Diagnostic Imaging Findings and Endovascular Treatment of Patients Presented with Abdominal Pain Caused by Spontaneous Isolated Superior Mesenteric Artery Dissection

Abstract

Background: Isolated dissection of visceral artery organs is very infrequently reported and when occurred mostly affected is the superior mesenteric artery (SMA) with abdominal pain as the commonest presenting features in symptomatic patients. Dissection can be detected by ultrasound and CT, but computed tomography angiography (CTA) is the best for demonstration of the true and false lumens of the lesion. Nonetheless, the perfect treatment has not been accepted yet. However, if left untreated, it is a lifethreatening condition. Objectives: Our aim is to evaluate diagnostic imaging and endovascular treatment outcome of spontaneous isolated superior mesenteric artery dissection (SISMAD). Based on the angiographic configuration of SMA and location of dissection we will share our experience based on deployment of a bare straight stent, bare tapered stent, overlapping bare stent or coil assisting bare stent. Patients and Methods: Medical data from patients presented with symptomatic superior mesenteric artery dissection (SMAD) and had received endovascular treatment between January 2007 and December 2017 were extracted. Patient demographics, symptoms, diagnostic imaging, endovascular treatment, and follow-up findings were analyzed.Results: Total of 31 patients were included in this study [87.1% (n = 27) male, 12.9% (n = 4) female, and mean age 52.9 ± 8.2 years]. All patients had abdominal pain as the main presenting symptom. The mean length of dissection was (4.79 ± 3.03) cm, mean distance from the aorta to dissection entry was 2.5 ± 1.0cm, mean percentage stenosis was 63.3 ± 12.7%, Sakamoto type IIA was seen in 35.5%(n = 11), and type IIB in 64.5% (n = 20). All of the patients received bare self-expandable stent whereby 90.3% (n = 28) received stent(s) without coil, of which 64.3% (n = 18) received single straight stent, 21.4% (n = 6) received overlapping stent and 14.3% (n = 4) received tapered stent. On the other hand, 9.7% (n = 3) received coil assisting stent. Post-procedure normal blood supply to the distal SMA and relief of symptoms was noted. One hundred percent (n = 31) primary success rate was recorded during mean fasting and follow-up time of 4.9 ± 1.9 days and 15.5 ± 4.8 months, respectively. Conclusion:Endovascular treatment with a bare stent is a safe, effective, and successful treatment for symptomatic SISMAD with satisfactory outcomes. We highly recommend it to be considered as a first-line treatment in severe co-morbidity patients who are unfit for open surgery.

Management of Spontaneous Isolated Mesenteric Artery Dissection: A Systematic Review

“…Original reports or reports from multi-center collaborations were included. Ninety-seven studies ( 1 …”

The ratio of superior mesenteric artery diameter to superior mesenteric vein diameter based on non-enhanced computed tomography in the early diagnosis of spontaneous isolated superior mesenteric artery dissection

“…[1,5] However, following improvements in diagnostic radiological practices and the wider availability of high-quality CTA and CECT in recent years, there has been a dramatic increase in reports of this disease. [1,2,[11][12][13] Although there are some reports on SISMAD, most of them focus on its treatment, followup, and clinical characteristics. [1,2,10,12,[14][15][16][17] There have been very few studies on the use of imaging in the early diagnosis of this disease, and the characteristics of non-enhanced CT have not been investigated in detail for doctors, especially emergency doctors.…”

“…SISMAD is a rare disease that is more prevalent in men in their fifties. [6,11,12] For SISMAD patients, abdominal pain is the most common symptom, accounting for 72%-100%. [1,3,5,6,8,11,13,15] Although a small number of SISMAD patients are diagnosed by ultrasound, its use is limited because it is aff ected by intestinal gas and obesity.…”

“…[6,11,12] For SISMAD patients, abdominal pain is the most common symptom, accounting for 72%-100%. [1,3,5,6,8,11,13,15] Although a small number of SISMAD patients are diagnosed by ultrasound, its use is limited because it is aff ected by intestinal gas and obesity. [6,21] CECT is the most appropriate examination for abdominal pain patients in many settings.…”

“…Owing to the lack of reliable clinical signs and laboratory findings, CECT and CTA are the main clinical methods for diagnosing SISMAD. [11,14,17] In order to improve the early diagnostic rate and avoid overdiagnosis for abdominal pain patients who have already undergone non-enhanced CT, it is a clinically urgent problem which patients should further performed CTA or CECT to diagnose or rule out SISMAD.…”