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Lee, Cho, Han, Jung, Park, Kim, Choi, Kang, and Park: Isolated Dissection of Superior Mesenteric Artery: Study on the Treatment Guidelines
Original Article
Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2010; 79(1): 64-70.

Published online: 25 June 2010

DOI: https://doi.org/10.4174/jkss.2010.79.1.64

Isolated Dissection of Superior Mesenteric Artery: Study on the Treatment Guidelines

Min Koo Lee, M.D., Byung Sun Cho, M.D., Hyun Young Han, M.D.1, In Mok Jung, M.D.2, Sung Hye Park, R.N., Chang Nam Kim, M.D., Young Jin Choi, M.D., Yoon Jung Kang, M.D., Joo Seung Park, M.D.

Department of Surgery, Eulji University Hospital, Daejeon, Korea.

1Department of Radiology, Eulji University Hospital, Daejeon, Korea.

2Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.

Corresponding author (sunjoe@eulji.ac.kr)

Received 17 February 2010       Accepted 26 March 2010

Copyright © 2010 The Korean Surgical Society

Abstract

Purpose

Isolated superior mesenteric artery (SMA) dissection is a rare, but increasing vascular disorder. However, optimal treatment guidelines are not well established. The purpose of this study is to review a single institutional experience in the management of isolated SMA dissections and establish optimal treatment guidelines.

Methods

Between November 2004 and August 2009, 26 patients were diagnosed with isolated SMA dissection at Eulji University Hospital. Diagnosis was confirmed with CT scans in all patients. We retrospectively reviewed the medical records, imaging studies, and the early outcomes of the patients.

Results

There were 22 (84.5%) men and 4 women. The mean age was 55.4 (39~74) years. The mean follow-up was 39.1 (4.1~53.3) months. In 15 patients, CT scans were performed for abdominal pain, and in the other 11 patients, the isolated SMA dissections were detected incidentally during workup for other causes. The radiographic findings included an intimal flap with a patent false lumen in 16 and intramural hematoma in 10. The dissection started at a mean of 22.3 (5~46) mm from the origin of the SMA with a mean length was 47.7 (10~150) mm. Treatments included expectant management in 13, anticoagulation in 6, stenting in 6 patients, and surgery in one case of bowel infarction. None required additional intervention. All patients remained asymptomatic during follow-up.

Conclusion

Most patients with isolated SMA dissection were successfully managed medically. Surgical or percutaneous intervention should be reserved for those with evidence of bowel necrosis or mesenteric ischemia and failed cases to initial medical treatment.

Keywords: Superior mesenteric artery dissection, Treatment guideline, Strategy, Algorithm

Figures and Tables

Fig. 1
Classification of CT findings shows double lumen without stenosis (A), intramural thrombosis without stenosis (B), intramural thrombosis with stenosis (C), double lumen with closed false lumen and stenosis (D).
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Fig. 2
Incidental finding. (A) SMA has intramural thrombosis without stenosis. (B) Double lumen with intimal flap begins from proximal SMA.
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Fig. 3
CT findings of symptomatic patient. (A) CT scan shows intramural thrombosis and stenosis. (B) SMA has double lumen with patent false lumen without stenosis. (C) Double lumen with closed false lumen and stenosis is present on the CT scan.
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Fig. 4
Proposed guidelines for the treatment of superior mesenteric artery dissection.
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Table 1
Patients characteristics
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*DM = diabetes mellitus.

Table 2
CT findings (n=26)
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*50%> reduction of diameter.

Table 3
Treatments (n=26)
jkss-79-64-i003

*Adjunctive procedure.

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