMAD. Methods: Forty-two consecutive SISMAD patients between October 2009 and May 2018 in a single center were enrolled in the study. Based on their symptoms, 15 had conservative treatment and 27 had endovascular treatment. The baseline characteristics, treatments, and follow-up results of the conservative group and endovascular group were analyzed. Results: The rate of symptom relief was 93.3% in the conservative group and 96.3% in the endovascular group, respectively. The procedure-related complications in the endovascular group included one case of pseudoaneurysm formation in the left brachial artery. During the follow-up period (median 28.5 months), a higher proportion of patients in the conservative group had symptom recurrence (42.9% in the conservative group versus 4.8% in the endovascular group, p < 0.001). Four patients in the conservative group and one patient in the endovascular group had additional endovascular intervention during follow-up. Compared with the conservative group, patients in the endovascular group had statistically significantly longer symptom-free survival ( p = 0.014) and a higher rate of superior mesenteric artery (SMA) remodeling ( p < 0.001). Conclusions: For symptomatic SISMAD, endovascularly treated patients had a lower rate of symptom recurrence and a higher rate of SMA remodeling in the long term. Endovascular treatment should be considered as the first-line treatment of SISMAD.

scholarly journals Long-Term Outcomes of Spontaneous Isolated Superior Mesenteric Artery Dissection

2019 ◽  
Vol 12 (4) ◽  
pp. 456-459
Author(s):  
Hirono Satokawa ◽  
Shinya Takase ◽  
Hiroki Wakamatsu ◽  
Yuki Seto ◽  
Hiroyuki Kurosawa ◽  
...  
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Artery Dissection ◽  
Long Term Outcomes ◽  
Superior Mesenteric Artery Dissection

scholarly journals Long-term Outcomes of Spontaneous Isolated Superior Mesenteric Artery Dissection

2018 ◽  
Vol 58 (10) ◽  
pp. 195-199
Author(s):  
Hirono Satokawa ◽  
Shinya Takase ◽  
Hiroki Wakamatsu ◽  
Yuki Seto ◽  
Hiroyuki Kurosawa ◽  
...  
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Artery Dissection ◽  
Long Term Outcomes ◽  
Superior Mesenteric Artery Dissection

The value of a new image classification system for planning treatment and prognosis of spontaneous isolated superior mesenteric artery dissection

Vascular ◽  
2015 ◽  
Vol 23 (5) ◽  
pp. 504-512 ◽  
Author(s):  
Jiang Xiong ◽  
Zhongyin Wu ◽  
Wei Guo ◽  
Xiaoping Liu ◽  
Lijun Wang ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Superior Mesenteric Artery ◽  
Computed Tomography Angiography ◽  
Mesenteric Artery ◽  
Intestinal Ischemia ◽  
Artery Dissection ◽  
Term Outcome ◽  
Superior Mesenteric Artery Dissection

Objective To aid diagnosis of spontaneous isolated superior mesenteric artery dissection and planning management, we investigated the role of classification of features as observed on computed tomography angiography images. Methods A retrospective study was conducted, comprising computed tomography angiography images and clinical data of 28 consecutive patients with spontaneous isolated superior mesenteric artery dissection. Based on the computed tomography angiography images, a new classification for spontaneous isolated superior mesenteric artery dissection was proposed. Patients with intestinal ischemia not relieved or worsened after 10 days of conservative treatment underwent surgery or stenting. All patients were followed up with computed tomography angiography. Results Spontaneous isolated superior mesenteric artery dissection was categorized into five types (I–V). Type III was further divided into subtypes IIIa–IIIc. Spontaneous isolated superior mesenteric artery dissection IIIa and IV typified nine (32.1%) and seven (25%) patients, respectively. Six (21.4%) patients had aortic or branch artery abnormalities and 21 (78%) showed prior intestinal ischemia. Four (14.3%) patients had intestinal ischemia and underwent surgery or stenting. Conclusions Spontaneous isolated superior mesenteric artery dissection type IIIa is more likely to occur than other types. Long-term computed tomography angiography follow-up is valuable for determining treatment strategy for spontaneous isolated superior mesenteric artery dissection. Conservative therapy with anticoagulants is recommended for five days, and surgery or stenting should be considered if symptoms of intestinal ischemia are not relieved. Stent implantation provides relatively satisfactory mid-term outcome for true lumen construction of the superior mesenteric artery.

scholarly journals Presentation, treatment, and outcomes in patients with spontaneous isolated celiac and superior mesenteric artery dissection

2017 ◽  
Vol 22 (6) ◽  
pp. 505-511 ◽  
Author(s):  
Charles DeCarlo ◽  
Suvranu Ganguli ◽  
Jorge C Borges ◽  
Robert M Schainfeld ◽  
Ari J Mintz ◽  
...  
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Ct Scans ◽  
Artery Dissection ◽  
Rare Clinical Entity ◽  
Arterial Diameter ◽  
Aneurysmal Dilatation ◽  
Appropriate Treatment ◽  
Superior Mesenteric Artery Dissection

Spontaneous isolated celiac or superior mesenteric artery (SMA) dissection (SICMAD) is a rare clinical entity. Not much is known about the natural history and appropriate treatment. We retrospectively queried a prospectively collected institutional radiology database for all patients diagnosed with SICMAD from 1990 to 2017. We identified 42 arteries in 40 patients (83.3% male), mean age 54.8 ± 10.9 years, consisting of 24 celiac arteries and 18 SMA. SMA lesions were longer than celiac lesions (5.15 ± 3.81 vs 2.38 ± 1.40 cm, p = 0.008). Thirty-one patients had follow-up; mean follow-up was 4.9 ± 4.8 years. Morphologic improvement was seen in 20 (48%) arteries. Sakamoto IV lesions were more likely to remodel (OR: 11.26, 95% CI: 1.13, 588.26, p = 0.039), and Sakamoto II lesions less likely to remodel (OR: 0, 95% CI: 0.00, 0.93, p = 0.05). Patients received an average of 2.35 scans during follow-up. Symptom resolution occurred in all symptomatic patients, and 16% of patients had recurrence of symptoms. Follow-up CT scans revealed a stable arterial diameter for the majority of patients. In conclusion, the majority of patients with SICMAD improve with medical therapy alone. Aneurysmal dilatation is uncommon.

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