Management Strategy For Spontaneous Isolated Dissection Of The Superior Mesenteric Artery Based On Morphologic Classification

The Objective:To explore a therapy strategy for the spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) based on morphologic classification.Methods:56symptomatic patients with SIDSMA presenting with abdominal pain between January2007and August2013were enrolled in this retrospective study. We proposed a new morphologic classification with subtypes depending on the patency of the true lumen and reviewed the patients’clinical features, risk factors, computed tomography images (morphologic classification, location of entry site, dissection length, and true lumen residual diameter), treatment modalities, and follow-up results.Results:33patients received only observation treatment,7received open surgery, and16received endovascular therapy. True lumen residual diameter in the observation group (46.9%) was statistically better than that in the surgery group (0%) and the endovascular group (23.3%)(P<.05). There was clinical progression in3and imaging progression in7of the observation group, of which2patients received endovascular treatment and1patient died of bowel infarction. There were2clinical progressions and1imaging progression in the surgery group, of which2patients received additional surgery and1patient died of bowel infarction. The endovascular group obtained encouraging results with no progressions or complications. Conclusions:Symptomatic patients with SIDSMA are at risk of progression. We suggested a morphologic classification to guide the treatment. We recommend observation treatment with close follow-up for patients with patent true lumen flow and endovascular intervention for high-risk patients with true lumen stenosis or occlusion. Surgery is indicated for patients with suspected bowel infarction or arterial rupture.