Symptomatic isolated superior mesenteric artery dissection: focusing on the morphologic type associated with invasive treatment.
- Author:
Hyun Kyu KWAK
1
;
Byung Soo LEE
;
Bohyun KIM
;
Jung Hwan AHN
Author Information
1. Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea. erdrajh@naver.com
- Publication Type:Original Article
- Keywords:
Abdominal pain;
Mesenteric artery;
Superior;
Dissection;
Mesenteric ischemia
- MeSH:
Abdominal Pain;
Aorta;
Classification;
Humans;
Mesenteric Arteries;
Mesenteric Artery, Superior*;
Mesenteric Ischemia;
Observational Study;
Retrospective Studies;
Risk Factors
- From:Journal of the Korean Society of Emergency Medicine
2018;29(2):223-230
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
OBJECTIVE: This study was conducted to investigate the relationship between invasive treatments and computed tomographic (CT) classification or findings in symptomatic spontaneous isolated superior mesenteric artery dissection (SISMAD). METHODS: This retrospective observational study included 30 patients with SISMAD from Jan 2012 to Dec 2016. Demographic data, risk factor, treatment modalities, and CT findings including morphological classification, dissection length, and true lumen relative diameter (TLRD) were reviewed. The enrolled patients were classified into two groups (conservative management group, CG; invasive management group, IG). RESULTS: Based on CT classifications, one patient was type I (CG, n=1; IG, n=0), two were type IIa (CG, n=2; IG, n=0), five were type IIIa (CG, n=5; IG, n=0), 10 were type IIIb (CG, n=9; IG, n=1), and 12 were type IIIc (CG, n=1; IG, n=11). There was a high tendency to undergo invasive treatment among type IIIc (P < 0.001). The TLRD, distance from the aorta to dissection point, and dissection length were 18.3% (range, 0%–29.8%), 1.7 cm (range, 0–3.5 cm), and 7.3 cm (range, 4.9–10.0 cm), respectively. There TLRD (CG, 26.8% [range, 22.2%–48.8%]; IG, 0%; P < 0.001) and distance from the aorta to dissection point (CG, 1.0 cm [range, 0–2.1 cm]; IG, 3.5 cm [range, 0.8–5.4 cm]; P=0.024) differed significantly between groups. However, there was no significant difference in dissection length between CG and IG (P=0.527). CONCLUSION: The TLRD, distance from the aorta to dissection point, and CT classification such as type IIIc were associated with invasive management. Further studies on extended natural course of the disease from a larger number of subjects are necessary to draw a strong conclusion.
