title: Isolated dissection of the superior mesenteric artery treated using open emergency surgery.
abstract: BACKGROUND
  Isolated dissection of the superior mesenteric artery (IDSMA) remains a rare diagnosis. However, new diagnostic means such as computed tomography makes it possible to detect even asymptomatic patients. If patients present symptomatic on admission, the risk of bowel infarction makes immediate therapy necessary. Today, endovascular techniques are often successfully used; however, open surgery remains important for special indications. In this paper, we present two cases with IDSMA and show why open surgical repair is still important in current treatment concepts.
  
  
  METHODS
  Two cases with ISDMA that presented in our department from January 1, 2014 to June 1, 2014 are described. Data collection was performed retrospectively. Additionally, a review of articles which reported small cases series on patients with IDSMA within the past five years is provided.
  
  
  RESULTS
  Both patients underwent open surgical repair following interdisciplinary consultation. Both patients were transferred to the intensive care unit after surgical repair and needed bowel rest, nasogastric suction and intravenous fluid therapy. CT scans were performed within the first week after operation. Platelet aggregation inhibitors were used in both cases as postoperative medication. Both patients survived and are able to participate in everyday activities.
  
  
  CONCLUSIONS
  Open surgical repair remains important in cases of anatomic variants of visceral arteries and suspected bowel infarction. Therefore, it is important that knowledge about open surgical techniques still be taught and trained.
authors.affiliation: Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Moorenstraße.5, 40225 Düsseldorf, Germany.
authors.forename: Markus Udo
authors.initials: MU
authors.lastname: Wagenhäuser
authors.affiliation: Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Moorenstraße.5, 40225 Düsseldorf, Germany.
authors.forename: Tolga Atilla
authors.initials: TA
authors.lastname: Sagban
authors.affiliation: Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Moorenstraße.5, 40225 Düsseldorf, Germany.
authors.forename: Mareike
authors.initials: M
authors.lastname: Witte
authors.affiliation: Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Moorenstraße.5, 40225 Düsseldorf, Germany.
authors.forename: Mansur
authors.initials: M
authors.lastname: Duran
authors.affiliation: Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Moorenstraße.5, 40225 Düsseldorf, Germany.
authors.forename: Hubert
authors.initials: H
authors.lastname: Schelzig
authors.affiliation: Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Moorenstraße.5, 40225 Düsseldorf, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Oberhuber
keywords: Aorta; Bowel infarction; Dissection; Open surgery; Superior mesenteric artery