Clinical and angiographic follow up of spontaneous isolated superior mesenteric artery dissection.
OBJECTIVES To observe the clinical features and angiographic findings in patients with a spontaneous isolated superior mesenteric artery dissection (SISMAD) and to identify any correlation between them. METHODS From a single institution, 32 patients (22 symptomatic patients at presentation; mean age 54years; men 97% with SISMAD were retrospectively reviewed. All patients were available for clinical follow up after treatment (conservative, n=28, 88% open or endovascular superior mesenteric artery (SMA) reconstruction, n=4, 12% and follow up CT scans were available in 28 patients (mean 22months, range 1 80months) RESULTS We found a positive correlation between pain severity and dissection length (p=0.03, rho=0.50, Spearman's partial correlation analysis) After conservative treatment, only one patient (3% required bowel resection, and there was no difference in outcome between patients who were treated with anticoagulation or anti platelet therapy and those who were not (p=1.00, Fisher's exact test) No patients had progression of their lesion on the follow up CT angiography. CONCLUSIONS In SISMAD patients, dissection length is positively associated with more severe clinical symptoms. After conservative treatment, we observed a benign clinical course and no CT progression of the dissection, even without anticoagulation or anti platelet therapy. Based on our observation, patients with SISMAD can be treated conservatively without anticoagulation therapy.
European journal of vascular and endovascular surgery the official journal of the European Society for Vascular Surgery