Management of isolated spontaneous dissection of superior mesenteric artery.
OBJECTIVE
Our objectives were to clarify the management of isolated spontaneous dissection of the superior mesenteric artery (DSMA).


METHODS
We reviewed seven patients diagnosed as having DSMA from 2002 to 2007 (group A). Simultaneously, we analyzed 50 cases of DSMA previously reported in the literature between 2000 and 2008 (group B). In each group, clinical presentation, Sakamoto's classification, imaging appearances, need for emergent surgery, failure of medical management, and long-term outcome were analyzed.


RESULTS
In group A, according to Sakamoto's classification, there were two type I, two type II, and three type III. Two patients needed surgery (one type II, one type III). In group B, according to Sakamoto's classification, there were seven type I, five type II, 14 type III, and six type IV. Intestinal revascularization was necessary for 21 patients, especially for types II and III, while medical management was more frequent for types I and IV. We identified four indications for intestinal revascularization: acute mesenteric ischemia with mesenteric thrombosis, arterial rupture, chronic mesenteric ischemia with superior mesenteric artery (SMA) stenosis, and SMA dissecting aneurysm of at least 2 cm in diameter. If abdominal pain lasts for more than 1 week, types I and IV were able to be medically managed, whereas intestinal revascularization has to be considered in types II and III.


CONCLUSIONS
Patients with symptoms lasting for more than 1 week, aneurysmal dilatation more than 2 cm in diameter, and SMA stenosis are suitable candidates for surgical management.
Zerbib
Philippe
P
Digestive Surgery and Transplantation Department, Claude Huriez Hospital, Lille University Medical Center, Lille, France. p-zerbib@chru-lille.fr
Perot
Céline
C
Lambert
Marc
M
Seblini
Mohamad
M
Pruvot
François René
FR
Chambon
Jean Pierre
JP
D000328:Adult; D000784:Aortic Dissection / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior; D008875:Middle Aged; D012189:Retrospective Studies; D012422:Rupture, Spontaneous