Primary conservative treatment for peritonitis-absent symptomatic isolated dissection of the superior mesenteric artery with severely compressed true lumen

Abstract

Objectives The purpose of this study was to evaluate the safety and efficacy of primary conservative treatment (PCT) for peritonitis-absent symptomatic spontaneous isolated dissection of the superior mesenteric artery (S-SIDSMA) with severely compressed true lumen. Methods From January 2013 to December 2018, PCT was used in 26 cases of peritonitis-absent S-SIDSMA with severely compressed true lumen in our center based on our previous proposed treatment algorithm for S-SIDSMA. The demographics, duration from the onset to the admission, duration from the start of the conservative treatment to the alleviation of the symptoms, and in-hospital and follow-up clinical and angiographic outcomes were prospectively recorded and then analyzed. Results Among the 26 included patients, 84.6% were male. The mean age of the patients was 54.7 years. The mean duration from the onset to the admission was 3.1 days (range, 1–14 days). Symptoms in 22 patients were markedly or completely relieved during the first five-day medical treatment. Endovascular stent placement was attempted in the remaining four patients, which was successfully performed in three (75%) of them. The technical failure occurred in a patient whose compressed true lumen failed to be cannulated. Medical treatment was then continued in this patient, and his symptoms were relieved after a two-day medical treatment. During the mean follow-up period of 14.3 months, endovascular stent placement was performed in three patients due to the recurrence of the abdominal pain and the chronic intestinal ischemia. No patient showed dissection progression during the follow-up. The complete remodeling rate of the stent group was significantly higher than that of the medical group (83.3% vs. 25%, P = 0.021). Conclusions Based on our previous proposed treatment algorithm for S-SIDSMA, PCT could achieve satisfactory results both clinically and morphologically in peritonitis-absent S-SIDSMA with severely compressed true lumen.

A Case of Isolated Superior Mesenteric Artery Dissection Resulting in Recurrent Necrosis of the Small Intestine

“…Furthermore, several authors have reported that even in cases where the true lumen is occluded, as in Yun's type III, the prognosis is often good with conservative treatment and type IIb recovers spontaneously because of the absorption of false lumen thrombus, and conservative treatment should be considered. 21,23,[26][27][28] In our case, the true lumen of the SMA dissection site was narrowed but not completely occluded, and the contrast effect of the SMA main trunk distal to the dissection site was maintained. If our cases had been type III, we would have performed revascularization during the initial surgery.…”

Natural Course and Treatment of Symptomatic Spontaneous Isolated Superior Mesenteric Artery Dissection with Total True Lumen Occlusion

“…[12][13][14][15] However, many authors have reported that conservative treatment alone led to successful recovery in patients accompanied by true lumen occlusion. 4,16 Studies have reported conflicting follow-up results; therefore, the association between the imaging features and prognosis of SISMAD remains unclear, particularly in patients with Yun's type III SISMAD (SISMAD accompanied by true lumen occlusion). 5,8 In this study, we summarize our findings and results of long-term follow-up of patients admitted to our hospital for management of Yun's type III SISMAD.…”

“…12-15 However, many authors have reported that conservative treatment alone led to successful recovery in patients accompanied by true lumen occlusion. 4,16…”