Clinical course and angiographic changes of spontaneous isolated superior mesenteric artery dissection after conservative treatment

Abstract

Purpose The aim of this study was to evaluate the clinical course and angiographic changes of spontaneous isolated superior mesenteric artery dissection (SISMAD) after conservative treatment. Methods Twenty-four patients with SISMAD admitted from September 2006 through March 2013 were included in this study. The clinical characteristics, type and location of the dissection, clinical outcome and angiographic changes were analyzed retrospectively. Results The median follow-up was 18.7 months (range 1.4–67.5 months). Eighteen patients (75 %) were symptomatic, and themedian duration of abdominal pain was 2.5 days. All of the patients were treated conservatively. Follow-up computed tomography angiography showed complete remodeling in six patients (25 %), partial remodeling in four patients (17 %), no changes in nine patients (38 %), progression to total occlusion in four patients (17 %) and aneurysmal changes of the false lumen in one patient (4 %). Endovascular intervention was performed in the patient with aneurysmal changes. There was no mortality or morbidity related to the dissection. Conclusion SISMAD represented variable angiographic changes, and its clinical course was benign in this study. For patients with SISMAD, if there is no evidence of bowel infarction, bleeding or aneurysmal changes, conservative treatment with close follow-up is sufficient and could reduce unnecessary endovascular interventions. Keywords Superior mesenteric artery Dissection Conservative treatment Remodeling pattern Clinical course