Clinical Feature And Therapeutic Option Of Spontaneous Isolated Of Superior Mesenteric Artery Dissection

Objective To explore the clinical features and therapeutic option of spontaneous isolated of superior mesenteric artery dissection (SISMAD).Methods29patients with SISMAD from Feb.2008through Jan.2014treated in Wuhan Union Hospital were retrospectively analyzed to investigate the clinical features and therapy option of this disease. Its prognosis was also estimate through the follow-up with them. Conservative treatment were implemented for the symptomatic SISMAD patients without bowel necrosis after they were admitted to our hospital-Conservative treatment was initially carried out in25patients.5cases of them received endovascular therapy due to ineffective conservative treatment.4patients underwent urgent surgery because of small bowel ischemia and varying degrees of peritoneal irritation sign.2of them received thrombectomy plus intimectomy, and intra-artery transcatheter thrombolytic therapy plus bare stent placement before open-surgery, respectively.Results There were29patients in our investigation,of which lease was female,other were all men.The average age of them is53.The symptoms were totally under control in7days without recurrence during the follow-up period of1-46months by conservative treatment in20cases. CTA demonstrated diminished extent and length of dissection or completed remodeling of dissection in14cases, no change of dissection in2cases. The good results were seen in5cases following endovascular therapy at a median follow-up of11.8months. CTA showed disappeared or thrombosed false lumen with the patency of true lumen. Among4patients with surgery, one was died of multiple organ failure. The remaining3patients were well recovered after operation. Conclusion The therapeutic regimen should be formulated on the basic of both imaging examination results and clinical manifestation. Conservative treatment for most of patients with SISMAD is effective. Endovascular therapy should be recommended for the patients with persistent abdominal symptoms or progressing of dissection or even manifesting signs of peritoneal irritation by conservative treatment. Surgery is mainly indicated for the patients related to intestinal ischemia or rupture of aneurysm.