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

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 patients 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.

Current strategy for the treatment of symptomatic spontaneous isolated dissection of superior mesenteric artery

“…7 ES for the treatment of SIDSMA was initially reported by Leung et al 16 Since that time, 16 patients with SIDSMA have been treated with ES. 3,[5][6][7]12,[15][16][17][18][19][20]22 ES was offered as an initial treatment for aneurysmal dilation or bowel ischemia in nine patients and secondary to failed conservative treatment with or without anticoagulation in seven patients. ES provided immediate symptomatic improvement and prevented further progression of the SMA dissection with a shorter fasting time.…”

“…27 Recently, however, SIDSMA has been reported more frequently. [1][2][3][5][6][7][8][9][10][11][12][15][16][17][18][19][20][21][22] SIDSMA can be detected as an incidental finding, but may also cause drastic complications such as bowel infarction and severe hemorrhage. Although four approaches -conservative management, anticoagulation, endovascular stenting, and open surgery -have been previously reported, given the paucity of the SMA dissections, the optimal treatment for SIDSMA remains a matter of some controversy.…”

The value of a new image classification system for planning treatment and prognosis of spontaneous isolated superior mesenteric artery dissection

“…Before the present study, CTA imaging had not been utilized in the management of SISMAD. According to the new classification, in a total of 26 cases of symptomatic SISMAD that underwent surgery or stenting from 23 studies, 9,11,13,15–33 types IIIa accounted for 37.5% ( n = 21). Meanwhile, in our report, type IIIa (32.1%, n = 9) accounted for the highest proportion.…”

“…Although different strategies for SISMAD have been proposed, 1,2,4,18,19 there is no consensus on the superiority of any treatment, primarily because standards for disease outcomes vary 1,4 as well as surgical and stenting experiences. 18–24 Computed tomography angiography (CTA) has proved useful for classifying types of SISMAD based on scan images, and for suggesting treatment strategies. 17…”

Spontaneous isolated superior mesenteric artery dissection treated under intravascular ultrasound guidance

“…While treatment of SMA dissection consists of bowel rest, medication, surgery, and endovascular treatment, it is still unclear as to which of these is the best treatment for the disease [3]. Although use of endovascular treatment has gradually developed along with endovascular devices and techniques [3][4][5][6][7][8][9][10][11][12][13][14], it is usually only performed after medical treatment fails [3]. We report a case of SMA dissection that occurred within several hours and was successfully treated using endovascular treatment without preceding medical therapy.…”