Safety and efficacy of conservative, endovascular bare stent and endovascular coil assisting bare stent treatments for patients diagnosed with spontaneous isolated superior mesenteric artery dissection.

Abstract

Introduction Isolated dissection of visceral artery organs is very infrequently reported and when it occurs it mostly affects the superior mesenteric artery (SMA) with abdominal pain as the commonest presenting symptom. However, the best therapeutic strategy in symptomatic patients has not yet been established. Aim To evaluate the safety and efficacy of conservative, endovascular bare stent and endovascular coil assisting bare stent treatments for patients diagnosed with spontaneous isolated superior mesenteric artery dissection (SISMAD). Material and methods We reviewed patients who had SISMAD and received conservative, bare stent and coil assisting bare stent as a primary treatment between 2014 and 2018. Patient demographics, symptoms, angiographic findings and treatment outcomes were analyzed. Results A total of 62 patients was found to have SISMAD among whom 83.9% (n = 52) were male and 16% (n = 10) were female with the mean age of 52.55 ±7.22 years, range 33–77. 22.6% (n = 14) received conservative, 62.9% (n = 39) endovascular bare stent and 14. Four percent (n = 9) endovascular coil assisting bare stent treatment. The success rate in primary treatment was conservative 78.5% (n = 11), bare stent 97.4% (n = 38), coil assisting bare stent 100% (n = 9). The mean follow-up duration (months) was 28.76 ±12.87. Conclusions Endovascular bare stent placement is a safe, effective, and successful treatment in the management of symptomatic SISMAD. The diagnostic imaging result is a key point for planning appropriate treatment especially in patients with tapered vessels, longer dissection lesion, and dissection aneurysm where coil assisting bare stent shows good results. Conservative treatment should be given priority for the asymptomatic patient, but close monitoring is highly recommended.

Anastomotic stenosis of a reconstructed dissecting superior mesenteric artery aneurysm undetectable by intraoperative indocyanine green angiography: A case report

“…Recent reports have highlighted the safety and efficacy of endovascular treatment for dSMAA, including entry closure with a covered stent, coil embolization of the false lumen, and stenting of the narrowed true lumen. 6 , 7 , 8 However, problems, such as the risk of intestinal ischemia owing to blockage of some branches or coil migration, the possibility of aneurysm enlargement, and rupture owing to endoleak or stent migration, persist.…”

“…The location of the entry of dissection, status of the arterial wall, and diameter of the artery determines whether treatment is possible. 6 , 7 , 8 For cases of ruptured aneurysms or intestinal necrosis, emergency surgery is given priority over endovascular treatment. In actual clinical practice, it is necessary to discuss in detail whether endovascular treatment is appropriate in each case.…”

“…Endovascular treatment is minimally invasive and offers faster recovery compared with surgical treatment. The location of the entry of dissection, status of the arterial wall, and diameter of the artery determines whether treatment is possible 6–8 . For cases of ruptured aneurysms or intestinal necrosis, emergency surgery is given priority over endovascular treatment.…”

Clinical characteristics and misdiagnosis of spontaneous isolated superior mesenteric artery dissection

“…Spontaneous isolated superior mesenteric artery (SMA) dissection (SISMAD), in which the involvement of the aorta is ruled out, is considered to be an uncommon vascular disease with a potentially fatal pathology [ 1 , 2 ]. Bauersfeld first described this disease in 1947 [ 3 ].…”

3D printing in the preoperative planning and endovascular treatment of splenic artery aneurysm. Own clinical experience and literature review.

“…Various techniques are used in endovascular treatment. The most commonly used techniques are embolization with embolizing spirals or liquid embolic materials and stent grafts [2][3][4][5][6][7][8][9]. The choice of treatment method and technique is difficult and is based on the type of aneurysm as well as its location and morphology.…”