| Objective:1.To explore a new CT classification of spontaneous isolated superior mesenteric artery dissection(SISMAD)by analyzing the morphological characteristics.2.To discuss the guiding value of the new classification for the treatment strategy of SISMAD based on the new classification method and the clinical experience in our center.Method:The clinical data of 56 patients with SISMAD treated in our department from August 2012 to December 2018 were retrospectively analyzed and categorized according to the new imaging classification: Type I: patent false lumen with both entry and reentry(Ia: false lumen without thrombosis;Ib: partial thrombosis of false lumen,patent false lumen;Ic: thrombosed false lumen with ulcerous entry and reentry).Type II: false lumen without reentry(?a: false lumen without thrombosis;? b: completely thrombosed false lumen without ulcer-like projection;? c:thrombosed false lumen with ulcer-like projection).Type III: thrombosed true lumen.To evaluate the guiding value of the new classification for treatment and the better treatment strategy was put forward.combined with the specific treatment plan and effect follow-up.Results:There were 56 patients were included in this study,including 7 females and 49 males.The mean age was(56.0 ± 9.2)years(range,35–87),there were 33 cases(58.9%)were complicated with hypertension and 18 cases(32.1%)had a long history of smoking.There were 55 cases with symptoms and 1 case without prominent symptoms.The proportion of conservative treatment for type I dissection was large,in which,type Ia was the primary type;the difference was statistically significant(P = 0.006).The proportion of endovascular treatment for type II was high,especially for type IIc;the difference is statistically significant(P = 0.001).There was no significant difference between the two treatment methods for type III dissection.The improvement time of symptoms in the conservative treatment group was significantly longer than that of the endovascular treatment group(6.4±1.6 vs 2.2±1.1,P < 0.001).Follow-up for 6 months showed that the dissection remodeling rate in conservative treatment was lower than the endovascular treatment and the difference was statistically significant(P < 0.001).Endovascular treatment included23 cases of single stent implantation and 16 cases of stent-assisted coiling.The patients were followed up for 1 to 60 months,with an average follow-up of(10.9±12.5)months.There was no significant difference between both treatments in improvement time of symptoms,dissection remodeling rate and superior mesenteric artery(SMA)trunk patency rate at 6 months after the procedure,but 3 months after endovascular treatment,the dissection remodeling rate in stent-assisted coiling group was higher than the stent implantation group,the difference was statistically significant(P =0.020).Conclusion:Conservative treatment with drugs can be carried out for patients who are asymptomatic or classified as type I;the curative effect is definite.Close follow-up observation is recommended for type IIa and type IIb dissection.For high-riskpatients with failed conservative treatment,severe stenosis of the true lumen and dissecting aneurysm,and classified as type IIc,endovascular intervention should be taken actively.For type III patients with mild clinical symptoms and collateral blood supply confirmed by imaging examination,conservative treatment can be given;but if there were apparent abdominal pain symptoms,endovascular treatment is recommended to restore SMA in time.The new classification of SISMAD has a certain guiding significance for the treatment of the disease.The symptoms in the conservative treatment group were relieved slowly.Endovascular treatment is safe and effective.It can rapidly improve the symptoms of patients,and stent-assisted coiling could reconstruct the dissection more quickly.The short-term efficacy of endovascular treatment is satisfactory,but its long-term effectiveness still needs further evaluation. |
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