title: Management strategy of isolated spontaneous dissection of the superior mesenteric artery.
abstract: OBJECTIVE
  Isolated spontaneous dissection of the superior mesenteric artery (SMA) is very rare among of the visceral artery dissection and its treatment is not established. In this paper we present our experiences and consider the treatment of isolated SMA dissection.
  
  
  METHODS
  A retrospective review of our cases from 2005 was performed. Clinical symptoms, radiologic findings and results were evaluated. There were 14 cases of visceral artery dissection, in which all cases were with SMA dissection. There were 12 males and 2 females with a mean age of 57 years (range 41-78 years).
  
  
  RESULTS
  We categorized SMA dissection into the six types according to the Sakamoto's and Zerbib's classification. One patient with type VI underwent emergent endovascular surgery with stent. One patient with type VI received thrombectomy and intimectomy with open surgery. One patient with type II underwent aneurysmectomy due to enlarged dissected SMA 3 months later from onset. The other eleven patients were managed conservatively. At follow-up, the diameter of SMA did not enlarged and the length of the dissection significantly decreased to 20.7 ± 15.7 mm from 38.0 ± 15.1 mm at onset (p <0.01). After treatment, imaging indicated the following changes in classification: type I, one patient; type II, 4 patients; type IV, 4 patients; complete remodeling, one patient, all without any event during the follow-up period of 5-82 months.
  
  
  CONCLUSIONS
  Most patients with isolated visceral artery dissection occurred in superior mesenteric artery and can be treated conservatively; however, endovascular or surgical procedures including laparotomy are indicated when there is suspicion of severe mesenteric ischemia. Because the dissection configuration will change, long term follow-up is necessary. (English translation of Jpn J Vasc Surg 2013; 22: 695-701).
authors.affiliation: Department of Cardiovascular Surgery, Fukushima Medical University, School of Medicine, Fukushima, Fukushima, Japan.
authors.forename: Hirono
authors.initials: H
authors.lastname: Satokawa
authors.affiliation: Department of Cardiovascular Surgery, Fukushima Medical University, School of Medicine, Fukushima, Fukushima, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Takase
authors.affiliation: Department of Cardiovascular Surgery, Fukushima Medical University, School of Medicine, Fukushima, Fukushima, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Seto
authors.affiliation: Department of Cardiovascular Surgery, Fukushima Medical University, School of Medicine, Fukushima, Fukushima, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yokoyama
authors.affiliation: Department of 1st Surgery, Fukushima Medical University, School of Medicine, Fukushima, Fukushima, Japan.
authors.forename: Mitsukazu
authors.initials: M
authors.lastname: Gotoh
authors.affiliation: Department of 1st Surgery, Fukushima Medical University, School of Medicine, Fukushima, Fukushima, Japan.
authors.forename: Michihiko
authors.initials: M
authors.lastname: Kogure
authors.affiliation: Department of Cardiovascular Surgery, Minami Tohoku General Hospital, Kooriyama, Fukushima, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Midorikawa
authors.affiliation: Department of Circulatory Internal Medicine, Shirakawa Kosei General Hospital, Shirakawa, Fukushima, Japan.
authors.forename: Tomiyoshi
authors.initials: T
authors.lastname: Saito
authors.affiliation: Department of Circulatory Internal Medicine, Shirakawa Kosei General Hospital, Shirakawa, Fukushima, Japan.
authors.forename: Kazuhira
authors.initials: K
authors.lastname: Maehara
keywords: abdominal open surgery; endovascular treatment; spontaneous isolated dissection of superior mesenteric artery; visceral artery dissection