title: The value of a new image classification system for planning treatment and prognosis of spontaneous isolated superior mesenteric artery dissection.
abstract: OBJECTIVE
  To aid diagnosis of spontaneous isolated superior mesenteric artery dissection and planning management, we investigated the role of classification of features as observed on computed tomography angiography images.
  
  
  METHODS
  A retrospective study was conducted, comprising computed tomography angiography images and clinical data of 28 consecutive patients with spontaneous isolated superior mesenteric artery dissection. Based on the computed tomography angiography images, a new classification for spontaneous isolated superior mesenteric artery dissection was proposed. Patients with intestinal ischemia not relieved or worsened after 10 days of conservative treatment underwent surgery or stenting. All patients were followed up with computed tomography angiography.
  
  
  RESULTS
  Spontaneous isolated superior mesenteric artery dissection was categorized into five types (I-V). Type III was further divided into subtypes IIIa-IIIc. Spontaneous isolated superior mesenteric artery dissection IIIa and IV typified nine (32.1%) and seven (25%) patients, respectively. Six (21.4%) patients had aortic or branch artery abnormalities and 21 (78%) showed prior intestinal ischemia. Four (14.3%) patients had intestinal ischemia and underwent surgery or stenting.
  
  
  CONCLUSIONS
  Spontaneous isolated superior mesenteric artery dissection type IIIa is more likely to occur than other types. Long-term computed tomography angiography follow-up is valuable for determining treatment strategy for spontaneous isolated superior mesenteric artery dissection. Conservative therapy with anticoagulants is recommended for five days, and surgery or stenting should be considered if symptoms of intestinal ischemia are not relieved. Stent implantation provides relatively satisfactory mid-term outcome for true lumen construction of the superior mesenteric artery.
authors.affiliation: Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, P.R. China.
authors.forename: Jiang
authors.initials: J
authors.lastname: Xiong
authors.affiliation: Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, P.R. China.
authors.forename: Zhongyin
authors.initials: Z
authors.lastname: Wu
authors.affiliation: Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, P.R. China xiongjiangdoc@126.com.
authors.forename: Wei
authors.initials: W
authors.lastname: Guo
authors.affiliation: Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, P.R. China.
authors.forename: Xiaoping
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, P.R. China.
authors.forename: Lijun
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, P.R. China.
authors.forename: Hongpeng
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, P.R. China.
authors.forename: Xin
authors.initials: X
authors.lastname: Jia
authors.affiliation: Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, P.R. China.
authors.forename: Xiaohui
authors.initials: X
authors.lastname: Ma
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000145:classification / Q000000981:diagnostic imaging* / Q000628:therapy; D015901:Angiography, Digital Subtraction; D000925:Anticoagulants / Q000627:therapeutic use; D057510:Endovascular Procedures / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging*; D065666:Mesenteric Ischemia / Q000145:classification / Q000000981:diagnostic imaging* / Q000628:therapy; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
chemical_list: D000925:Anticoagulants
keywords: Superior mesenteric artery; computed tomography angiography; spontaneous isolated superior mesenteric artery dissection; treatment strategy