Diagnosis and treatment of isolated superior mesenteric artery dissection
10.3760/cma.j.issn.1007-631X.2011.11.009
- VernacularTitle:肠系膜上动脉夹层15例诊治分析
- Author:
Bin CHEN
;
Weiguo FU
;
Zhenyu SHI
;
Ting ZHU
- Publication Type:Journal Article
- Keywords:
Aneurysm,dissecting;
Mesenteric artery,superior;
Therapy
- From:
Chinese Journal of General Surgery
2011;26(11):914-916
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the diagnosis and treatment of isolated dissection of the superior mesenteric artery (SMA).Methods From Feb 2006 to July 2010,15 patients with isolated SMA dissection were treated in our center,there were 13 males,2 females,the mean age was(53 ± 8) years (range 43 -63).Among them,1 was caused by trauma,14 had unknown etiology,and 9 cases had a history of hypertension.Diagnosis was made by contrast-enhanced computed tomography (CT) in all cases.Management strategies inlcuded placement of self-expanding bare stent,medical treatment,and transperitoneal SMA fenestration.Results Endovascular stenting was attempted in 14 cases,with a success in 5 and a failure in 9 cases who were then given medical treatment with antiplatelet agents.One case with critical intestinal ischemia underwent open exploration and SMA fenestration.Blood vessel patency resumed.Follow-up with duplex and CT was accomplished in 13 cases,time ranging from 12 to 60 months (mean 28 ± 14mos).There was no recurrent abdominal pain or chronic intestinal ischemia developed during the follow-up.In medically treated patients,there was no aneurismal enlargement of SMA,while in the endovasculartreatmentgroup,allstentsremainedpatentthroughoutthefollow-up.Conclusions Endovascular treatment of isolated dissection of SMA appears to be feasible and effective,despite its relatively low technical success rate.For asymptomatic patients,medical treatment is the treatment of choice.In case of critical intestinal ischemia and with a suspected intestinal gangrene,emergency surgical exploration and fenestration should be performed.
