Outcomes and radiographic findings of symptomatic isolated mesenteric artery dissection with conservative management

Vascular ◽  
2020 ◽  
pp. 170853812091841
Author(s):  
Yingjiang Xu ◽  
Xiujuan Gao ◽  
Dan Shang ◽  
Jianyong Liu ◽  
Bi Jin ◽  
...  
Keyword(s):  
Conservative Management ◽  
Mesenteric Artery ◽  
Clinical Manifestations ◽  
Morphological Characteristics ◽  
Epidemiological Data ◽  
Dissecting Aneurysm ◽  
First Episode ◽  
Artery Dissection ◽  
Type I ◽  
Radiographic Findings

Objectives The aim of this study was to evaluate the computed tomography follow-up outcomes and radiographic findings of symptomatic isolated mesenteric artery dissection (IMAD) after conservative management. Methods In this retrospective study, 130 consecutive patients with symptomatic IMAD from three institutions were enrolled from January 2011 to December 2019. The general epidemiological data, clinical manifestations, first-episode symptoms, imaging findings, and treatment strategy selection were analyzed from the medical records. Results Among 130 patients diagnosed with symptomatic IMAD, positive remodeling of the SMA was achieved in 75.38% (98/130), and negative remodeling of the SMA was achieved in 24.62% (32/130). In the positive remodeling group, complete remodeling was achieved 39.23% (51/130) (type I 6 patients, type IIa 10 patients, type IIb 35 patients), in which type IIb was the most ( p = 0.004). Moreover, of the 32 patients in whom negative remodeling of the SMA was achieved, significant differences were observed between the type IIa with respect to dissecting aneurysm formation ( p = 0.04).Of the seven factors analyzed with a logistic regression model identified three factors significantly associated with negative remodeling: length of dissection (Waldχ2 13.331; OR 6.945; 95% CI 2.762–10.498; p = 0.014), true lumen residual diameter (TLRD) (Waldχ2 9.626; OR 7.85; 95% CI 1.892–19.063; p = 0.022), and branch involvement (Waldχ2 11.812; OR 7.247; 95% CI 1.245–14.830; p = 0.011). Conclusion The prognosis of most symptomatic IMAD has a tendency to positive remodeling after conservative management, in which the initial type IIb classification is common. In contrast, risk factors for negative remodeling were type IIa, length of dissection, TLRD, and branch involvement. Patients with these morphological characteristics may not benefit from conservative management.

The value of CT findings for prognostic prediction of spontaneous superior mesenteric artery dissection

2018 ◽  
Vol 60 (4) ◽  
pp. 542-548 ◽  
Author(s):  
Rika Yoshida ◽  
Takeshi Yoshizako ◽  
Minako Maruyama ◽  
Yoshikazu Takinami ◽  
Yoshihide Shimojo ◽  
...  
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Artery Dissection ◽  
Type I ◽  
Treatment Methods ◽  
Type Iii ◽  
Type Iv ◽  
Contrast Enhanced Ct ◽  
Prognostic Prediction

Background Spontaneous superior mesenteric artery (SMA) dissection is rare cause of acute abdomen. Time-dependent change of SMA dissection has not been established. Purpose To determine Sakamoto classification (SC) type of acute and chronic SMA dissection (aSMAD and cSMAD) to predict the treatment methods and outcome. Material and Methods From April 2003 to March 2017, unenhanced and contrast-enhanced CT were used to diagnose acute symptomatic or chronic asymptomatic SMA dissection in 25 consecutive patients without aortic dissection. Correlations between SCs and treatment methods and outcomes were investigated. Results All 13 patients with aSMAD initially received conservative treatment. Initial SCs in aSMAD were type I = 1, type III = 9, and type IV = 3. Three of nine initial type III and two of three initial type IV changed to type I at follow-up. One of nine type III changed to type II at follow-up. Ohers did not change. One with initial type III required vascular repair, so the final SC was not available. Three patients required bowel resection. In cSMAD of 12 patients, the initial/final SC were type I and IV in ten and two patients, respectively, without change during follow-up. cSMAD was significantly older than aSMAD. The initial length of dissection of aSMAD was longer than in the cSMAD group. In aSMAD, the final length of dissection was significantly shorter than in the initial computed tomography scan. Conclusion Initial SC differed significantly between aSMAD and cSMAD. Initial SC types in aSMAD were type III and IV mainly, and changed during the observation period. In cSMAD, SC types were I and IV without change.

scholarly journals A Staged Operation as a Surgical Strategy for a Patient with Type VI Isolated Superior Mesenteric Artery Dissection

2021 ◽  
pp. 715-719
Author(s):  
Ryosuke Nishi ◽  
Yasuhiko Fujita ◽  
Teruyoshi Amagai
Keyword(s):  
Small Intestine ◽  
Superior Mesenteric Artery ◽  
Abdominal Wall ◽  
Mesenteric Artery ◽  
Artery Bypass ◽  
Visceral Artery ◽  
Artery Dissection ◽  
Type I ◽  
Contrast Ct ◽  
Staged Operations

An isolated superior mesenteric artery (SMA) dissection (ISMAD) is extremely rare among visceral artery dissections. Its diagnosis is made by abdominal contrast CT scan which shows SMA occlusion partially or completely. The ISMAD is classified into 6 types: type I–V has partial occlusion and treated medically using antiplatelets or anticoagulants. On the other hand, type VI has complete occlusion and must be treated by urgent surgical operation. We present a 67-year-old female who presented with sudden onset abdominal pain and melena. An urgent contrast CT revealed type VI ISMAD. She underwent 3 staged operations as follows: (1) first, as laparotomy showed pale color in almost the extensive length of the small intestine, arterial bypassing of SMA was undertaken using SMA to the right common iliac artery bypass; (2) as the second-look operation on the next day, the terminal ileum was resected, and the remaining small intestine was able to be preserved. However, when the abdomen was tried to be closed, systemic blood pressure decreased to pre-shock condition, so the abdominal wall was closed at skin level with silastic sheet. (3) As the third-look operation on the 7th day, ileostomy was created, and the abdominal wall was safely closed. The postoperative course was uneventful. This case study shows that SMA grafting and staged operations might be an option to preserve the length of the small intestine when ISMAD is diagnosed as type VI.

Mesenteric Artery Remodeling after Conservative Management in Patients with Isolated Mesenteric Artery Dissection

2019 ◽  
Vol 30 (12) ◽  
pp. 1964-1971 ◽  
Author(s):  
Ke Wang ◽  
Wenhua Chen ◽  
Hongjian Shi ◽  
Qing Xu ◽  
Xueli Gao ◽  
...  
Keyword(s):  
Conservative Management ◽  
Mesenteric Artery ◽  
Artery Dissection ◽  
Artery Remodeling

scholarly journals Conservative management of spontaneous isolated superior mesenteric artery dissection: a case report

2021 ◽  
Author(s):  
Takashi Miyata ◽  
Yuta San-nomiya ◽  
Taigo Nagayama ◽  
Ryosuke Kin ◽  
Hisashi Nishiki ◽  
...  
Keyword(s):  
Case Report ◽  
Superior Mesenteric Artery ◽  
Conservative Management ◽  
Mesenteric Artery ◽  
Treatment Guidelines ◽  
Artery Dissection ◽  
Evidence Based ◽  
Evidence Based Treatment ◽  
Pathogenic Factors ◽  
Superior Mesenteric Artery Dissection

Spontaneous isolated superior mesenteric artery dissection (SISMAD) is a rare and potentially fatal cause diagnosis presenting with acute abdominal; however, because of its rarity, the pathogenic factors of SISMAD remain unknown and no clear cause has been found. Moreover, there is a lack of evidence-based treatment guidelines.

scholarly journals Factors Associated with Failed Conservative Management in Symptomatic Isolated Mesenteric Artery Dissection

2019 ◽  
Vol 58 (3) ◽  
pp. 393-399 ◽  
Author(s):  
Zhongzhi Jia ◽  
Wenhua Chen ◽  
Haobo Su ◽  
Hongjian Shi ◽  
Qing Xu ◽  
...  
Keyword(s):  
Conservative Management ◽  
Mesenteric Artery ◽  
Artery Dissection ◽  
Factors Associated

Therapeutic Regimen Options for Isolated Superior Mesenteric Artery Dissection

2012 ◽  
Vol 46 (3) ◽  
pp. 277-282 ◽  
Author(s):  
Xicheng Zhang ◽  
Yuan Sun ◽  
Zhaolei Chen ◽  
Xiaoqiang Li
Keyword(s):  
Mesenteric Artery ◽  
Conservative Therapy ◽  
False Lumen ◽  
Dissecting Aneurysm ◽  
Vascular Prosthesis ◽  
Artery Dissection ◽  
Endovascular Stenting ◽  
Aneurysm Resection ◽  
Superior Mesenteric Artery Dissection

Objective: To summarize the reproducible experience obtained during the treatment of superior mesenteric artery dissection (SMAD) and to investigate the therapeutic options for this condition. Methods: The clinical data from 10 patients with SMAD were retrospectively analyzed, including 6 patients receiving conservative therapy, 2 patients receiving endovascular stenting, 1 patient receiving dissecting aneurysm resection plus vascular prosthesis grafting, and 1 patient receiving thrombectomy plus intimectomy. Results: For the 6 patients subjected to the conservative therapy, the symptoms were thoroughly under control without relapse during the follow-up; for the 2 patients receiving endovascular stenting, the computed tomography (CT) examination performed during the follow-up demonstrated a patent true lumen and an occluded false lumen; for the patient with dissecting aneurysm resection plus vascular prosthesis grafting, a short dissection was observed at the distal end of the vascular prosthesis but without progression during the 14-month follow-up period; for the patient with thrombectomy plus intimectomy, postoperatively, the patient experienced diarrhea, body weight loss, and hypoproteinemia, and CT scanning demonstrated segmental SMA occlusions, which were not fully remitted by conservative therapy until the application of endovascular stenting 4 months later. Conclusions: The therapeutic regimen for isolated SMAD should be established based on the clinical symptoms of the patient and the hemodynamic status in SMA. The conservative therapy is mainly indicated for the asymptomatic patients or those with short-term symptoms, while the endovascular or surgical therapy should be recommended for those with persistent intestinal ischemia-related symptoms, rupture of artery, and/or obvious aneurysmal false lumen dilation at a high risk of rupture.

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