| Objective:To summarize the clinical characteristics,therapeutic effect and imaging clinical features of patients with spontaneous isolated superior mesenteric artery dissection(SISMAD),and to explore and analyze the risk factors of vascular remodeling of superior mesenteric artery(SMA)after conservative treatment of SISMAD,so as to provide reasonable diagnosis and treatment strategy and clinical reference value for disease treatment and follow-up outcome of patients with superior mesenteric artery dissection after discharge.Methods:A retrospective case study was used to collect 109 patients who were diagnosed as SISMAD and hospitalized from September 2016 to September 2018 in the Department of Vascular surgery of DOCTOR HIS Workstation of SuBei people’s Hospital.Among them,26 patients were excluded because they received non-conservative treatment(n=7),dissection progression(n=3)and lost clinical follow-up data(n=16).The data of 83 patients with conservative treatment were included in this study.Detailed records of all patients’ sex,age,body mass index(BMI),concomitant underlying diseases,days of hospitalization,time of relief of abdominal symptoms,concomitant underlying diseases,history of smoking and drinking,clinical symptoms,basic treatment,laboratory examination data and imaging examination data,follow-up feedback and other parameters.According to the vascular remodeling of superior mesenteric artery at the end of follow-up,the patients were divided into complete remodeling group and partial remodeling group.All patients were followed up for more than one year.Through statistical analysis,to explore the related factors affecting vascular remodeling of SMA.Univariate analysis may affect the risk factors of SMA vascular remodeling,including age,sex,BMI,concomitant diseases,history of smoking and drinking,basic treatment,laboratory data and imaging data.The independent factors related to vascular remodeling of superior mesenteric artery dissection were obtained by multivariate Logistic regression analysis,which were expressed as odds ratio(OR)and 95%confidence interval(CI).Results the difference was statistically significant(P<0.05).Results:1.Comparison of baseline data:83 SISMAD patients were included in this study,with an average age of(52.89±8.19)years,including 78 male patients(94.0%)and 5 female patients(6%).According to the results of vascular remodeling at the end of follow-up,the patients were divided into two groups:complete remodeling group(n=37)and partial remodeling group(n=46).The rate of complete vascular remodeling was 44.6%.There were 36 male patients(97.3%)and 1 female patient(2.7%)in the complete remodeling group,with an average age of(51.76±8.19)years.In the partial remodeling group,there were 42 male patients(91.3%)and 4 female patients(8.7%).The average age was(53.80±8.16)years old.There was no significant difference in sex,age,hospitalization days,abdominal pain relief time,BMI,concomitant diseases and clinical manifestations between the two groups.The average hospitalization time of all patients was(8.07±2.21)days,and the average relief time of abdominal pain symptoms after admission was(3.99±1.85)days.There was no significant difference in hospitalization days and abdominal pain relief time between the two groups(P>0.05).In terms of concomitant diseases,77 of the 83 patients were complicated with one or more basic diseases,including 42 cases of hypertension(50.6%),13 cases of diabetes(15.7%),10 cases of coronary heart disease(12.0%),and 12 cases of dyslipidemia(14.5%).There was no significant difference in concomitant diseases between the two groups(P>0.05).In terms of clinical manifestations,the main clinical manifestations included abdominal pain in 80 cases(96.4%),vomiting in 33 cases(39.8%),diarrhea in 9 cases(10.8%),abdominal distension in 11 cases(13.3%),bloody stool in 5 cases(6%),and so on.In terms of the location of abdominal pain,there were 47 cases of periumbilical pain(56.6%),29 cases of epigastric pain(34.9%),2 cases of lower abdominal pain(2.4%)and 2 cases of total abdominal pain(2.4%).There was no significant difference in clinical manifestation and location of abdominal pain between the two groups(P>0.05).5.Results of univariate and multivariate analysis:univariate analysis showed that Yun classification,SAA,distance from dissection to AA,length of dissection,stenosis of true cavity>70%,symptoms of abdominal pain,neutrophil count and NLR were related to vascular remodeling.There were significant differences in Yun classification,SAA,distance from dissection to AA,length of dissection,stenosis of true cavity>70%,symptoms of abdominal pain,neutrophil count and NLR between the two groups(P<0.05).Multivariate binary Logistic regression analysis showed that interlayer length(OR=1.063,95%CI 1.023-1.105,P<0.05),true cavity stenosis>70%(OR=8.464,95%CI 1.476-48.537,P<2.479),Yun classification(OR=0.536,95%CI0.050-5.779,P<2.479),NLR(OR=1.658,95%CI 1.109-2.479),P<0.05)is an independent risk factor for vascular remodeling.Conclusion:1.For the treatment of SISMAD,most of them achieved good results in clinical symptom relief and vascular remodeling through conservative treatment.2.Complete vascular remodeling is common in patients with conservative treatment of SISMAD.In Yun classification,most of the patients with complete vascular remodeling showed type Ⅱ a or Ⅱ b,while those with partial remodeling showed type II a.There are clinical symptoms in some patients during SISMAD follow-up.Regular CTA examination during follow-up is the first choice to evaluate whether good vascular remodeling occurs in SMA.3.According to the analysis,dissection length,true lumen stenosis>70%,Yun classification and NLR are independent risk factors for vascular remodeling in SISMAD.Early identification of related risk factors plays an important role in vascular remodeling in SISMAD. |
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