Isolated Superior Mesenteric Artery Research Articles

Isolated Superior Mesenteric Artery Dissection: A Systematic Review of Different Treatment Modalities

Introduction: To summarize all the published literature, and to compare three different management arms for isolated superior mesenteric artery (SMA) dissection. Methods: Embase, Cochrane, and MedLine databases were searched systematically for articles on SMA dissection since inception till June 2018. Results: A total of 461 articles were obtained on the initial search, out of which 111 articles consisting of 153 patients were selected. The mean age of these patients was found to be 55.67years (SD 9.66, 33-85) including 82% males and 18% females. These patients were managed conservatively (41.3%), endovascularly (28.10%) or surgically (30%). The median follow-up among the conservative group was ten months (m) (interquartile range (IQR) 4-18m) and 12m for endovascular (IQR 6-19m) and surgical management (IQR 6-20m). The most common presentation was abdominal pain in 48.4 % of conservative, 83.7% of endovascular, and 73.9% of the surgical group. Abdominal pain was present in 26% of the conservative, 16.3% and 23.9% of the endovascular and surgical groups respectively. Only 1.6% of patients of the conservative group presented with unusual symptoms like hematuria and chest pain. Contrast-enhanced 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%). 17.2 % of the conservative group used SMA angiography for diagnosis, while this percentage was less than 3% in other groups. Hypertension was the most common association in all three groups, with frequency 34.4%, 27.9%, and 30.4% in the conservative, endovascular and surgical groups. The surgical group had the highest association with comorbidities, with 21.7% associated with CAD and atrial septal defects and 4.3% smoking. About 96.7%, 97.4%, and 100% patients recovered successfully among conservative, endovascular and surgical groups respectively. There was no significant difference in the mortality between these three groups (Pearson Chi-Square 0.482). Conclusion: Based on our results, all the three different modalities had a similar outcome with no statistical difference between mortality. 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.

A Rare Cause of Acute Abdomen: Spontaneous Isolated Superior Mesenteric Artery Dissection

A Rare Cause of Acute Abdomen: Spontaneous Isolated Superior Mesenteric Artery Dissection

Isolated Superior Mesenteric Artery Dissection: An Unusual Presentation Quashed by an Unusual Approach

Isolated Superior Mesenteric Artery Dissection: An Unusual Presentation Quashed by an Unusual Approach

Correlation Between Computed Tomography Features and Clinical Presentation and Management of Isolated Superior Mesenteric Artery Dissection

To examine the correlation between computed tomography (CT) features and clinical presentation and to assess the management strategy for patients with isolated superior mesenteric artery (SMA) dissection. Retrospective analysis of clinical records and CT findings of patients with isolated superior mesenteric artery dissection treated between 2012 and 2016. The relationship between CT features and clinical symptoms and treatment options was studied. Follow up CT images were reviewed and telephone interviews were conducted with patients. Sixty-nine patients with isolated SMA dissection (47 symptomatic and 22 asymptomatic) were evaluated. The dissection length in patients with Sakamoto type IV lesions was significantly longer than that in patients with other lesion types (83.0±40.1mm, p=.001). Compared with the asymptomatic group, the symptomatic group had longer dissections (63.5±35.9mm, p<.001) and lesser true lumen diameter (3.1±1.7mm, p=.044). Fifty-six patients were treated conservatively, of whom 31 showed clinical improvement and exhibited no morphological change during long-term follow up. In patients with isolated SMA dissection, clinical symptoms were related to the length of dissection and degree of true lumen stenosis. Conservative treatment was commonly employed and yielded favourable outcomes.

Treatment Strategies and Outcomes of Symptomatic Spontaneous Isolated Superior Mesenteric Artery Dissection: A Systematic Review and Meta-analysis

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.

Outcomes of Spontaneous Isolated Superior Mesenteric Artery Dissection Without Antithrombotic Use

This study aimed to show the intention to treat results of treatment for spontaneous isolated superior mesenteric artery dissection (SISMAD) without anticoagulation or antiplatelet agents and the follow-up results of SISMAD according to the configuration on computed tomography (CT) scans. Retrospective, observational single centre study METHODS: All cases of SISMAD were enrolled consecutively from 2006 onwards. There were 25 symptomatic and four asymptomatic patients in whom SISMAD was found incidentally. The SISMAD patients were treated using a consistent therapeutic strategy without antithrombotics. SISMAD was categorized into four types based on the configuration on CT scans by Yun's classification. Follow-up CT was performed at 3 months, 6 months, and yearly thereafter. The median follow-up duration was 57 months (13-129 months). Improvement or complete resolution on CT scans, with no symptom recurrence, was seen in 27 patients. The non-invasive approach failed in three cases and two patients underwent further intervention. No patient died during the follow-up. Weighing the risks versus benefits of antithrombotics and considering the benign nature of SISMAD, conservative treatment without antithrombotics might be sufficient in patients without evidence of bowel ischaemia or infarction on initial CT scan.

Isolated Superior Mesenteric Artery Dissection: A Rare Cause of Chronic Abdominal Pain

Isolated superior mesenteric artery dissection ISMAD is unusual We present a case of a year old man who had chronic abdominal pain for three months Contrast enhanced computed tomography CECT revealed type B superior mesenteric artery dissection SMAD without thrombus The patient was managed conservatively

Serial Follow-Up Evaluation With Computed Tomography After Conservative Medical Treatment in Patients With Symptomatic Spontaneous Isolated Superior Mesenteric Artery Dissection.

There is no detailed information available about trend in the morphological change after conservative medical treatment in patients with symptomatic spontaneous isolated superior mesenteric artery dissection (SISMAD). We enrolled 27 consecutive patients with symptomatic SISMAD who underwent conservative medical treatment between 2006 and 2015. The long-term prognosis, natural history, and serial follow-up computed tomography (CT) findings of risk factors of rupture such as arterial diameter and false lumen enhancement were retrospectively assessed. Spontaneous isolated superior mesenteric artery dissection usually developed in middle-aged men around 50 years old who had a history of smoking. Follow-up CT was performed at 1 to 6 months, 7 to 12 months, and after 12 months. Superior mesenteric artery (SMA) maximum diameter was 10.3 mm (quartile 9.5-11.3) on initial CT and expanded in 47.1% patients during 1- to 6-month follow-up, which decreased over time ( P < .001 at 7- to 12-month follow-up, P = .001 after 12-month follow-up). On the other hand, false lumen enhancements were revealed in 9 (33.3%) patients on initial CT. The size of false lumen enhancement was expanded in the longest diameter in 35.3% patients and in shortest diameter in 29.4% during 1- to 6-month follow-up. However, the size of false lumen decreased in all patients after 12-month follow-up. All patients were alive without arterial aneurysm rupture and hospital readmission during the median of 523 days (170-799) study period. We demonstrated that both SMA maximum diameter and false lumen enhancement were transiently expanded in some patients during 6-month follow-up, but no longer expanded after 12-month follow-up. Patients with symptomatic SISMAD could be treated medically with scheduled careful follow-up CT evaluations.

Isolated Superior Mesenteric Artery Dissection: An Uncommon Cause of Abdominal Pain

Isolated Superior Mesenteric Artery Dissection: An Uncommon Cause of Abdominal Pain

The Significance of the Angle between Superior Mesenteric Artery and Aorta in Spontaneous Isolated Superior Mesenteric Artery Dissection

The aim of this study is to assess the significance of the angle between superior mesenteric artery (SMA) and distal aorta in spontaneous isolated superior mesenteric artery dissection (SISMAD) by clinical and biomechanical analyses. Thirty-seven patients with SISMAD (1 asymptomatic) and 148 controls (1:4 matched for age [mean 50.2years], gender [92% male], and body mass index, and being ruled out for arterial disease) underwent aortic computed tomography angiography. SMA-distal aorta angle, measured on sagittal plane, was compared along with baseline characteristics (body mass index, smoking history, and comorbidities) between groups, and assessed as tool to evaluate SISMAD risk after stratification into 4 angle-interval categories. Flow analysis and fluid-structure interaction study were conducted based on patient-specific models with ultrasound-measured boundary conditions to further reveal the flow pattern and loading distribution in the 4 angle-interval categories. SISMAD patients versus controls had larger mean SMA-distal aorta angle (73±19.8° vs. 50±18.81°, P<0.001), and more frequently smoking history (62% vs. 40%, P=0.02) and hypertension (59% vs. 34%, P<0.001), all multivariate predictors of no SISMAD (odds ratio 0.946 [95% confidence interval 0.927-0.966]; 0.415 [0.198-0.87]; and 0.252 [0.117-0.544], respectively). Odds ratio for SISMAD increased with increasing SMA-distal aorta angle (1,10, 57, and 73 for <50°, 50-69°, 70-90°, and >90°, respectively; P < 0.05 for >70°). In silico study confirmed that larger angle is associated with higher stress in the arterial wall and higher oscillatory shear index in the vessel lumen at the SMA superior convex, where dissection commonly occurs. Besides smoking history and hypertension, SISMAD was positively associated with a morphological parameter, the SMA-distal aorta angle. This might be due to the greater wall stress and oscillatory stress index in the arterial convex with a larger angle.

IP239 Spontaneous Isolated Superior Mesenteric Artery Dissection Has Treatment Time Window for Complete Resolution

IP239 Spontaneous Isolated Superior Mesenteric Artery Dissection Has Treatment Time Window for Complete Resolution

The Classification and Management Strategy of Spontaneous Isolated Superior Mesenteric Artery Dissection

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.

Current Understandings of Spontaneous Isolated Superior Mesenteric Artery Dissection.

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.

Evolution of Computed Tomographic Characteristics of Spontaneous Isolated Superior Mesenteric Artery Dissection During Conservative Management.

Spontaneous isolated superior mesenteric artery (SMA) dissection is a rare condition, and its clinical and angiographic courses are poorly defined. We aimed to monitor the morphological characteristics of spontaneous isolated SMA dissection using computed tomography (CT) over 2 years of follow-up, including the recovery process via vascular remodeling, and identify the factors that affect vascular remodeling using univariate analysis. We retrospectively reviewed the medical records and morphological findings of 59 consecutive patients with spontaneous isolated SMA dissection between October 2007 and July 2014, which included 36 symptomatic and 23 asymptomatic patients. Surgical intervention with open laparotomy was required in 3 patients during the follow-up period; 41 patients who received conservative treatment were followed up over 2 years with regular CT. Complete remodeling was achieved in 16 of 25 symptomatic patients who were treated conservatively (64.0%). A patent false lumen and aneurysmal formation on an initial CT scan were identified as negative factors that affected remodeling in patients with spontaneous isolated SMA dissection. Conservative management of spontaneous isolated SMA dissection is associated with a good prognosis, both clinically and morphologically. Surgical intervention is only required in patients with severe intestinal ischemia or rapid aneurysmal enlargement. (Circ J 2016; 80: 1452-1459).

Endovascular Stent Placement in a Patient with a Posttraumatic Isolated Superior Mesenteric Artery Dissection with Focally Progressing Dissecting Aneurysms and a Severely Compressed True Lumen

Endovascular Stent Placement in a Patient with a Posttraumatic Isolated Superior Mesenteric Artery Dissection with Focally Progressing Dissecting Aneurysms and a Severely Compressed True Lumen

IF7. Clinical and Angiographic Outcomes After Conservative Treatment of Isolated Superior Mesenteric Artery Dissection

IF7. Clinical and Angiographic Outcomes After Conservative Treatment of Isolated Superior Mesenteric Artery Dissection

Treatment Results for Spontaneous Isolated Superior Mesenteric Artery Dissection according to Our Previous Guidelines and Collective Literature Review

Isolated superior mesenteric artery dissection (ISMAD) is not a rare disease. However, its optimal treatment strategy has not yet been established. This study included 13 consecutive patients with ISMAD who were treated between April 2010 and July 2013 according to published treatment guidelines. Through a literature search, 10 studies on treatments and outcomes for ISMAD that were published from 2007 to the present were analyzed. In the present study, 11 patients had acute onset abdominal pain and 2 patients were asymptomatic. Twelve patients were treated with conservative treatment, whereas 1 patient underwent coil embolization. In the literature review, initial conservative treatment, endovascular procedure, and surgical repair were done in 172, 25, and 14 patients, respectively. Bowel resection was done in 8 patients (3.7%) due to bowel necrosis. Conservative treatment failed in 15 patients (6.8%) during follow-up. If bowel necrosis or arterial rupture was not present, conservative treatment of ISMAD was a safe and effective treatment. Aneurysmal type IV patients on computed tomography scan should be carefully followed up, and if there is a recurrence of pain or aneurysmal progression, an endovascular procedure could be safely performed.

A Case of Isolated Superior Mesenteric Artery Dissection with Severe Stenosis of The True Lumen in Which Angiography Was Effective in Determining Treatment Strategy

A Case of Isolated Superior Mesenteric Artery Dissection with Severe Stenosis of The True Lumen in Which Angiography Was Effective in Determining Treatment Strategy

Isolated Superior Mesenteric Artery Dissection Presenting as Acute Abdominal Pain

Isolated Superior Mesenteric Artery Dissection Presenting as Acute Abdominal Pain

Spontaneous Isolated Superior Mesenteric Artery Dissection Mimicking Superior Mesenteric Artery Syndrome

Spontaneous Isolated Superior Mesenteric Artery Dissection Mimicking Superior Mesenteric Artery Syndrome