Diagnosis and treatment of spontaneous isolated superior mesenteric artery dissection: analysis of seven patients

Objective To analyze the CT manifestations of spontaneous isolated superior mesenteric artery dissection (SISMAD) and evaluate the feasibility and efficacy of endovascular stent placement therapy. Methods Seven male patients (mean age,48 years; range,36-62 years) who suffered from SISMAD received endovascular stent placement in our institution.All patients were diagnosed by computed tomographic angiography (CTA).Follow-up was performed with CTA at the first,third and sixth month after discharge.The CT manifestations,clinical results,complications,and follow-up outcomes were reviewed. Results An intimal flap separating the proximal portion of the SMA into stenotic true and dilated false lumina could be seen on all patients' CTA images.Patient No.1 had a concomitant celiac trunk dissection and patient No.2 had a celiac trunk saccular aneurysm.Endovascular stent placement was successfully performed for 7 patients with complete relief of clinical symptoms.Eleven self-expanding stents (6-8 mm in diameter and 30-40 mm in length) were deployed in the SMAs.One stent was used in 3 patients and two stents were used in 4 patients.The concomitant dissection and aneurysm in the celiac trunks were thought to be at risk of rupture,so a self-expanding stent and a covered stent were deployed in the celiac trunks during the same session respectively.During the follow-up period (median,28 months; range,16-42 months),false lumina were thrombosed and disappeared in 6 patients by the end of the third month.One patient who had mild recurrent abdominal pain during the first follow-up month became asymptomatic with continued antiplatelet and anticoagulation therapy for 3 months.CTA showed that the mural thrombosis resulted in stenosis in the proximal segment of the SMA.No thrombosis or stenosis was found in the lumina of the stents. Conclusion Endovascular stent placement is a safe and feasible treatment for SISMAD. Key words: Superior mesenteric artery; Dissection; Stent,endovascula