Isolated Spontaneous Dissection of Superior Mesenteric Artery: Treated by Percutaneous Endovascular Stent Placement

Jae Wuk Kwak; Chang Nyol Paik; Kang Moon Lee; Woo Chul Chung; Sung Hoon Jung; Ji Eun Kim; Jun Hyun Baik; Jin Mo Yang

doi:10.4166/kjg.2010.55.1.58

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Kwak, Paik, Lee, Chung, Jung, Kim, Baik, and Yang: Isolated Spontaneous Dissection of Superior Mesenteric Artery: Treated by Percutaneous Endovascular Stent Placement

Original Article

Korean J Gastroenterol 2010;55(1):58-61.

Published online: 21 February 2010

DOI: https://doi.org/10.4166/kjg.2010.55.1.58

Isolated Spontaneous Dissection of Superior Mesenteric Artery: Treated by Percutaneous Endovascular Stent Placement

Jae Wuk Kwak, M.D., Chang Nyol Paik, M.D., Kang Moon Lee, M.D., Woo Chul Chung, M.D., Sung Hoon Jung, M.D., Ji Eun Kim, M.D., Jun Hyun Baik, M.D.^∗, Jin Mo Yang, M.D.

Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea

^∗Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Korea

Correspondence to: Chang Nyol Paik, M.D. Department of Gastroenterology, Catholic University Saint Vincent's Hospital, 93-6, Ji-dong, Paldal-gu, Suwon 442-723, Korea Tel: +82-31-249-7138, Fax: +82-31-249-7137 E-mail: cmcu@catholic.ac.kr

Received 18 August 2009 Accepted 22 August 2009

Abstract

Isolated spontaneous dissection of the superior mesenteric artery (SMA) without aortic dissection is a rare cause of acute mesenteric ischemia. A sudden decrease of intestinal blood flow can lead to fatal complications such as ischemic necrosis, shock, and death. Therefore, early diagnosis and therapeutic approach before the occurrence of intestinal infarction are the most important factor to determine the patient's prognosis. A 52-year-old male presented with postprandial periumbilical pain, and isolated spontaneous dissection of the superior mesenteric artery with mural thrombus was detected by abdominal computed tomography with contrast enhancement. By the percutaneous implantation of vascular metallic stent via femoral artery, he was treated successfully. We report a case of isolated spontaneous dissection of the SMA treated by a percutaneous endovascular stent replacement with a review of literature.

Keywords: Superior mesenteric artery dissection, Percutaneous stent

REFERENCES

1. Bauersfeld SR. Dissecting aneurysm of the aorta: a presentation of fifteen cases and a review of the recent literature. Ann Intern Med. 1947; 26:873–889.

2. Wu XM, Wang TD, Chen MF. Percutaneous endovascular treatment for isolated spontaneous superior mesenteric artery dissection: report of two cases and literature review. Catheter Cardiovasc Interv. 2009; 73:145–151.

3. Javerliat I, Becquemin JP, d'Audiffret A. Spontaneous isolated dissection of the superior mesenteric artery. Eur J Vasc Endovasc Surg. 2003; 25:180–184.

4. Leung DA, Schneider E, Kubik-Huch R, Marincek B, Pfam-matter T. Acute mesenteric ischemia caused by spontaneous isolated dissection of the superior mesenteric artery: treatment by percutaneous stent placement. Eur Radiol. 2000; 10:1916–1919.

5. Nagai T, Torishima R, Uchida A, et al. Spontaneous dissection of the superior mesenteric artery in four cases treated with anticoagulation therapy. Intern Med. 2004; 43:473–478.

6. Jeong JD, Lee JH, Lee SJ, Ryu SY, Hwang SY. Clinical review of acute mesenteric ischemia. J Korean Soc Vasc Surg. 2004; 20:78–82.

7. Suzuki S, Furui S, Kohtake H, et al. Isolated dissection of the superior mesenteric artery: CT findings in six cases. Abdom Imaging. 2004; 29:153–157.

8. Goueffic Y, Costargent A, Dupas B, Heymann MF, Chaillou P, Patra P. Superior mesenteric artery dissection: case report. J Vasc Surg. 2002; 35:1003–1005.

9. Sparks SR, Vasquez JC, Bergan JJ, Owens EL. Failure of nonoperative management of isolated superior mesenteric artery dissection. Ann Vasc Surg. 2000; 14:105–109.

10. Solis MM, Ranval TJ, McFarland DR, Eidt JF. Surgical treatment of superior mesenteric artery dissecting aneurysm and simultaneous celiac artery compression. Ann Vasc Surg. 1993; 7:457–462.

11. Kodaira M, Fukaya T. Gastrointestinal: isolated and spontaneous dissection of the superior mesenteric artery. J Gastroenterol Hepatol. 2001; 16:933.

12. Yasuhara H, Shigematsu H, Muto T. Self-limited spontaneous dissection of the main trunk of the superior mesenteric artery. J Vasc Surg. 1998; 27:776–779.

13. Kim SW, Na YG, Kim IH, Lee SO, Lee ST. Isolated spontaneous dissection of the superior mesenteric artery. Korean J Med. 2005; 69:457–458.

14. Kim JH, Roh BS, Lee YH, Choi SS, So BJ. Isolated spontaneous dissection of the superior mesenteric artery: percutaneous stent placement in two patients. Korean J Radiol. 2004; 5:134–138.

15. Ko GJ, Han KJ, Han SG, et al. A case of spontaneous dissection of the superior mesenteric artery treated by percutaneous stent placement. Korean J Gastroenterol. 2006; 47:168–172.

16. Kim JY, Baek KJ, Lee KR, Lee YJ, Ki W. A case of solitary dissection of superior mesenteric artery. J Korean Soc Emerg Med. 2006; 17:512–514.

17. Kim HK, Kwon TW, Cho YP, Kim GE. Treatment of an isolated superior mesenteric artery dissection. J Korean Vasc Surg Soc. 2007; 23:159–162.

18. Miyamoto N, Sakurai Y, Hirokami M, et al. Endovascular stent placement for isolated spontaneous dissection of the superior mesenteric artery: report of a case. Radiat Med. 2005; 23:520–524.

Fig. 1.

Contrast-enhanced abdominal CT scan findings. (A) A Intimal flap in the superior mesenteric artery (SMA) separating two lumen (white arrow). (B) A partial intraarterial low density thrombus in the proximal portion of the SMA without aortic dissection was demonstrated (white arrow).

Fig. 2.

SMA angiography findings. (A) A dissection of proximal superior mesenteric artery was noted (white arrow). (B) A dissection of SMA was located about 2 cm distal to SMA orifice and the collapse of true lumen was showed (white arrow).

Fig. 3.

SMA angiography finding after the stent insertion. A 6-40-mm self-expandible stent was placed covering the opening of the intimal flap (white arrows).

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