Diagnosis and Management of Isolated Superior Mesenteric Artery Dissection: A Systematic Review and Meta-Analysis

Abstract

The objective of this study was to analyze the three different management modalities for isolated superior mesenteric artery (SMA) dissection. We did a comprehensive literature search and found 703 articles on the initial search, out of which 111 articles consisting of 145 patients were selected for analysis. The mean age was 55.7 years (standard deviation,9.7;33–85) and 80.6% were male. These patients were managed conservatively (41.3%), endovascularly (28.1%) or surgically (30%). The median follow-up was 10 months (interquartile range [IQR], 4–18 months), 12 months (IQR, 6–19 months) and 14 months (IQR, 6–20 months) respectively. Contrast-enhanced computed tomography (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% percent of the conservative group had SMA angiography for diagnosis, while this was less than 3% in the other groups. Of these patients, 96.7%, 97.4%, and 100.0% recovered successfully in the conservative, endovascular, and surgical groups respectively. There was no significant difference in the mortality between the three groups (Pearson χ 2 =0.482). 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 in Emergency Room: Isolated Superior Mesenteric Artery Dissection

“…Direct radiographs or blood tests have no role in the diagnosis of SMA dissection 1 . In this case laboratory findings of the patient were normal except white blood cell count.…”

“…Our patient had signs of bowel ischemia so he underwent urgent revascularization and died from total ischemic necrosis. Since SMA dissection is a rare clinical entity, its management, diagnostic methods and outcomes have not been determined in detail yet 1 . Clinical experiences and outcomes related to ISMAD management mainly consist of case series in the literature.…”

“…Isolated superior mesenteric artery dissection (ISMAD) is a dissecting lesion of the superior mesenteric artery (SMA) and its branches. Compared to other arteries, such as the splenic, hepatic, celiac and gastric arteries, superior mesenteric artery dissection is the most common visceral artery dissection 1 . SMA dissection is usually associated with aortic dissection.…”

Middle-aged Man With Abdominal Pain

“…Spontaneous isolated superior mesenteric artery dissection. Spontaneous isolated superior mesenteric artery dissection is a rare but critical cause of abdominal pain that can be misdiagnosed as gastroenteritis, 1 and delayed diagnosis can lead to mesenteric ischemia or aneurysm rupture in the dissected superior mesenteric artery. 2 Although CT angiography remains the criterion standard for diagnosis, 3 bedside ultrasonography may be critical for early evaluation.…”

“…With appropriate treatment, the overall survival rate of superior mesenteric artery dissection without complications is greater than 90%. 1 The patient was admitted for emergency angioplasty and was discharged uneventfully after 11 days.…”