Real clinical management of patients with isolated superior mesenteric artery dissection in Japan (original) (raw)
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Korean Circulation Journal, 2019
The objective of this study was to analyze the three different management modalities for isolated superior mesenteric artery (SMA) dissection. We did a comprehensive literature search and found 703 articles on the initial search, out of which 111 articles consisting of 145 patients were selected for analysis. The mean age was 55.7 years (standard deviation,9.7;33-85) and 80.6% were male. These patients were managed conservatively (41.3%), endovascularly (28.1%) or surgically (30%). The median follow-up was 10 months (interquartile range [IQR], 4-18 months), 12 months (IQR, 6-19 months) and 14 months (IQR, 6-20 months) respectively. Contrast-enhanced computed tomography (CT) was the most commonly used diagnostic tool in the conservative group (43.8%), while conventional CT scan was the most widely used in endovascular (58.1%) and surgical group (50%). 17% percent of the conservative group had SMA angiography for diagnosis, while this was less than 3% in the other groups. Of these patients, 96.7%, 97.4%, and 100.0% recovered successfully in the conservative, endovascular, and surgical groups respectively. There was no significant difference in the mortality between the three groups (Pearson χ 2 =0.482). This suggests a conservative and endovascular approach could be used in most patients, which can reduce costs and surgery-related morbidity and mortality. Surgical management should be reserved for cases having infarction or widespread bowel ischemia and in cases where other treatment modalities fail.
Journal of Vascular Surgery, 2014
Objective: To explore a therapy strategy for the spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) based on morphologic classification. Methods: Forty-two symptomatic patients with SIDSMA presenting with abdominal pain between January 2007 and December 2012 were enrolled in this retrospective study. We proposed a new morphologic classification with subtypes depending on the patency of the true lumen and reviewed the patients' clinical features, risk factors, computed tomography images (morphologic classification, location of entry site, dissection length, and true lumen residual diameter), treatment modalities, and follow-up results. Results: Twenty-four patients received only observation treatment, seven received open surgery, and 11 received endovascular therapy. True lumen residual diameter in the observation group (46.6%) was statistically better than that in the surgery group (0%) and the endovascular group (18.3%) (P < .05). There was clinical progression in three and imaging progression in seven of the observation group, of which two patients received endovascular treatment and one patient died of bowel infarction. There were two clinical progressions and one imaging progression in the surgery group, of which two patients received additional surgery and one patient died of bowel infarction. The endovascular group obtained encouraging results with no progressions or complications. Conclusions: Symptomatic patients with SIDSMA are at risk of progression. We suggested a morphologic classification to guide the treatment. We recommend observation treatment with close follow-up for patients with patent true lumen flow and endovascular intervention for high-risk patients with true lumen stenosis or occlusion. Surgery is indicated for patients with suspected bowel infarction or arterial rupture.
The American Journal of Emergency Medicine, 2006
Isolated superior mesenteric artery dissection is a rare condition, predominantly observed in men with the greatest incidence over the age of forty. The contrast-enhanced multi-detector computed tomography is considered essential for diagnosis, therapeutic management and follow-up. Therapeutic approach ranges from conservative medical treatment to surgery or endovascular stent placement, but there are, to date, no approved guidelines. We report the case of a 68-years-old man, which was admitted to our Emergency Department just for mild abdominal pain, which, later, proved to have acute superior mesenteric artery dissection. N o n -c o m m e r c i a l u s e case of a 68-years-old man, which was admitted to our Emergency Department just for mild u s e case of a 68-years-old man, which was admitted to our Emergency Department just for mild abdominal pain, which, later, proved to have acute superior mesenteric artery dissection. u s e abdominal pain, which, later, proved to have acute superior mesenteric artery dissection.
Management strategy of isolated spontaneous dissection of the superior mesenteric artery
Annals of vascular diseases, 2014
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. 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). 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 conservative...
Acta Cardiologica Sinica, 2017
The current standard care for acute mesenteric ischemia (AMEI) involves urgent revascularization and resection of the necrotic bowel. Since 2012, we have used an AMEI protocol of our own design, which focused on early treatment and allowed interventional cardiologists to become involved when interventional radiologist was not available. A total of 8 patients were treated, and two interventional cardiologists performed all the stenting procedures. The procedure success rate was 100% in patients with non-calcified lesions (6/8). The 30-day survival rate was 100% in patients with angiographic success, and was 0% in patients with failed procedure. In two patients with total occlusion of the superior mesenteric artery, laparotomy was avoided when interventions were successful and completed within six hours of protocol activation. Four surviving patients were discharged after short intensive care unit stays (less than 48 hours); these patients returned to and remained at home throughout t...
Endovascular treatment of a case presented as isolated superior mesenteric artery dissection
Saudi medical journal, 2016
Endovascular treatment of a case presented as isolated superior mesenteric artery dissection Clinical Presentation * Upon acceptance of a paper all authors must be able to provide the full paper for each reference cited upon request at any time up to publication. * Only 1-2 up to date references should be used for each particular point in the text.
Symptomatic spontaneous superior mesenteric artery dissection treated with endovascular stent repair
Journal of Surgical Case Reports, 2021
Spontaneous isolated superior mesenteric artery dissection (SISMAD) is a rare condition in which patients develop an isolated dissection of the superior mesenteric artery without traumatic or iatrogenic causes. We present the case of a 52-year-old woman who presented with SISMAD and underwent endovascular stenting as her symptoms failed to respond to medical management. We also spend the bulk of the report discussing the current literature on management of SISMAD.
Epidemiology and Prognostic Factors in Acute Superior Mesenteric Artery Occlusion
Journal of Gastrointestinal Surgery, 2010
Reports on trends in incidence and mortality of acute superior mesenteric artery (SMA) occlusion and evaluation of prognostic factors in recent years are lacking. Patients with acute SMA occlusion were identified through the in-patient and autopsy registry between 1970 and 1982 (n = 270), 1987 to 1996 (n = 135), and 2000 and 2006 (n = 100) in Malmö, Sweden. The overall incidence rate decreased from 8.6 to 5.4/100,000 person years and the autopsy rate from 87% to 25% over time. A higher serum creatinine level was associated with a lower probability of undergoing multi-detector row computed tomography with intravenous contrast (MDCTiv) (p = 0.006). Not performing a MDCTiv (odds ratio 4.0; 95% confidence interval [1.0-16.0]) remained as independent prognostic factor for in-hospital mortality. General and vascular surgeons collaborated in 25 out of 61 patients that underwent an intervention, of which 21 (84%) (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) survived. A close collaboration between radiologists and general and vascular surgeons seems to be most important to lower the mortality in patients with acute SMA occlusion.
Catheterization and Cardiovascular Interventions, 2009
Isolated spontaneous superior mesenteric artery (SMA) dissection is a rare and sporadically reported condition. Therapeutic options include medical treatment, surgery, and endovascular treatment. However, the optimal treatment strategy has still not been established. We herein present two patients with acute abdomen due to isolated spontaneous SMA dissection, in whom symptoms remained despite initial anticoagulation therapy. Percutaneous endovascular treatment with stenting of the dissected main trunk to achieve complete coverage of the entry site and balloon angioplasty for the distally involved side branches were performed successfully and resulted in complete resolution of the symptoms. According to our experience and previous case reports, early (within 1 week) elective percutaneous endovascular intervention with background anticoagulation therapy is a feasible and effective treatment strategy for symptomatic patients with isolated SMA dissection.