Diagnostic Imaging Findings and Endovascular Treatment of Patients Presented with Abdominal Pain Caused by Spontaneous Isolated Superior Mesenteric Artery Dissection

Abstract

Background: Isolated dissection of visceral artery organs is very infrequently reported and when occurred mostly affected is the superior mesenteric artery (SMA) with abdominal pain as the commonest presenting features in symptomatic patients. Dissection can be detected by ultrasound and CT, but computed tomography angiography (CTA) is the best for demonstration of the true and false lumens of the lesion. Nonetheless, the perfect treatment has not been accepted yet. However, if left untreated, it is a life-threatening condition. Objectives: Our aim is to evaluate diagnostic imaging and endovascular treatment outcome of spontaneous isolated superior mesenteric artery dissection (SISMAD). Based on the angiographic configuration of SMA and location of dissection we will share our experience based on deployment of a bare straight stent, bare tapered stent, overlapping bare stent or coil assisting bare stent. Patients and Methods: Medical data from patients presented with symptomatic superior mesenteric artery dissection (SMAD) and had received endovascular treatment between January 2007 and December 2017 were extracted. Patient demographics, symptoms, diagnostic imaging, endovascular treatment, and follow-up findings were analyzed. Results: Total of 31 patients were included in this study [87.1% (n = 27) male, 12.9% (n = 4) female, and mean age 52.9 ± 8.2 years]. All patients had abdominal pain as the main presenting symptom. The mean length of dissection was (4.79 ± 3.03) cm, mean distance from the aorta to dissection entry was 2.5 ± 1.0cm, mean percentage stenosis was 63.3 ± 12.7%, Sakamoto type IIA was seen in 35.5% (n = 11), and type IIB in 64.5% (n = 20). All of the patients received bare self-expandable stent whereby 90.3% (n = 28) received stent(s) without coil, of which 64.3% (n = 18) received single straight stent, 21.4% (n = 6) received overlapping stent and 14.3% (n = 4) received tapered stent. On the other hand, 9.7% (n = 3) received coil assisting stent. Post-procedure normal blood supply to the distal SMA and relief of symptoms was noted. One hundred percent (n = 31) primary success rate was recorded during mean fasting and follow-up time of 4.9 ± 1.9 days and 15.5 ± 4.8 months, respectively. Conclusion: Endovascular treatment with a bare stent is a safe, effective, and successful treatment for symptomatic SISMAD with satisfactory outcomes. We highly recommend it to be considered as a first-line treatment in severe co-morbidity patients who are unfit for open surgery.