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Zhang X, Chen J, Qiu C, He Y, Wang B, Zhang H, Wu Z, Chen D. Validation of classification system for isolated superior mesenteric artery dissections using image-based computational flow analysis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 255:108364. [PMID: 39146760 DOI: 10.1016/j.cmpb.2024.108364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 07/25/2024] [Accepted: 08/03/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND AND OBJECTIVE The isolated superior mesenteric artery dissection (ISMAD) is a rare but potentially fatal vascular disorder. Classifications for ISMAD were previously proposed based on morphometric features. However, the classification systems were not standardized and verified yet. This study conducted computational flow analysis to validate the latest classification system of ISMAD and aid clinical decision-making based on hemodynamic parameters. METHODS 62 patients with ISMAD were included and classified into different types according to false lumen structures (five types, Type I-V) and true lumen patency (two types, Type P and Type S) according to Qiu classification system. Computational fluid dynamics and three-dimensional structural analyses were conducted on the basis of computed tomography angiography datasets. Quantitative and qualitative functional analyses were performed via parameters of interest including volume flow of each minute, pressure drop, pressure gradient, the derivative parameters of wall shear stress such as time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), and the relative residence time (RRT). Statistical analyses were conducted among different ISMAD types. RESULTS TAWSS, OSI and RRT showed significant difference among different types when classified using false lumen structures. In detail, Type IV showed significantly higher TAWSS than other types (p = 0.007). OSI was obviously higher in Type II (p = 0.015). Type IV also presented the lowest RRT (p = 0.005). The pressure drop, pressure gradient, OSI and RRT showed higher value in Type S than that in Type P, demonstrating a statistical significance with p values of 0.017, 0.041, 0.001 and 0.012, respectively. While Type P had larger volume flow than Type S (p = 0.041). CONCLUSIONS The notable differences in hemodynamic features among different types demonstrated the feasibility of Qiu classification system. The evaluation based on hemodynamic simulation might also provide insights into risk identification and guide therapeutic decisions for ISMAD.
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Affiliation(s)
- Xuehuan Zhang
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Jiale Chen
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Chenyang Qiu
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou 310000, China
| | - Yangyan He
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou 310000, China
| | - Bing Wang
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou 310000, China
| | - Hongkun Zhang
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou 310000, China
| | - Ziheng Wu
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou 310000, China.
| | - Duanduan Chen
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China
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Ye M, Zhou Q, Wu J, Zhang Z, Li B, Zheng T, Shao G. Conservative Versus Endovascular Treatment for Spontaneous Isolated Superior Mesenteric Artery Dissection: A Clinical and Imaging Follow-up Study. J Endovasc Ther 2024; 31:840-852. [PMID: 37026460 DOI: 10.1177/15266028231163733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
PURPOSE Spontaneous isolated superior mesenteric artery dissection (SISMAD) is a rare vascular disease, the treatment strategies for which remain debated. This retrospective study aimed to compare the outcomes of conservative and endovascular treatments in patients with SISMAD. MATERIALS AND METHODS Fifty-eight patients with SISMAD confirmed by computed tomography angiography admitted to our hospital between November 2017 and May 2021 and received confirmed conservative (n=43) or endovascular (n=15) treatment. The patient demographics, imaging analysis, and follow-up results were analyzed and compared. RESULTS The cohort included 54 males and 4 females with a mean age of 52 years. Abdominal pain was the major complaint (49/58, 84.5%), followed by chest pain (2/58, 3.4%). The mean follow-up was 9.1±7.9 months. The 2 main Sakamoto types were type III (27/58, 46.6%) and type IV (16/58, 27.6%). Most patients in both groups had angle 1 (aortomesenteric angle) and angle 2 (superior mesenteric artery [SMA] course) of over 80°. About 67.3% of patients had long length of dissection (>60 mm). The median distance between the SMA root and the dissection entry site was 1.5 cm, mostly (84.5% of the patients) in the curved segment of the SMA. Telephone follow-ups found that most patients survived pain-free, and none underwent intestinal resection. Only 4 patients, 2 in each group, had recurrent abdominal pain during follow-up and received stenting treatment to achieve complete vascular remodeling. Importantly, we found that the conservative and endovascular therapies achieved similar high remodeling rates (94% and 100%, respectively; p=0.335). The conservative group achieved satisfying vascular remodeling (partial, 35%; complete, 59%), making it as safe and effective a treatment as endovascular therapy. CONCLUSIONS Initial conservative management is safe and effective in patients with SISMAD. A high technical success rate and favorable short-term outcomes were associated with endovascular procedures as secondary interventions. It would be helpful to conduct large-scale, prospective, randomized controlled trials with long-term follow-up for SISMAD. CLINICAL IMPACT 1. This research provided more detail clinical information, such as evaluation of abdominal pain and measurements of SMA angles, which is all relevant to treatment. 2. What's more, the most surprising results of follow-up part shown that conservative treatment could reached the remodeling rate as high as endovascular treatment, which was relatively low in other studies. It helps us share our treatment experience with clinicians. 3. In addition, we get limited knowledge about this rare disease, it's encouraging us to do more researches based on the results we had.
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Affiliation(s)
- Mengmeng Ye
- Ningbo University of Medical School, Ningbo, China
| | - Qingyun Zhou
- Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Jiacheng Wu
- Ningbo University of Medical School, Ningbo, China
| | - Zheng Zhang
- Ningbo University of Medical School, Ningbo, China
| | - Bo Li
- Ningbo University of Medical School, Ningbo, China
| | - Tao Zheng
- Ningbo University of Medical School, Ningbo, China
| | - Guofeng Shao
- Ningbo University of Medical School, Ningbo, China
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Bang JH, Choi JB, Lee BC, Kim DH, Jung HJ. Conservative Treatment in Two Patients With Spontaneous Hepatic Artery Dissection. Vasc Endovascular Surg 2022; 57:60-63. [PMID: 36162935 DOI: 10.1177/15385744221130848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Spontaneous dissection of the hepatic artery is a rare finding for which there is no specific treatment algorithm. Even though endovascular treatment and surgery have been used to treat other visceral artery dissections, these approaches can be challenging in the case of hepatic artery dissection because it is difficult to access the hepatic artery. CASE SUMMARY 2 patients with spontaneous dissection of the hepatic artery were admitted due to epigastric pain. Although the liver function test results were normal, and there were no complications such as bleeding, shock, or ischemia in other organs, a subsequent computed tomography scan directly revealed the spontaneous dissection of the hepatic artery in both patients. The patients were treated with anticoagulants without surgery. Because it is difficult to perform surgery or endovascular treatment on the hepatic artery, we focused on preventing the progression of hepatic artery dissection and the formation of a new thrombus in the dissection. CONCLUSION Considering the risk of surgical treatment for the hepatic artery and the condition of the patients, medical treatment with anticoagulants may be considered as an initial treatment and provide more benefits than surgical treatment.
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Affiliation(s)
- Jun Hyung Bang
- Department of Surgery, Biomedical Research Institute, 220312Pusan National University Hospital, Busan, Korea
| | - Jung Bum Choi
- Department of Surgery, Biomedical Research Institute, 220312Pusan National University Hospital, Busan, Korea
| | - Byoung Chul Lee
- Department of Surgery, Biomedical Research Institute, 220312Pusan National University Hospital, Busan, Korea
| | - Dae Hwan Kim
- Department of Surgery, Biomedical Research Institute, 220312Pusan National University Hospital, Busan, Korea
| | - Hyuk Jae Jung
- Department of Surgery, Biomedical Research Institute, 220312Pusan National University Hospital, Busan, Korea
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Feng Q, Zhao J, Zang L, Chen Y, Li S. A case report of an isolated superior mesenteric artery dissection caused by childbirth. BMC Gastroenterol 2021; 21:428. [PMID: 34774024 PMCID: PMC8590309 DOI: 10.1186/s12876-021-01994-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 10/26/2021] [Indexed: 12/15/2022] Open
Abstract
Background The isolated superior mesenteric artery dissection (SMAD) is a rare and sporadic cause of acute abdominal pain. It most frequently affects male patients in their fifth to sixth decades, while our patient was a young woman who delivered a baby before the onset of abdominal pain. Possible risk factors for SMAD include hypertension, arteriosclerosis, abnormalities in elastic fibres, trauma, and pregnancy. In our case, delivery was suggested as a risk factor, which has not been reported previously. Case presentation A 27-year-old woman complained of acute severe upper abdominal pain and vomiting for 2 days after delivery. The patient had no significant medical history. Physical examination revealed epigastric mild tenderness. All routine blood tests, blood coagulation analysis, liver function tests and abdomen computed tomography showed no remarkable findings. Computed tomography angiography revealed a marked dissection 3.5 cm below the superior mesenteric artery ostium. Since distal blood flow existed and the patient was in a puerperal state with no evidences of mesenteric ischemia, she was managed conservatively, including intestinal rest by fasting, parenteral nutritional support and antibioticis, without anticoagulants or antiplatelet agents. Fortunately, she recovered smoothly and had no recurrence. Conclusions SMAD is a rare and sporadic cause of acute abdominal pain that occurs in young women after delivery.
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Affiliation(s)
- Qian Feng
- Department of Gastroenterology, Liaocheng People's Hospital, Liaocheng, China.
| | - Jingrun Zhao
- Department of Gastroenterology, Liaocheng People's Hospital, Liaocheng, China
| | - Lina Zang
- Department of Gastroenterology, Liaocheng People's Hospital, Liaocheng, China
| | - Yuanyuan Chen
- Department of Gastroenterology, Liaocheng People's Hospital, Liaocheng, China
| | - Senlin Li
- Department of Gastroenterology, Liaocheng People's Hospital, Liaocheng, China
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Detecting isolated superior mesenteric artery dissection with computed tomography. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.826766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ou Yang CM, Yen YT, Chua CH, Wu CC, Chu KE, Hung TI. Spontaneous superior mesenteric artery dissection following upper gastrointestinal panendoscopy: A case report and literature review. World J Clin Cases 2019; 7:3276-3281. [PMID: 31667179 PMCID: PMC6819304 DOI: 10.12998/wjcc.v7.i20.3276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/13/2019] [Accepted: 08/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Complications associated with upper gastrointestinal (UGI) endoscopy are uncommon, and rarely involve those of cardiovascular nature. We report herein a unique case of spontaneous superior mesenteric artery dissection (SMAD) after UGI pandenoscopy.
CASE SUMMARY A 45-year-old man who had previously undergone UGI panendoscopy and colonoscopy during a voluntary health check-up at our facility was admitted to the emergency room (ER) at the same facility due to persistent epigastric pain with radiation to the back. At the ER, the patient did not present notable abnormalities upon physical, conscious, or laboratory examinations apart from mild tenderness in the epigastric abdomen. Acute abdominal aortic dissection was suspected, and abdominal contrast-enhanced computed tomography confirmed SMAD. He was then transferred to the cardiovascular ward and treated conservatively with fasting, prostaglandin E1, and aspirin. The patient recovered and returned home soon after, and was symptom-free 6 months after discharge from the facility.
CONCLUSION SMAD after UGI panendoscopic procedure is a previously unreported complication. Awareness of this complication and associated sequela is warranted.
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Affiliation(s)
- Chih-Ming Ou Yang
- Department of General Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan
| | - Yu-Tong Yen
- Department of Cardiovascular Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan
| | - Chai-Hock Chua
- Department of Cardiovascular Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan
| | - Chin-Chu Wu
- Department of Radiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan
| | - Kuan-En Chu
- Department of Internal Medicine, Division of Gastroenterology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan
| | - Tsung-I Hung
- Department of General Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan
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Nakamura T, Osaka M, Mastuyama T, Harada S, Nakao T, Nobori S, Ushigome H. Isolated Superior Mesenteric Artery Dissection Following Liver Transplant: Report of 3 Cases. Transplant Proc 2019; 51:1502-1505. [PMID: 31155183 DOI: 10.1016/j.transproceed.2019.01.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 01/04/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Isolated superior mesenteric artery (SMA) dissection (SMAD) is considered a relatively rare disease. Especially, isolated SMAD following liver transplant has been rarely reported. REPORT OF CASES Among 96 consecutive adult recipients who underwent liver transplant at our institution, 3 recipients (3.1%) demonstrated isolated noncommunicating SMAD, type IV according to Sakamoto's classification. Patient characteristics are the following: mean age, 53 years (range, 49-60 years); male to female ratio, 2:1, right lobe graft to left lobe graft ratio, 2:1; operating time, 760 minutes (range, 614-880 minutes); and blood loss, 6570 mL (range, 2435-13,329 mL). New onset of abdominal pain was noted in 33.3% (1/3). The diagnosis was made by the first follow-up computed tomography scan after liver transplant. The mean distance between the proximal end of SMAD and the root of SMA was 21.3 mm (range, 9-40 mm). There were no signs of ischemic changes in the small intestine in any of the 3 patients. Thus, conservative managements such as anticoagulation therapy were performed without other aggressive interventions. One patient died because of subarachnoid hemorrhage. In the other 2 patients, SMAD disappeared at 6 months following the diagnosis. DISCUSSION The morbidity of isolated SMAD is around less than 0.1% at the autopsy. Compared with this result, we found significantly higher morbidity rate in liver transplant recipients. It is true that mechanical stress from retraction of the stomach to the caudal end including the root of SMA may play an important role in the onset of SMA dissection. CONCLUSION Isolated SMA dissection following living donor liver transplant is a rare but potentially life-threatening condition. It is required to ascertain whether emergency revascularization should be considered.
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Affiliation(s)
- T Nakamura
- Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto-prefecture, Japan.
| | - M Osaka
- Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto-prefecture, Japan
| | - T Mastuyama
- Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto-prefecture, Japan
| | - S Harada
- Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto-prefecture, Japan
| | - T Nakao
- Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto-prefecture, Japan
| | - S Nobori
- Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto-prefecture, Japan
| | - H Ushigome
- Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto-prefecture, Japan
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Clinical and CT Angiographic Follow-Up Outcome of Spontaneous Isolated Intramural Hematoma of the Superior Mesenteric Artery. Cardiovasc Intervent Radiol 2019; 42:1088-1094. [PMID: 30949761 DOI: 10.1007/s00270-019-02212-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 03/26/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the clinical course and vascular remodeling of spontaneous isolated intramural hematoma of the superior mesenteric artery (SIHSMA) after treatment. METHODS In this retrospective study, 24 consecutive patients with SIHSMA admitted from January 2009 through December 2016 were included in this study. The clinical characteristics, type and location of the dissection, clinical outcome and vascular remodeling were analyzed retrospectively. RESULTS The subjects included 21 men and three women, with a mean age of 50.58 years. The chief complaint was abdominal pain in all patients. The mean follow-up was 10.08 months. Among the 24 patients examined, two patients (8.33%) showed no obvious changes in the CT. Twenty patients were treated by conservative strategy. One case underwent exploratory laparotomy along with embolectomy and arteriotomy. Another three cases received angioplasty and stent implanting. Complete and partial remodeling was observed in 15 (62.5%) and four patients (16.67%). Three (12.5%) of the lesions had dissection remodeling and aneurysm change. CONCLUSIONS SIHSMA represented variable vascular remodeling, while most of the patient got a complete resolution during follow-up, and its clinical course was benign in this study. Vast majority of patients can be managed conservatively when there are no signs indicating organ ischemia.
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Ullah W, Mukhtar M, Abdullah HM, Ur Rashid M, Ahmad A, Hurairah A, Sarwar U, Figueredo VM. Diagnosis and Management of Isolated Superior Mesenteric Artery Dissection: A Systematic Review and Meta-Analysis. Korean Circ J 2019; 49:400-418. [PMID: 31074212 PMCID: PMC6511528 DOI: 10.4070/kcj.2018.0429] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/11/2019] [Accepted: 03/13/2019] [Indexed: 12/17/2022] Open
Abstract
The objective of this study was to analyze the three different management modalities for isolated superior mesenteric artery (SMA) dissection. We did a comprehensive literature search and found 703 articles on the initial search, out of which 111 articles consisting of 145 patients were selected for analysis. The mean age was 55.7 years (standard deviation,9.7;33-85) and 80.6% were male. These patients were managed conservatively (41.3%), endovascularly (28.1%) or surgically (30%). The median follow-up was 10 months (interquartile range [IQR], 4-18 months), 12 months (IQR, 6-19 months) and 14 months (IQR, 6-20 months) respectively. Contrast-enhanced computed tomography (CT) was the most commonly used diagnostic tool in the conservative group (43.8%), while conventional CT scan was the most widely used in endovascular (58.1%) and surgical group (50%). 17% percent of the conservative group had SMA angiography for diagnosis, while this was less than 3% in the other groups. Of these patients, 96.7%, 97.4%, and 100.0% recovered successfully in the conservative, endovascular, and surgical groups respectively. There was no significant difference in the mortality between the three groups (Pearson χ²=0.482). This suggests a conservative and endovascular approach could be used in most patients, which can reduce costs and surgery-related morbidity and mortality. Surgical management should be reserved for cases having infarction or widespread bowel ischemia and in cases where other treatment modalities fail.
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Affiliation(s)
- Waqas Ullah
- Department of Internal Medicine, Abington Hospital - Jefferson Health, Abington, PA, USA.
| | - Maryam Mukhtar
- Department of Internal Medicine, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Hafez Mohammad Abdullah
- Department of Internal Medicine, University of South Dakota Sanford School of Medicine, SD, USA
| | - Mamoon Ur Rashid
- Department of Internal Medicine, Florida Hospital Orlando, Orlando, FL, USA
| | - Asrar Ahmad
- Department of Internal Medicine, Abington Hospital - Jefferson Health, Abington, PA, USA
| | - Abu Hurairah
- Department of Gastroenterology, Advent Health Orlando, FL, USA
| | - Usman Sarwar
- Department of Internal Medicine, Abington Hospital - Jefferson Health, Abington, PA, USA
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Salt Ö, Sayhan MB, Duyar E. Isolated superior mesenteric artery dissection in the emergency department: A rare cause of abdominal pain. Am J Emerg Med 2018; 36:2341.e1-2341.e2. [DOI: 10.1016/j.ajem.2018.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/04/2018] [Accepted: 09/18/2018] [Indexed: 10/28/2022] Open
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Tsai DY, Tseng HS, Chen JM, Phan WL, Wang JY, Chao CL. Staged Endovascular Intervention with Ultrasound-Assisted Thrombolysis and Stent Placement for Spontaneous Isolated Superior Mesenteric Artery Dissection with Total Thrombotic Occlusion. ACTA CARDIOLOGICA SINICA 2018; 34:533-538. [PMID: 30449996 DOI: 10.6515/acs.201811_34(6).20180529a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | | | - Jian-Ming Chen
- Department of Cardiothoracic Surgery, Cardinal Tien Hospital, Fu-Jen Catholic University, New Taipei City
| | | | | | - Chia-Lun Chao
- Department of Internal Medicine.,Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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Ullrich LA, Streiff W, Mariner DR, Song B, Obmann MA, Nikam SD. Non-operative management of isolated spontaneous superior mesenteric artery dissection. J Surg Case Rep 2018; 2018:rjy274. [PMID: 30397433 PMCID: PMC6207843 DOI: 10.1093/jscr/rjy274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/27/2018] [Indexed: 11/14/2022] Open
Abstract
Isolated spontaneous superior mesenteric artery (SMA) dissection is a rare differential for patients presenting with abdominal pain. Due to limited cases reported, management strategies have been poorly defined. We present the case of a 49-year-old male with history of hypertension and ischemic colitis, presenting with abdominal pain. CT imaging demonstrated a thrombosed dissection of the SMA extending into second and third order braches. He was managed conservatively with therapeutic anticoagulation. His symptoms improved and upon discharge he was transitioned to aspirin and warfarin. Repeat CT imaging continued to show the dissection with resolution of the SMA thrombus. Spontaneous SMA dissection is exceedingly rare with no universally agreed upon standard of care for treatment. Operative intervention should be reserved for failed conservative management or vascular compromise. Understanding the current treatment options helps ensure a favorable patient outcome.
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Affiliation(s)
- Lauryn A Ullrich
- General Surgery, Geisinger Wyoming Valley Hospital, Wilkes-Barre, PA, USA
| | - William Streiff
- General Surgery, Geisinger Wyoming Valley Hospital, Wilkes-Barre, PA, USA
| | - David R Mariner
- Vascular Surgery, Geisinger Wyoming Valley Hospital, Wilkes-Barre, PA, USA
| | - Boyoung Song
- Vascular Surgery, Geisinger Wyoming Valley Hospital, Wilkes-Barre, PA, USA
| | - Melissa A Obmann
- Vascular Surgery, Geisinger Wyoming Valley Hospital, Wilkes-Barre, PA, USA
| | - Shivprasad D Nikam
- Vascular Surgery, Geisinger Wyoming Valley Hospital, Wilkes-Barre, PA, USA
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13
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Zhu Y, Peng Y, Xu M, Wei Y, Wu S, Guo W, Wu Z, Xiong J. Treatment Strategies and Outcomes of Symptomatic Spontaneous Isolated Superior Mesenteric Artery Dissection: A Systematic Review and Meta-analysis. J Endovasc Ther 2018; 25:640-648. [PMID: 30153774 DOI: 10.1177/1526602818796537] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose: To analyze the published treatment experience with symptomatic spontaneous isolated superior mesenteric artery dissection (SISMAD). Methods: A literature search of the PubMed and Cochrane databases was conducted for articles on symptomatic SISMAD published in English from January 2007 to January 2018. Case series reporting on both treatment modalities and outcomes were included, while those on traumatic or iatrogenic SMA dissection or SMA dissection accompanied by aortic or other visceral artery dissection were excluded. Overall event rates for treated symptomatic SISMAD were calculated using pooled analyses. The rate of initial conservative treatment, the success rate, the rate of conversion to intervention, and the failure rate in patients with vs without antithrombotic therapy were calculated for each study and compared using a meta-analysis of proportions. Results: The 25 articles selected encompassed 616 SISMAD cases, of which 514 were symptomatic cases eligible for the analysis. Among the latter, initial treatment consisted of conservative therapy in 447 (87.0%) patients and surgical interventions in 67 (13.0%) patients [45 (8.7%) endovascular procedures and 22 (4.3%) open surgeries]. Among conservative cases, 238 (53.2%) received antithrombotic therapy while 172 (38.5%) did not; 50 (11.2%) cases were converted to intervention [42 (84%) endovascular]. Conservative treatment was initially used in 85.2% of pooled cases with an 84.7% success rate, a 14.3% rate of conversion to intervention, and conservative treatment failure rates of 17.8% and 10.1% in patients treated with vs without antithrombotic therapy, respectively (p=0.103). Conclusion: Conservative treatment appeared safe and effective in >80% of symptomatic SISMAD cases, without apparent benefit for antithrombotic agent use. Initial or secondary intervention was more often endovascular, with favorable success rates and short-term outcomes. Large, prospective randomized trials with long-term follow-up are warranted on the treatment for symptomatic SISMAD.
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Affiliation(s)
- Yating Zhu
- Department of General Surgery & Vascular Surgery, Chinese PLA General Hospital Hainan Branch, Sanya, China
| | - Yanghong Peng
- Department of Radiology, Chinese PLA the 309th Hospital, Beijing, China
| | - Mingyue Xu
- Department of General Surgery & Vascular Surgery, Chinese PLA General Hospital Hainan Branch, Sanya, China
| | - Yingqi Wei
- Beijing Center for Diseases Prevention and Control, Beijing, China
| | - Shanshan Wu
- National Clinical Research Center of Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wei Guo
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Zhongyin Wu
- Department of Vascular Surgery, Affiliated Hospital of Chengde Medical College, Chengde, China
| | - Jiang Xiong
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, China
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14
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Barnes S, Kushner B. Isolated Dissection of the Superior Mesenteric Artery. Clin Pract Cases Emerg Med 2018; 2:43-46. [PMID: 29849290 PMCID: PMC5965138 DOI: 10.5811/cpcem.2017.7.34224] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/28/2017] [Accepted: 07/11/2017] [Indexed: 11/24/2022] Open
Abstract
Isolated dissection of the superior mesenteric artery is a novel disease often presenting with vague signs and symptoms. Although the disease entity is rare, the potential for morbidity and mortality is high. This is a case report of a healthy 58-year-old male presenting with diffuse persistent abdominal pain. Diagnosed on computed tomography, this patient’s condition was managed conservatively with anticoagulants.
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Affiliation(s)
- Stacey Barnes
- St. Joseph's Regional Medical Center, Department of Emergency Medicine, Paterson, New Jersey
| | - Beth Kushner
- St. Joseph's Regional Medical Center, Department of Emergency Medicine, Paterson, New Jersey
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15
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Yu Z, Kondo N, Chiyoya M, Suzuki Y, Fukuda I. Selection and Determination of Treatment for the Spontaneous Isolated Dissection of the Superior Mesenteric Artery. Ann Vasc Dis 2018; 11:101-105. [PMID: 29682115 PMCID: PMC5882352 DOI: 10.3400/avd.oa.17-00120] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective: This study aimed to clarify the selection and determination of appropriate treatment for acute symptomatic spontaneous isolated dissection of the superior mesenteric artery (SIDSMA). Methods: Data from 10 consecutive patients, who were diagnosed with symptomatic SIDSMA using computed tomography angiography and were managed in our hospital from January 2010 to October 2015, were retrospectively collected and analyzed. Results: There were nine males and one female; mean patient age was 50.3 (range, 35-64) years. All patients experienced acute abdominal pain, and three patients experienced concomitant vomiting. Only one patient exhibited symptoms of suspected peritonitis and intestinal ischemia. Three patients showed improved abdominal pain before admission to our hospital. One patient experienced severe abdominal pain that could not be managed using morphine; he underwent right external iliac to superior mesenteric artery bypass with a great saphenous vein graft. No patient presented with intestinal necrosis. All patients survived, and no patient developed complications during the follow-up period of up to 42 (24.5±16.5) months. Conclusion: Conservative management appears to be the most feasible treatment for SIDSMA. However, open surgery can be performed in patients presenting with any symptoms of intestinal ischemia.
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Affiliation(s)
- Zaiqiang Yu
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Norihiro Kondo
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Mari Chiyoya
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Yasuyuki Suzuki
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Ikuo Fukuda
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
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16
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DeCarlo C, Ganguli S, Borges JC, Schainfeld RM, Mintz AJ, Mintz J, Jaff MR, Weinberg I. Presentation, treatment, and outcomes in patients with spontaneous isolated celiac and superior mesenteric artery dissection. Vasc Med 2017; 22:505-511. [DOI: 10.1177/1358863x17729770] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
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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Affiliation(s)
- Charles DeCarlo
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Suvranu Ganguli
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jorge C Borges
- Paul and Phyllis Fireman Vascular Center, Massachusetts General Hospital, Boston, MA, USA
| | - Robert M Schainfeld
- Paul and Phyllis Fireman Vascular Center, Massachusetts General Hospital, Boston, MA, USA
| | - Ari J Mintz
- The Landsman Heart & Vascular Center, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Jessica Mintz
- The Landsman Heart & Vascular Center, Lahey Hospital and Medical Center, Burlington, MA, USA
| | | | - Ido Weinberg
- Paul and Phyllis Fireman Vascular Center, Massachusetts General Hospital, Boston, MA, USA
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17
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Jia Z, Tu J, Jiang G. The Classification and Management Strategy of Spontaneous Isolated Superior Mesenteric Artery Dissection. Korean Circ J 2017; 47:425-431. [PMID: 28765730 PMCID: PMC5537140 DOI: 10.4070/kcj.2016.0237] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/23/2016] [Accepted: 11/11/2016] [Indexed: 12/26/2022] Open
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.
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Affiliation(s)
- Zhongzhi Jia
- Department of Interventional Radiography, No. 2 People's Hospital of Changzhou, Nanjing Medical University, Chang zhou, China
| | - Jianfei Tu
- Department of Radiology and Interventional Radiology, Lishui Central Hospital, Lishui, China
| | - Guomin Jiang
- Department of Interventional Radiography, No. 2 People's Hospital of Changzhou, Nanjing Medical University, Chang zhou, China
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18
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Funahashi H, Shinagawa N, Saitoh T, Takeda Y, Iwai A. Conservative treatment for isolated dissection of the superior mesenteric artery: Report of two cases. Int J Surg Case Rep 2016; 26:17-20. [PMID: 27429179 PMCID: PMC4954935 DOI: 10.1016/j.ijscr.2016.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/01/2016] [Accepted: 07/05/2016] [Indexed: 11/30/2022] Open
Abstract
Isolated spontaneous dissection of the superior mesenteric artery is very rare condition. Imaging studies are effective for diagnosis. Common treatment strategy consists of three methods as follows; conservative therapy, endovascular treatment, and surgery. The etiology and the best treatment have not been established yet. Introduction Isolated spontaneous dissection of the superior mesenteric artery (SMA) is rare and a treatment strategy has not been established yet. In this paper, we present our experience with two cases and review the literature. Presentation of case Both cases were treated conservatively as they did not show signs of bowel ischemia. They were symptom free with no evidence of disease progression after a median follow-up of 3.5 years. Discussion There are three methods for the treatment of isolated SMA dissection; observation with medical therapy, endovascular surgery, and open surgery. Most patients with isolated SMA dissection can be treated with observation alone. Although the indications for surgery are still controversial, patients with bowel ischemia should undergo invasive treatment in the form of either endovascular or open surgery. Conclusion We recommend observation with medical therapy as the first choice for isolated SMA dissection. However, long term follow-up is necessary as the extent of the dissection may change over time.
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Affiliation(s)
- Hitoshi Funahashi
- Division of Surgery, JA Mie Komono Public Welfare Hospital, 75 Fukumura, Komono-cho, Mie 5101234, Japan.
| | - Naoya Shinagawa
- Division of Surgery, JA Mie Komono Public Welfare Hospital, 75 Fukumura, Komono-cho, Mie 5101234, Japan.
| | - Takaaki Saitoh
- Division of Surgery, JA Mie Komono Public Welfare Hospital, 75 Fukumura, Komono-cho, Mie 5101234, Japan.
| | - Yoshihide Takeda
- Division of Surgery, JA Mie Komono Public Welfare Hospital, 75 Fukumura, Komono-cho, Mie 5101234, Japan.
| | - Akihiko Iwai
- Division of Surgery, JA Mie Komono Public Welfare Hospital, 75 Fukumura, Komono-cho, Mie 5101234, Japan.
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19
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Kim YW. Current Understandings of Spontaneous Isolated Superior Mesenteric Artery Dissection. Vasc Specialist Int 2016; 32:37-43. [PMID: 27386450 PMCID: PMC4928602 DOI: 10.5758/vsi.2016.32.2.37] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 03/11/2016] [Indexed: 01/19/2023] Open
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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Affiliation(s)
- Young-Wook Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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20
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Chen ZL, Zhang XC, Pan GR, Sun Y, Xu M, Li XQ. Clinical Features and Therapeutic Options for Isolated Visceral Artery Dissection. Ann Vasc Surg 2016; 30:227-35. [DOI: 10.1016/j.avsg.2015.07.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 07/09/2015] [Accepted: 07/22/2015] [Indexed: 01/20/2023]
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21
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Tomita K, Obara H, Sekimoto Y, Matsubara K, Watada S, Fujimura N, Shibutani S, Nagasaki K, Hayashi S, Harada H, Asami A, Uchida N, Kakefuda T, Kitagawa Y. Evolution of Computed Tomographic Characteristics of Spontaneous Isolated Superior Mesenteric Artery Dissection During Conservative Management. Circ J 2016; 80:1452-9. [DOI: 10.1253/circj.cj-15-1369] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Koichi Tomita
- Department of Surgery, Keio University School of Medicine
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine
| | | | | | | | - Naoki Fujimura
- Department of Surgery, Keio University School of Medicine
| | - Shintaro Shibutani
- Department of Surgery (Vascular Surgery), Saiseikai Yokohamashi Tobu Hospital
| | | | - Shinobu Hayashi
- Department of Surgery (Vascular Surgery), Saiseikai Yokohamashi Tobu Hospital
| | - Hirohisa Harada
- Department of Surgery, Tokyo Dental College Ichikawa General Hospital
| | | | | | | | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine
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22
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Lee SI, Kim JJ, Yang HJ, Lee K. Spontaneous dissection of celiac trunk with concurrent splenic artery dissection. Clin Exp Emerg Med 2015; 2:256-259. [PMID: 27752606 PMCID: PMC5052905 DOI: 10.15441/ceem.15.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 08/21/2015] [Accepted: 08/22/2015] [Indexed: 11/23/2022] Open
Abstract
Isolated spontaneous dissection of the celiac trunk is rarely diagnosed in acute abdominal pain. We present two cases of celiac trunk and splenic artery dissection with splenic infarction. Patients were successfully managed and stabilized by medical treatment. Isolated celiac trunk dissection can be fatal, therefore providers should be careful not to overlook this entity.
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Affiliation(s)
- Seo In Lee
- Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Jin Joo Kim
- Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Hyuk Jun Yang
- Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Keun Lee
- Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon, Korea
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23
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Successful endovascular treatment of delayed arterial rupture from celiac artery dissection in a patient with type IV Ehlers-Danlos syndrome. Diagn Interv Imaging 2015; 97:261-3. [PMID: 26471911 DOI: 10.1016/j.diii.2015.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 08/14/2015] [Accepted: 08/28/2015] [Indexed: 11/21/2022]
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24
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Takahashi B, Nakayama Y, Shiroma S, Ido K. Three Case Report of Spontaneous Isolated Dissection of the Superior Mesenteric Artery-With an Algorithm Proposed for the Management. Ann Vasc Dis 2015; 8:120-3. [PMID: 26131035 DOI: 10.3400/avd.cr.15-00013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 04/12/2015] [Indexed: 12/18/2022] Open
Abstract
Spontaneous isolated dissection of the superior mesenteric artery (SID-SMA) is a rare condition, and there is still no consensus on optimal management. Here, we present three cases of SID-SMA, that were treated by surgical revascularization with urgent iliomesenteric bypass surgery without intestine resection, endovascular therapy with stent placement, and conservative management. The purpose of this study is to review these three cases and propose an algorithm for optimal management of SID-SMA.
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Affiliation(s)
- Baku Takahashi
- Department of Cardiovascular Surgery, Osumikanoya Hospital, Kanoya, Kagoshima, Japan
| | - Yoshihiro Nakayama
- Department of Cardiovascular Surgery, Osumikanoya Hospital, Kanoya, Kagoshima, Japan
| | - Shinyu Shiroma
- Department of General Surgery, Osumikanoya Hospital, Kanoya, Kagoshima, Japan
| | - Koki Ido
- Department of General Surgery, Osumikanoya Hospital, Kanoya, Kagoshima, Japan
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25
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Three cases of spontaneous isolated dissection of the superior mesenteric artery. J Emerg Med 2015; 48:e111-6. [PMID: 25641410 DOI: 10.1016/j.jemermed.2014.12.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 11/11/2014] [Accepted: 12/21/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Spontaneous isolated superior mesenteric artery dissection is a rare disease that may cause bowel ischemia or aneurysm rupture and subsequent death. Thus, the establishment of a correct diagnosis in the early stage is quite important. OBJECTIVE To describe the presentation of 3 patients diagnosed with spontaneous isolated supramesenteric artery dissection and briefly summarize the diagnostic procedure, treatment, and clinical course. CASE REPORTS We experienced three cases of isolated mesenteric artery dissection in the past 5 years. A definitive diagnosis was obtained by abdominal spiral computed tomography in two cases and angiography in one case. All patients were provided anticoagulation therapy. CONCLUSION One patient died of bowel ischemia, 2 were discharged within 21 days without complications, and one was able to discontinue anticoagulation therapy 12 months after discharge. The remaining patient has continued warfarin, making it difficult to determine the end point of anticoagulation.
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26
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Ko SH, Hye R, Frankel DA. Management of spontaneous isolated visceral artery dissection. Ann Vasc Surg 2015; 29:470-4. [PMID: 25595112 DOI: 10.1016/j.avsg.2014.10.026] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 10/08/2014] [Accepted: 10/28/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Spontaneous isolated dissection of the celiac artery (CA) or the superior mesenteric artery (SMA) is rare but increasingly recognized because of widespread use of advanced abdominal imaging technology. Indications for specific therapeutic options and long-term outcomes are not well defined. This study analyzed clinical features, management strategies, and outcomes for patients with spontaneous visceral artery dissections. METHODS Medical records of all patients diagnosed with CA or SMA dissections at 2 institutions (Scripps Green Hospital and San Diego Kaiser Medical Center) between January 2005 and January 2014 were retrospectively reviewed. Patient demographics included age, symptoms, associated comorbidities, and type of intervention. Anatomic features including length of dissection and entry point were measured. Efficacy of the various treatments was compared on the basis of symptom resolution and clinical course. RESULTS Over an 8-year period, 23 patients with a diagnosis of visceral artery dissection were identified. Eighteen (78%) patients were men. Most patients (78%) were symptomatic on initial presentation with abdominal or back pain. Treatment included observation in 4, anticoagulation in 13, and endovascular stenting in 6 patients. The mean follow-up was 23.8 months. No patient required bowel resection. Twenty of twenty-three patients reported resolution of symptoms at follow-up. CONCLUSIONS In this series, all patients with isolated visceral artery dissection had favorable outcomes, with no significant morbidity or mortality. Conservative management with anticoagulation is recommended as the first-line therapy. When conservative management fails, endovascular therapy is the treatment of choice.
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Affiliation(s)
- Sae Hee Ko
- University of California at San Diego Health Center, San Diego, CA.
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27
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Alcantara S, Yang CK, Sasson J, Goss S, Benvenisty A, Todd G, Lantis J. The Evidence for Nonoperative Management of Visceral Artery Dissections: A Single-Center Experience. Ann Vasc Surg 2015; 29:103-8. [DOI: 10.1016/j.avsg.2014.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 08/28/2014] [Accepted: 09/08/2014] [Indexed: 10/24/2022]
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28
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Lv PH, Zhang XC, Wang LF, Chen ZL, Shi HB. Management of isolated superior mesenteric artery dissection. World J Gastroenterol 2014; 20:17179-17184. [PMID: 25493033 PMCID: PMC4258589 DOI: 10.3748/wjg.v20.i45.17179] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 07/20/2014] [Accepted: 09/30/2014] [Indexed: 02/06/2023] Open
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.
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29
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Lü PH, Zhang XC, Wang LF, Shi HB. Percutaneous Endovascular Reconstruction With Bare Stent Implantation for Isolated Superior Mesenteric Artery Dissection. Vasc Endovascular Surg 2014; 48:406-11. [PMID: 25232023 DOI: 10.1177/1538574414543275] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Spontaneous isolated superior mesenteric artery dissection (ISMAD) is exceedingly rare. The therapeutic options range from observation to medical treatment to surgery or endovascular repair. We present our experience of the clinical management of ISMADs. Methods: Sixteen patients with ISMAD from January 2008 to July 2012 were retrospectively analyzed. The decision to intervene was based on anatomic suitability, patient comorbidities, and symptoms. Percutaneous endovascular reconstruction with bare stents was carried out in 7 patients in this study, for patients with persistent abdominal pain despite conservative treatment or signs of bowel ischemia. The patients were kept on antiplatelet therapy from 6 to 10 months postoperatively. Results: All attempted bare stent placements were successfully accomplished without any treatment-related complication. Of the 7 patients with ISMADs, 4 were treated by single stents, 2 by double overlapping stents, and 1 by triple overlapping stents. The abdominal pain alleviated after procedure and disappeared gradually within 3 days. None of the patients had ISMAD symptoms during follow-up (median, 21.7 months; range, 11-32 months). Follow-up computed tomography (CT) and CT angiography revealed patent stent and patent superior mesenteric artery (SMA) branches with complete obliteration of the dissection. Conclusion: Isolated SMA dissection may be managed successfully in a variety of ways based on the clinical symptoms. In this small series, percutaneous endovascular reconstruction with bare stent implantation is a feasible treatment choice with a high success rate and good clinical outcome.
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Affiliation(s)
- Peng-Hua Lü
- Department of Radiology, First Hospital Affiliated to Nanjing Medical University, Nanjing, China
- Department of Interventional Radiology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Xi-Cheng Zhang
- Department of Vascular Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Li-Fu Wang
- Department of Interventional Radiology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Hai-Bin Shi
- Department of Radiology, First Hospital Affiliated to Nanjing Medical University, Nanjing, China
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30
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Satokawa H, Takase S, Seto Y, Yokoyama H, Gotoh M, Kogure M, Midorikawa H, Saito T, Maehara K. Management strategy of isolated spontaneous dissection of the superior mesenteric artery. Ann Vasc Dis 2014; 7:232-8. [PMID: 25298823 DOI: 10.3400/avd.oa.14-00071] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 06/11/2014] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Isolated spontaneous dissection of the superior mesenteric artery (SMA) is very rare among of the visceral artery dissection and its treatment is not established. In this paper we present our experiences and consider the treatment of isolated SMA dissection. METHODS A retrospective review of our cases from 2005 was performed. Clinical symptoms, radiologic findings and results were evaluated. There were 14 cases of visceral artery dissection, in which all cases were with SMA dissection. There were 12 males and 2 females with a mean age of 57 years (range 41-78 years). RESULTS We categorized SMA dissection into the six types according to the Sakamoto's and Zerbib's classification. One patient with type VI underwent emergent endovascular surgery with stent. One patient with type VI received thrombectomy and intimectomy with open surgery. One patient with type II underwent aneurysmectomy due to enlarged dissected SMA 3 months later from onset. The other eleven patients were managed conservatively. At follow-up, the diameter of SMA did not enlarged and the length of the dissection significantly decreased to 20.7 ± 15.7 mm from 38.0 ± 15.1 mm at onset (p <0.01). After treatment, imaging indicated the following changes in classification: type I, one patient; type II, 4 patients; type IV, 4 patients; complete remodeling, one patient, all without any event during the follow-up period of 5-82 months. CONCLUSION Most patients with isolated visceral artery dissection occurred in superior mesenteric artery and can be treated conservatively; however, endovascular or surgical procedures including laparotomy are indicated when there is suspicion of severe mesenteric ischemia. Because the dissection configuration will change, long term follow-up is necessary. (English translation of Jpn J Vasc Surg 2013; 22: 695-701).
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Affiliation(s)
- Hirono Satokawa
- Department of Cardiovascular Surgery, Fukushima Medical University, School of Medicine, Fukushima, Fukushima, Japan
| | - Shinya Takase
- Department of Cardiovascular Surgery, Fukushima Medical University, School of Medicine, Fukushima, Fukushima, Japan
| | - Yuki Seto
- Department of Cardiovascular Surgery, Fukushima Medical University, School of Medicine, Fukushima, Fukushima, Japan
| | - Hitoshi Yokoyama
- Department of Cardiovascular Surgery, Fukushima Medical University, School of Medicine, Fukushima, Fukushima, Japan
| | - Mitsukazu Gotoh
- Department of 1st Surgery, Fukushima Medical University, School of Medicine, Fukushima, Fukushima, Japan
| | - Michihiko Kogure
- Department of 1st Surgery, Fukushima Medical University, School of Medicine, Fukushima, Fukushima, Japan
| | - Hirofumi Midorikawa
- Department of Cardiovascular Surgery, Minami Tohoku General Hospital, Kooriyama, Fukushima, Japan
| | - Tomiyoshi Saito
- Department of Circulatory Internal Medicine, Shirakawa Kosei General Hospital, Shirakawa, Fukushima, Japan
| | - Kazuhira Maehara
- Department of Circulatory Internal Medicine, Shirakawa Kosei General Hospital, Shirakawa, Fukushima, Japan
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31
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Options for treatment of spontaneous mesenteric artery dissection. J Vasc Surg 2014; 59:1433-9.e1-2. [DOI: 10.1016/j.jvs.2014.01.040] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 01/10/2014] [Accepted: 01/19/2014] [Indexed: 01/17/2023]
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32
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Go J, Park J, Roh YN. Clinical Experience of Symptomatic Spontaneous Isolated Splanchnic Artery Dissection. Vasc Specialist Int 2013. [DOI: 10.5758/kjves.2013.29.4.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jin Go
- Department of Surgery, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jehoon Park
- Department of Surgery, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Young-Nam Roh
- Department of Surgery, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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33
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Li N, Lu QS, Zhou J, Bao JM, Zhao ZQ, Jing ZP. Endovascular stent placement for treatment of spontaneous isolated dissection of the superior mesenteric artery. Ann Vasc Surg 2013; 28:445-51. [PMID: 24070572 DOI: 10.1016/j.avsg.2013.01.028] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 01/08/2013] [Accepted: 01/10/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) is a rare condition often associated with a poor prognosis. The goal of this study is to assess the efficacy of endovascular treatment of SIDSMA with stenting and investigate the possible therapeutic mechanisms involved. METHODS This is a retrospective review of all patients undergoing endovascular treatment of SIDSMA from January 2009 to December 2011. Patient demographics, history, clinical presentation, laboratory tests, image characteristics, endovascular treatments, and follow-up outcome were analyzed. RESULTS Twenty-four patients with symptoms were treated. All except 1 patient (23 of 24, 96%) underwent successful stent placement (16 with single stent and 7 with overlapping stents). A total of 30 stents (4 balloon-expanded and 26 self-expanding) were placed during the procedures. In the perioperative period and during follow-up, symptom relief was achieved in 20 (83%) patients, and abdominal pain remained unchanged in 4 (17%). No death or serious complications occurred. The median length of hospital stay and follow-up was 3.25 ± 2.23 days (range 2-7 days) and 13.15 ± 8.27 months (range 6-23 months), respectively. Computed tomography angiography (CTA) performed 6 months postoperatively revealed stent patency in 23 cases (100%), false lumen patency in 5 cases (22%), and new development of dissection in the SMA distal to the stent in 1 case (4%). No significant differences were observed in the incidence of false lumen patency between patients treated with a single stent and those treated with overlapping stents, and between patients with and without symptom relief (P > 0.05 for both). CONCLUSIONS For symptomatic SIDSMA patients without intra-abdominal hemorrhage and intestinal infarction, endovascular stent placement is a feasible treatment choice with a high success rate and good clinical outcome. Overlapping stenting may be proposed for patients with aneurysmal dilation. False lumen patency may occur in some cases during follow-up, but it does not affect improvement of SIDSMA symptoms.
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Affiliation(s)
- Nan Li
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Qing-Sheng Lu
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jian Zhou
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jun-Min Bao
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhi-Qing Zhao
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zai-Ping Jing
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
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Vasodilator and endovascular therapy for isolated superior mesenteric artery dissection. J Vasc Surg 2013; 57:1612-20. [DOI: 10.1016/j.jvs.2012.11.121] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 11/27/2012] [Accepted: 11/27/2012] [Indexed: 11/22/2022]
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35
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Jia Z, Zhao J, Tian F, Li S, Wang K, Wang Y, Jiang L, Jiang G. Initial and Middle-term Results of Treatment for Symptomatic Spontaneous Isolated Dissection of Superior Mesenteric Artery. Eur J Vasc Endovasc Surg 2013; 45:502-8. [DOI: 10.1016/j.ejvs.2013.01.039] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Accepted: 01/28/2013] [Indexed: 10/27/2022]
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36
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Galastri FL, Nasser F, Affonso BB, Amorim JED, Travassos FB. Dissecção espontânea do tronco celíaco: qual a melhor abordagem terapêutica? J Vasc Bras 2013. [DOI: 10.1590/s1677-54492013000100014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A dissecção espontânea das artérias viscerais é um evento relativamente raro. Dor abdominal súbita no epigástrio é o sintoma mais frequentemente manifestado pelos pacientes. O avanço das técnicas de exames de imagem possibilitou o diagnóstico deste evento com maior facilidade, aumentando a incidência das dissecções das artérias viscerais. O tratamento clínico conservador, a revascularização cirúrgica, e a terapia endovascular são as três possíveis opções terapêuticas. Neste artigo, relatamos os casos de dois pacientes com dissecção espontânea do tronco celíaco conduzidos de formas diversas, de acordo com a apresentação clínica e exames de imagem, além de realizar uma revisão bibliográfica sobre esta doença.
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Affiliation(s)
| | - Felipe Nasser
- Universidade de São Paulo; Hospital Israelita Albert Einstein, Brasil
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37
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Pang P, Jiang Z, Huang M, Zhou B, Zhu K, Shan H. Value of endovascular stent placement for symptomatic spontaneous isolated superior mesenteric artery dissection. Eur J Radiol 2013; 82:490-6. [DOI: 10.1016/j.ejrad.2012.09.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 09/11/2012] [Accepted: 09/16/2012] [Indexed: 11/28/2022]
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38
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Dong Z, Fu W, Chen B, Guo D, Xu X, Wang Y. Treatment of symptomatic isolated dissection of superior mesenteric artery. J Vasc Surg 2013; 57:69S-76S. [DOI: 10.1016/j.jvs.2012.07.060] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 06/28/2012] [Accepted: 07/05/2012] [Indexed: 10/27/2022]
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39
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Spontaneous Dissection of the Splanchnic Arteries: CT Findings, Treatment, and Outcome. AJR Am J Roentgenol 2013; 200:219-25. [DOI: 10.2214/ajr.11.7877] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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40
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Jibiki M, Inoue Y, Kudo T. Conservative treatment for isolated superior mesenteric artery dissection. Surg Today 2012; 43:260-3. [DOI: 10.1007/s00595-012-0304-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 01/03/2012] [Indexed: 11/30/2022]
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41
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Isolated Dissection of the Superior Mesenteric Artery After Living Donor Liver Transplantation: A Case Report. Transplant Proc 2012; 44:588-90. [DOI: 10.1016/j.transproceed.2012.01.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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42
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Natural history of spontaneous isolated superior mesenteric artery dissection derived from follow-up after conservative treatment. J Vasc Surg 2011; 54:1727-33. [DOI: 10.1016/j.jvs.2011.07.052] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Revised: 07/07/2011] [Accepted: 07/11/2011] [Indexed: 11/20/2022]
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43
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Min SI, Yoon KC, Min SK, Ahn SH, Jae HJ, Chung JW, Ha J, Kim SJ. Current strategy for the treatment of symptomatic spontaneous isolated dissection of superior mesenteric artery. J Vasc Surg 2011; 54:461-6. [DOI: 10.1016/j.jvs.2011.03.001] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 02/28/2011] [Accepted: 03/01/2011] [Indexed: 11/25/2022]
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44
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Lim EH, Jung SW, Lee SH, Kwon BS, Park JY, Koo JS, Yim HJ, Lee SW, Choi JH. Endovascular Management for Isolated Spontaneous Dissection of the Superior Mesenteric Artery: Report of Two Cases and Literature Review. J Vasc Interv Radiol 2011; 22:1206-11. [DOI: 10.1016/j.jvir.2011.01.446] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 01/11/2011] [Accepted: 01/25/2011] [Indexed: 10/17/2022] Open
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45
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Spontaneous isolated superior mesenteric artery dissection treated under intravascular ultrasound guidance. Cardiovasc Interv Ther 2011; 26:269-73. [DOI: 10.1007/s12928-011-0067-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 04/13/2011] [Indexed: 10/18/2022]
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46
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Katsura M, Mototake H, Takara H, Matsushima K. Management of spontaneous isolated dissection of the superior mesenteric artery: Case report and literature review. World J Emerg Surg 2011; 6:16. [PMID: 21549001 PMCID: PMC3108290 DOI: 10.1186/1749-7922-6-16] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Accepted: 05/08/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND METHOD The aim of this study was to assess retrospectively the clinical presentation, management and outcome of three patients with isolated SMA dissection encountered at Okinawa Prefectural Chubu Hospital, Japan from 2005 to 2006, along with a review of the literature. We follow up the patient's clinical symptoms and the image by using enhanced dynamic CT at 1 week, 1 or 2 months, 6 months, and yearly after onset. CASE PRESENTATION We present three patients with acute abdominal pain due to spontaneous dissection of the superior mesenteric artery (SMA), who were treated by surgical revascularization or conservative management. Two patients underwent surgery because of signs or symptoms of intestinal ischemia and one patient elected conservative management. The SMA was repaired by bypass graft in two cases, and in one of these, the graft was occluded because of prominent native flow from the SMA. All patients were symptom free and there was no evidence of disease recurrence after a median follow-up of 4.3 years. CONCLUSION Although the indications for surgery are still controversial, we should proceed with exploratory laparotomy if the patient has acute symptoms with suspicion of mesenteric ischemia. A non-operative approach for SMA dissection requires close follow-up abdominal CT, with a focus on the clinical signs of mesenteric ischemia and the vascular supply of the SMA, including collateral flow from the celiac artery and inferior mesenteric artery.
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Affiliation(s)
- Morihiro Katsura
- Department of General Surgery, Okinawa Prefectural Hokubu Hospital, 2-12-3 Onaka, Nago, Okinawa 905-8512, Japan.
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47
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Crowhurst TD, Ho P. Hepatic Artery Dissection in a 65-Year-Old Woman With Acute Pancreatitis. Ann Vasc Surg 2011; 25:386.e17-21. [DOI: 10.1016/j.avsg.2010.09.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 09/25/2010] [Indexed: 10/18/2022]
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48
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Inference from clinical and fluid dynamic studies about underlying cause of spontaneous isolated superior mesenteric artery dissection. J Vasc Surg 2010; 53:80-6. [PMID: 20855179 DOI: 10.1016/j.jvs.2010.07.055] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Revised: 07/19/2010] [Accepted: 07/24/2010] [Indexed: 12/29/2022]
Abstract
PURPOSE Due to increased use and improvements in diagnostic imaging studies, spontaneous isolated superior mesenteric artery dissection (SISMAD), which is a rare vascular event, has been reported to occur on a more frequent basis. Although there have been some anecdotal case reports describing the underlying pathology of SISMAD, the etiology of the majority of SISMAD is still poorly understood. The purpose of this study was to determine the underlying cause of SISMAD. METHOD From July 2001 to March 2010, 51 consecutive patients with SISMAD (symptomatic 39, asymptomatic 12) and 38 patients with combined aortic and superior mesenteric artery dissection (CASMAD) were identified in a single institution by retrospective investigations. Diagnosis was dependent on multi-detector helical computed tomography (CT) scan. To find clinical characteristics of SISMAD, we compared demographic, clinical, and lesion (site of entry tear, type, length) characteristics between the two groups. To find any flow dynamic abnormalities at the proximal segment of the superior mesenteric artery (SMA), we conducted flow dynamic studies using computational fluid dynamic models (V.12; ANSYS, Inc., Canonsburg, Pa). Streamline patterns and wall shear stress distributions were tested with computer simulation models using three different branching angles of SMA from the abdominal aorta. RESULTS Compared to CASMAD, SISMAD was more common in men (90.2% vs 71.1%; P = .02), less frequently associated with hypertension (31.4% vs 65.8%; P = .001), and more frequently associated with intra-abdominal cancers (11.8% vs 0%; P = .036). In a fluid dynamic study using computational fluid dynamic models, we found abnormal mechanical stresses at the anterior wall around the convex portion of the SMA. CONCLUSION Development of SISMAD seems to be less likely the result of hypertension or connective tissue disease but more likely due to hemodynamic force caused by convex curvature.
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49
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Silvestre JMDS, Sardinha WE, Piazzalunga M, Fernandes B, Motta F, Silvestre GDS. Dissecção isolada do tronco celíaco: relato de caso. J Vasc Bras 2010. [DOI: 10.1590/s1677-54492010000300010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A dissecção espontânea isolada do tronco celíaco sem a dissecção concomitante da aorta é uma condição rara, pouco descrita na literatura. O objetivo do presente trabalho é descrever um caso dessa entidade clínica em um paciente masculino, 74 anos, assintomático, cujo diagnóstico foi feito por ultrassonografia e confirmado com angiotomografia computadorizada. O paciente tem sido acompanhado com sucesso mediante observação clínica por um período de 25 meses.
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50
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Hwang CK, Wang JY, Chaikof EL. Spontaneous dissection of the superior mesenteric artery. Ann Vasc Surg 2010; 24:254.e1-5. [PMID: 20142003 DOI: 10.1016/j.avsg.2009.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Accepted: 09/01/2009] [Indexed: 01/18/2023]
Abstract
We describe a case of spontaneous dissection and thrombosis of the superior mesenteric artery in a 54-year-old man who presented with new onset of hypertension and epigastric pain. Initial unsuccessful treatment with catheter-directed thrombolysis was followed by surgical intervention. In cases in which an extensive intimectomy is performed, early institution of antiplatelet therapy or anticoagulation may be necessary to preserve vessel patency due to the presence of a prothrombotic surface and compromised outflow.
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Affiliation(s)
- Christopher K Hwang
- Division of Vascular Surgery and Endovascular Therapy, Emory University School of Medicine, Atlanta, GA, USA
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