Endovascular stent placement for treatment of spontaneous isolated dissection of the superior mesenteric artery.
BACKGROUND
Spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) is a rare condition often associated with a poor prognosis. The goal of this study is to assess the efficacy of endovascular treatment of SIDSMA with stenting and investigate the possible therapeutic mechanisms involved.


METHODS
This is a retrospective review of all patients undergoing endovascular treatment of SIDSMA from January 2009 to December 2011. Patient demographics, history, clinical presentation, laboratory tests, image characteristics, endovascular treatments, and follow-up outcome were analyzed.


RESULTS
Twenty-four patients with symptoms were treated. All except 1 patient (23 of 24, 96%) underwent successful stent placement (16 with single stent and 7 with overlapping stents). A total of 30 stents (4 balloon-expanded and 26 self-expanding) were placed during the procedures. In the perioperative period and during follow-up, symptom relief was achieved in 20 (83%) patients, and abdominal pain remained unchanged in 4 (17%). No death or serious complications occurred. The median length of hospital stay and follow-up was 3.25 ± 2.23 days (range 2-7 days) and 13.15 ± 8.27 months (range 6-23 months), respectively. Computed tomography angiography (CTA) performed 6 months postoperatively revealed stent patency in 23 cases (100%), false lumen patency in 5 cases (22%), and new development of dissection in the SMA distal to the stent in 1 case (4%). No significant differences were observed in the incidence of false lumen patency between patients treated with a single stent and those treated with overlapping stents, and between patients with and without symptom relief (P > 0.05 for both).


CONCLUSIONS
For symptomatic SIDSMA patients without intra-abdominal hemorrhage and intestinal infarction, endovascular stent placement is a feasible treatment choice with a high success rate and good clinical outcome. Overlapping stenting may be proposed for patients with aneurysmal dilation. False lumen patency may occur in some cases during follow-up, but it does not affect improvement of SIDSMA symptoms.
Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Nan
N
Li
Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Qing-Sheng
QS
Lu
Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Jian
J
Zhou
Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Jun-Min
JM
Bao
Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Zhi-Qing
ZQ
Zhao
Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China. Electronic address: vasc065linan@sina.com.
Zai-Ping
ZP
Jing
D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D015901:Angiography, Digital Subtraction; D000800:Angioplasty, Balloon / Q000295:instrumentation; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging / Q000503:physiopathology; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D013152:Splanchnic Circulation; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency