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KMID : 0371320100790010064
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Journal of the Korean Surgical Society
2010 Volume.79 No. 1 p.64 ~ p.70
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Isolated Dissection of Superior Mesenteric Artery: Study on the Treatment Guidelines
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Lee Min-Koo
Jung In-Mok
Kim Chang-Nam
Joe Byung-Sun
Kang Yoon-Jung
Park Joo-Seung
Choi Young-Jin
Park Sung-Hye
Han Hyun-Young
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Abstract
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Purpose: Isolated superior mesenteric artery (SMA) dissection is a rare, but increasing vascular disorder. However, optimal treatment guidelines are not well established. The purpose of this study is to review a single institutional experience in the management of isolated SMA dissections and establish optimal treatment guidelines.
Methods: Between November 2004 and August 2009, 26 patients were diagnosed with isolated SMA dissection at Eulji University Hospital. Diagnosis was confirmed with CT scans in all patients. We retrospectively reviewed the medical records, imaging studies, and the early outcomes of the patients.
Results: There were 22 (84.5%) men and 4 women. The mean age was 55.4 (39∼74) years. The mean follow-up was 39.1 (4.1∼53.3) months. In 15 patients, CT scans were performed for abdominal pain, and in the other 11 patients, the isolated SMA dissections were detected incidentally during workup for other causes. The radiographic findings included an intimal flap with a patent false lumen in 16 and intramural hematoma in 10. The dissection started at a mean of 22.3 (5∼46) mm from the origin of the SMA with a mean length was 47.7 (10∼150) mm. Treatments included expectant management in 13, anticoagulation in 6, stenting in 6 patients, and surgery in one case of bowel infarction. None required additional intervention. All patients remained asymptomatic during follow-up.
Conclusion: Most patients with isolated SMA dissection were successfully managed medically. Surgical or percutaneous intervention should be reserved for those with evidence of bowel necrosis or mesenteric ischemia and failed cases to initial medical treatment. (J Korean Surg Soc 2010;79:64-70)
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KEYWORD
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Superior mesenteric artery dissection, Treatment guideline, Strategy, Algorithm
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