Comparison of Superior Mesenteric Artery Remodeling and Clinical Outcomes between Conservative or Endovascular Treatment in Spontaneous Isolated Superior Mesenteric Artery Dissection.

Sz-Han Yu,Ing-Heng Hii,I-Hui Wu

doi:10.3390/jcm11020465

Abstract

The aim of this study was to analyze the superior mesenteric artery (SMA) remodeling after initial conservative or endovascular treatment with a standardized definition and midterm outcomes in patients with spontaneous isolated dissection of the superior mesenteric artery (SIDSMA). This retrospective study enrolled patients with SIDSMA from January 2007 to August 2019. All patients were treated initially with conservative treatment. If they failed the medical treatment, they were converted to interventional treatment. The morphological endpoint was determined by the standardized SMA remodeling, and the clinical endpoints were determined by the in-hospital mortality, hospital stay, and the bowel-related mid-term mortality. A total of 34 consecutive patients with SIDSMA were identified. Twenty-three (67.6%) and eleven (33.4%) patients underwent conservative and interventional treatments, respectively. Clinical features and morphologic changes on CTA were available in 25 (73.5%) patients during the median follow-up of 23.3 months. Standardized SMA remodeling was significantly (p < 0.05) better in patients undergoing endovascular stenting, especially in patients with Yun’s IIb classification. There was no mesenteric ischemia or SMA aneurysm during follow-up period. Patients with SIDSMA can be treated safely with initial conservative treatment. However, significant portions of patients will require endovascular intervention due to the persistent symptoms. Clinically endovascular stenting could be performed successfully, and SMA remodeling was satisfactory during the mid-term follow-up.

Highlights

Spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) is rare but increasingly diagnosed because of the widespread availability of high-quality computed tomography angiography (CTA), especially in the lack of specific lab tests and clinical signs
We investigated the risk factors of failure of initial medical therapy, the comparison of SMA remodeling between the intervention and conservative treatments by the CTA morphological change in the mid-term follow-up, and the clinical outcomes by reviewing patients with SIDSMA undergoing initial conservative treatment
This study showed that SMA stenting in patients with SIDSMA was significantly better for SMA remodeling compared to medical treatment, especially in patients presenting with

Summary

Introduction

Spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) is rare but increasingly diagnosed because of the widespread availability of high-quality computed tomography angiography (CTA), especially in the lack of specific lab tests and clinical signs. Hypertension, genetic variants, and the mechanical stress at the anterior wall of the SMA near the convex curvature have all been proposed [1]. Previous reports [2,3] have indicated that risk factors of SIDSMA included male, smoking, middle-aged, hypertension, and Asian population [1–8]. Clinical presentations can range from incidental CTA finding without symptoms to acute abdominal pain and can progress to superior mesenteric artery (SMA) occlusion and mesenteric ischemia. The CTA morphology alone could not predict the clinical course [3,9,10]. Initial treatment can always be managed conservatively with bowel rest, hydration, blood pressure

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