Strategies of diagnosis and treatment of symptomatic spontaneous isolated superior mesenteric artery dissection / 中国介入影像与治疗学

ABSTRACT

Objective: To explore the strategies of diagnosis and treatment of symptomatic spontaneous isolated mesenteric artery dissection (SSIMAD). Methods: Data of 44 patients with SSIMAD were retrospectively reviewed, and the strategies of diagnosis and treatment as well as follow-up results were analyzed. Results: Among 44 SSIMAD patients, abdominal pain was the initial symptoms in 39 cases, accompanied by nausea and vomiting in 27 cases. Twenty-eight patients underwent nonsurgical treatment (antithrombotic therapy and expectant treatment), while 13 underwent intraluminal interventional therapy and 3 underwent open surgery. Two cases after nonsurgical treatments and 1 case after surgery were lost. Totally 41 patients were followed up for (32.42±6.67)months. During follow up periods, positive remodeling and negative remodeling were observed in 21 and 5 cases among 25 patients after nonsurgical treatment, while in 10 and 5 cases among 15 patients after intraluminal interventional therapy or open surgery. Conclusion: For acute stage SSIMAD, nonsurgical treatment should be the first-line regimen. Endovascular intervention is safe and feasible if conservative management (≥7 days) fails to relieve persistent abdominal pain symptoms. When peritonitis is present, surgical treatment should be promptly performed.