title: Management strategy for spontaneous isolated dissection of the superior mesenteric artery based on morphologic classification.
abstract: OBJECTIVE
  To explore a therapy strategy for the spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) based on morphologic classification.
  
  
  METHODS
  Forty-two symptomatic patients with SIDSMA presenting with abdominal pain between January 2007 and December 2012 were 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
  Twenty-four patients received only observation treatment, seven received open surgery, and 11 received endovascular therapy. True lumen residual diameter in the observation group (46.6%) was statistically better than that in the surgery group (0%) and the endovascular group (18.3%) (P < .05). There was clinical progression in three and imaging progression in seven of the observation group, of which two patients received endovascular treatment and one patient died of bowel infarction. There were two clinical progressions and one imaging progression in the surgery group, of which two patients received additional surgery and one patient 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.
authors.affiliation: Department of Vascular Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Dong-lin
authors.initials: DL
authors.lastname: Li
authors.affiliation: Department of Vascular Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Yang-yan
authors.initials: YY
authors.lastname: He
authors.affiliation: Department of Vascular Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Adel M
authors.initials: AM
authors.lastname: Alkalei
authors.affiliation: Department of Vascular Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Xu-dong
authors.initials: XD
authors.lastname: Chen
authors.affiliation: Department of Vascular Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Jin
authors.affiliation: Department of Vascular Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Vascular Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China. Electronic address: doczhk@yahoo.com.cn.
authors.forename: Hong-kun
authors.initials: HK
authors.lastname: Zhang
authors.affiliation: Department of Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China. Electronic address: liangtingbo@zju.edu.cn.
authors.forename: Ting-bo
authors.initials: TB
authors.lastname: Liang
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000145:classification* / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016009:Chi-Square Distribution; D018450:Disease Progression; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D057832:Watchful Waiting