Clinical course and angiographic changes of spontaneous isolated superior mesenteric artery dissection after conservative treatment.
OBJECTIVE
The aim of this study was to evaluate the clinical course and angiographic changes of spontaneous isolated superior mesenteric artery dissection (SISMAD) after conservative treatment.


METHODS
Twenty-four patients with SISMAD admitted from September 2006 through March 2013 were included in this study. The clinical characteristics, type and location of the dissection, clinical outcome and angiographic changes were analyzed retrospectively.


RESULTS
The median follow-up was 18.7 months (range 1.4-67.5 months). Eighteen patients (75 %) were symptomatic, and the median duration of abdominal pain was 2.5 days. All of the patients were treated conservatively. Follow-up computed tomography angiography showed complete remodeling in six patients (25 %), partial remodeling in four patients (17 %), no changes in nine patients (38 %), progression to total occlusion in four patients (17 %) and aneurysmal changes of the false lumen in one patient (4 %). Endovascular intervention was performed in the patient with aneurysmal changes. There was no mortality or morbidity related to the dissection.


CONCLUSIONS
SISMAD represented variable angiographic changes, and its clinical course was benign in this study. For patients with SISMAD, if there is no evidence of bowel infarction, bleeding or aneurysmal changes, conservative treatment with close follow-up is sufficient and could reduce unnecessary endovascular interventions.
Department of Vascular Surgery, Dongsan Medical Center, Keimyung University School of Medicine, 56 Dalseong-Ro, Jung-Gu, Daegu, 700-712, Korea, junapark@dsmc.or.kr.
Ui Jun
UJ
Park
Hyoung Tae
HT
Kim
Won Hyun
WH
Cho
Young Hwan
YH
Kim
Tetsuro
T
Miyata
D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging* / Q000628:therapy*; D000792:Angiography; D057510:Endovascular Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging*; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed