Clinical Diagnosis And Treatment Analysis Of Spontaneous Solitary Superior Mesenteric Artery Dissection

BackgroundThe superior mesenteric artery dissection was once thought to be caused by the aortic dissection involving the superior mesenteric artery,and the spontaneous isolated superior mesenteric artery dissection was first described by Bauersfeld in 1947.Rarely reported in the early world,often in the form of rare case reports,with the advancement of imaging techniques,abdominal computed tomography examination is increasingly used in patients with acute abdominal pain,making the number of SISMAD patients diagnosed has increased significantly.As a result,SISMAD has received increasing attention.The cause of SISMAD is still unclear.At present,it is widely accepted that pathological changes of blood vessel walls and connective tissue diseases.Hemodynamic changes:SMA walks on the mechanical shear stress of the lower edge of the pancreas.Changes in the branching angle of the vascular at the beginning of the SMA cause hemodynamic stress changes,oscillating mechanical stress,increased SMA blood flow,hypertension,smoking history,high levels of homocysteine,gene mutations,etc.Clinical manifestations are mostly abdominal pain.In order to facilitate the management and treatment of diseases,scholars have carried out imaging classification of diseases.Treatment mainly includes conservative treatment,endovascular treatment and open surgery.There is no standardized treatment plan at present,but most scholars believe that conservative treatment can achieve satisfactory results,and it is recommended as the initial choice.ObjectiveTo investigate the clinical features,diagnosis and treatment of patients with spontaneous isolated superior mesenteric artery dissection.MethodsRetrospective analysis of 16 patients with spontaneous isolated superior mesenteric artery dissection in the Department of Vascular Surgery,Yangzhou University Affiliated Hospital from May 2012 to May 2017,including 14 males and 2 females,aged 39-60 Aged,average age(49.6±2.8)years old.All patients were diagnosed by computed tomographic angiography.Diagnostic criteria:Double-cavity structure is seen in SMA,contrast agent is seen in double lumen;inner membrane is formed in SMA,and even eccentric calcification plaque is visible;semilunar structure can be seen in SMA wall,which may be accompanied by ulcer and communicate with arterial cavity;At the same time,the aorta and other visceral arteries are unobstructed,and there is no manifestation of dissection.Of these,11 patients underwent conservative treatment,5 underwent endovascular treatment,1 underwent balloon angioplasty(PTA),and no stents were placed;4 patients underwent balloon dilatation+stent implantation,total implantation 5 self-expanding bare stents;2 cases with transfemoral approach,3 cases with left iliac artery approach,in order to avoid distal vasospasm during operation,routine transcatheter injection of papaverine 30 mg dilution.All patients were followed up for 3 months,6 months,12 months,and 24 months after treatment,and the prognosis of abdominal CTA was followed up.To understand the changes of SMA stenosis rate,whether there was recurrence of the dissection,whether the stent was displaced or not,and the blood flow in the stent was recorded.The patient's abdominal pain,diet,drug use,and comorbidity control were recordedResults1 Patients who underwent conservative treatment,anticoagulant therapy,fasting and/or gastrointestinal decompression,analgesia,dilatation of blood vessels,inhibition of vasospasm,nutritional support treatment,patients with abdominal pain gradually disappeared,review of abdominal CTA after 1 week.The patient's SISMAD was not significantly aggravated,and the blood flow in the lumen was smooth2 The success rate of surgical technique in patients undergoing endovascular treatment was 100%.The angiography showed that the SMA had good blood circulation,the SMA branch vessels were well developed,and the volume of the false lumen was small.None of the 16 patients had abdominal pain during the follow-up period.CTA showed that the dissection cavity was not developed,the stent was unobstructed,and there were no serious complications such as intestinal necrosis and death.ConclusionThe most patients of spontaneous isolated superior mesenteric artery dissection,can achieve a satisfactory therapeutic effect after conservative treatment.If the true stenosis is severe,involving the distal ileal artery,abdominal pain cannot be relieved or relapsed,or severe persistent intestinal ischemia occurs,endovascular treatment or surgery should be considered.