ABSTRACT
Objective To investigate the role of multi-detector computed tomography (CT) in the diagnosis and classification of isolated spontaneous superior mesenteric artery dissection (ISSMAD). Methods From July 2012 to December 2016, 30 consecutive patients with ISSMAD underwent CT scan at least two times. We retrospectively summarized the clinical characteristics and CT findings of them. The stenosis ratio of true lumen was compared between the patients without bowel ischemia and ones with bowel ischemia. Results There were 5 cases of type I ISSMAD, 14 cases of type 2, 1 case of type 3, 7 cases of type 4 and 3 cases of type V. Intestinal ischemia occurred in 5 patients. The stenosis ratio of true lumen in the patients without bowel ischemia was lower than that with bowel ischemia (45.6% vs. 76.0%, t=-14.5, P=0.000). Five patients with intestinal ischemia underwent superior mesenteric artery stenting and others received conservative therapy. The abdominal pain was alleviated for all the patients after treatment. Follow-up was complete in 30 cases. Follow-up CT angiography of superior mesenteric artery showed dissection remodeling in 12 patients. Conclusion Multi-detector CT is a valuable method in diagnosis and classification of ISSMAD and monitoring the changes of dissection.
Subject(s)
Aortic Dissection , Mesenteric Artery, Superior/diagnostic imaging , Tomography, X-Ray Computed/methods , Aged , Aortic Dissection/classification , Aortic Dissection/diagnostic imaging , Aortic Dissection/surgery , Female , Humans , Intestines/blood supply , Male , Mesenteric Ischemia/classification , Mesenteric Ischemia/diagnostic imaging , Mesenteric Ischemia/surgery , Middle AgedABSTRACT
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.
Subject(s)
Aortic Dissection/diagnostic imaging , Mesenteric Artery, Superior/diagnostic imaging , Mesenteric Ischemia/diagnostic imaging , Tomography, X-Ray Computed , Adult , Aortic Dissection/classification , Aortic Dissection/therapy , Angiography, Digital Subtraction , Anticoagulants/therapeutic use , Endovascular Procedures/instrumentation , Female , Humans , Male , Mesenteric Ischemia/classification , Mesenteric Ischemia/therapy , Middle Aged , Patient Selection , Predictive Value of Tests , Reproducibility of Results , Retrospective Studies , Stents , Time Factors , Treatment Outcome , Vascular Surgical ProceduresABSTRACT
Acute mesenteric ischemia encompasses a group of diseases with a high morbidity and mortality. Surgical treatment is frequently delayed due to difficulties in making a prompt clinical diagnosis. Mutislice computed tomography has emerged as a useful tool in the detection of intestinal ischemia and the spectrum of vascular pathology that produce it. The physiopathologic basis of intestinal ischemic damage, the spectrum of bowel, peritoneal and vascular findings as well as optimization of the computed tomography technique are discussed.
Las distintas variantes de isquemia mesentérica aguda constituyen un grupo de patologías con alta morbimortalidad. Suelen ser de difícil diagnóstico clínico, lo que frecuentemente deriva en un retraso en el tratamiento quirúrgico. La tomografía computada mutidetector ha surgido como una herramienta de gran utilidad en la detección de la isquemia intestinal y de la patología vascular causal. Se discute la fisiopatología del daño isquémico mesentérico, el espectro de alteraciones posibles del intestino delgado, peritoneo y vasculatura abdominal según la etiología, y se revisarán los parámetros para optimizar el estudio tomográfico en la evaluación de esta patología.
