Abstract
BackgroundSpontaneous 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.MethodsForty-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.ResultsThe 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).ConclusionsFor 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.
Highlights
Spontaneous isolated superior mesenteric artery dissection (SISMAD) is a rare vascular disorder, and the treatment strategies remain controversial
For symptomatic SISMAD, endovascularly treated patients had a lower rate of symptom recurrence and a higher rate of SMA remodeling in the long term
Hyperhomocysteinemia was common in these symptomatic SISMAD patients
Summary
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. As recommended by the European Society of Vascular Surgery (ESVS) guidelines, conservative treatment is the first-line therapy for symptomatic patients [3]. Conservative treatment as an initial treatment had unsatisfactory results in some symptomatic patients. Garrett reported that the failure rate of initial conservative treatment was approximately 16% in the symptomatic SISMAD patients, and some severe complications occurred [4]. During the follow-up period, 20% of the patients with initial conservative treatment underwent endovascular treatment [3]. Follow-up imaging showed that only 25% of the patients with conservative treatment achieved complete remodeling, and 12% had morphological progression [5]. Treated patients might be at risk of symptom recurrence and disease progression in the long term
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