title: Spontaneous and isolated dissection of the superior mesenteric artery: proposal of a management algorithm.
abstract: BACKGROUND
  Spontaneous and isolated dissection of the superior mesenteric artery (SIDSMA) is a rare pathology, and the treatment of symptomatic forms is not consensual. The objective of this study was to analyze the management of a series of patients presenting a symptomatic SIDSMA within a structure taking care of intestinal vascular emergencies.
  
  
  METHODS
  From January 2010 to January 2014, the patients presenting a symptomatic SIDSMA were included retrospectively. The clinical and radiologic data as well as the treatment and the follow-up were analyzed.
  
  
  RESULTS
  Nine patients were included. Among them, 2 patients presenting with acute mesenteric ischemia were revascularized surgically in emergency, and 1 patient presenting a rupture of a superior mesenteric artery aneurysm had an arteriography followed by medical care. The 6 other patients received medical treatment. Among these, 2 patients developed mesenteric angina requiring surgical revascularization during the follow-up.
  
  
  CONCLUSIONS
  The revascularization of spontaneous and isolated dissections of the superior mesenteric artery is indicated in the cases complicated with acute mesenteric ischemia, aneurysmal rupture, or in the event of appearance of mesenteric angina or aneurysmal evolution. It should also be discussed in the event of failure of the medical treatment.
authors.affiliation: Service de chirurgie vasculaire, Hôpital Bichat, Paris, France. Electronic address: arnaudkiem.roussel@gmail.com.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Roussel
authors.affiliation: Service de chirurgie vasculaire, Hôpital Bichat, Paris, France.
authors.forename: Quentin
authors.initials: Q
authors.lastname: Pellenc
authors.affiliation: Service de gastro-entérologie et assistance nutritive, Hôpital Beaujon, Clichy, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Corcos
authors.affiliation: Service de chirurgie vasculaire, Hôpital Bichat, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Tresson
authors.affiliation: Service de chirurgie vasculaire, Hôpital Bichat, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Cerceau
authors.affiliation: Service de chirurgie vasculaire, Hôpital Bichat, Paris, France.
authors.forename: Fady
authors.initials: F
authors.lastname: Francis
authors.affiliation: Service de chirurgie vasculaire, Hôpital Bichat, Paris, France.
authors.forename: Rabih
authors.initials: R
authors.lastname: Houbballah
authors.affiliation: Service de chirurgie vasculaire, Hôpital Bichat, Paris, France.
authors.forename: Guy
authors.initials: G
authors.lastname: Leseche
authors.affiliation: Service de chirurgie vasculaire, Hôpital Bichat, Paris, France.
authors.forename: Nikos
authors.initials: N
authors.lastname: Paraskevas
authors.affiliation: Service de radiologie, Hôpital Bichat, Paris, France.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Pasi
authors.affiliation: Service de chirurgie vasculaire, Hôpital Bichat, Paris, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Castier
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000784:Aortic Dissection / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D019091:Critical Pathways; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging / Q000601:surgery*; D065666:Mesenteric Ischemia / Q000175:diagnosis / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome