Gobble Ryan M, Brill Eliott R, Rockman Caron B, Hecht Elizabeth M, Lamparello Patrick J, Jacobowitz Glenn R, Maldonado Thomas S
Department of Surgery, New York University Langone Medical Center, New York, NY 10016, USA.
J Vasc Surg. 2009 Dec;50(6):1326-32. doi: 10.1016/j.jvs.2009.07.019. Epub 2009 Sep 26.
Spontaneous dissection of the superior mesenteric artery (SMA) is exceedingly rare. Treatment options range from observation to anticoagulation to open surgery or endovascular repair. We present our experience to date in the management of isolated SMA dissections.
A retrospective review of the vascular surgery and radiology databases from 1998 to 2008 was performed. In general, incidental radiologic findings of a dissection were managed expectantly. The decision to intervene was based on anatomic suitability, patient comorbidities and symptoms, and physician preference. Endovascular stents were placed using a brachial approach, with the choice of stent determined by physician preference. Patients who underwent endovascular stent placement (ESP) were maintained on antiplatelet therapy for 6 months postoperatively. Follow-up consisted of yearly office visits and adjunctive computerized tomography (CT) or magnetic resonance imaging (MRI) when clinically indicated.
CT or MRI imaging identified nine patients (7 men, 2 women) with an isolated SMA dissection. One patient also had a concomitant celiac artery dissection. Median age was 70 years (range, 46-73 years). Median follow-up time was 32 months (range, 13.8-62.5 months). Presentations included an incidental radiologic finding in three patients and acute onset abdominal pain in six. Treatment included expectant management in four patients, anticoagulation in two, and ESP in three. ESP was performed primarily in two patients and in a third patient after initial management with anticoagulation failed. The reduction in the diameter of the true lumen was significantly greater in patients treated with ESP vs patients who were successfully managed expectantly or with anticoagulation (F = 15.59, P < .005). No procedural complications were associated with ESP.
An isolated SMA dissection is a rare entity that may be managed successfully in a variety of ways based on clinical presentation. Endovascular stenting can be performed with good results and may be the preferred treatment in patients with symptomatic isolated SMA dissections.
肠系膜上动脉（SMA）自发性夹层极为罕见。治疗选择范围从观察、抗凝到开放手术或血管腔内修复。我们介绍迄今为止在孤立性SMA夹层治疗方面的经验。
对1998年至2008年的血管外科和放射学数据库进行回顾性研究。一般来说，对于夹层的偶然影像学发现采取保守观察。干预决策基于解剖学适宜性、患者合并症和症状以及医生的偏好。采用肱动脉途径放置血管腔内支架，支架的选择由医生偏好决定。接受血管腔内支架置入术（ESP）的患者术后维持抗血小板治疗6个月。随访包括每年门诊就诊，以及根据临床指征进行辅助计算机断层扫描（CT）或磁共振成像（MRI）检查。
CT或MRI成像发现9例（7例男性，2例女性）孤立性SMA夹层患者。1例患者同时合并腹腔干夹层。中位年龄为70岁（范围46 - 73岁）。中位随访时间为32个月（范围13.8 - 62.5个月）。临床表现包括3例患者为偶然影像学发现，6例为急性腹痛发作。治疗包括4例患者保守观察，2例抗凝治疗，3例接受ESP。ESP主要在2例患者中进行，第3例患者最初抗凝治疗失败后进行。与成功保守观察或抗凝治疗的患者相比，接受ESP治疗的患者真腔直径缩小更为显著（F = 15.59，P < .005）。ESP未出现手术相关并发症。
孤立性SMA夹层是一种罕见疾病，可根据临床表现以多种方式成功治疗。血管腔内支架置入术效果良好，可能是有症状的孤立性SMA夹层患者的首选治疗方法。
