Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea.
J Vasc Surg. 2011 Dec;54(6):1727-33. doi: 10.1016/j.jvs.2011.07.052. Epub 2011 Sep 23.
Optimal treatment of spontaneous isolated superior mesenteric artery dissection (SISMAD) has not been established in part because the natural history of this rare vascular disease is not well established. We attempted to determine the natural history of SISMAD by observing patients who underwent conservative treatment.
Among 58 consecutive patients with SISMAD, 46 who underwent conservative treatment and periodic follow-up of computed tomography (CT) angiography (CTA) were included for this study. Our first-line treatment for SISMAD patients was conservative (n = 53), reserving interventional treatment, either endovascular (n = 1) or surgical (n = 4), for patients with persistent abdominal pain despite conservative treatment or signs of bowel ischemia. We retrospectively investigated changes of the length, type, or remodeling of the dissection and superior mesenteric artery patency on multidetector CT scan. To evaluate clinical course, presence of persistent or recurrent abdominal symptoms was queried on an outpatient base.
After 23.0 (median, range 6.5-74.2) months, follow-up CT angiograms showed diminished extent of the false lumen size in 19 (41.3%), no change in 20 (43.5%), diminished length of dissection in 11 (23.9%), and complete remodeling of dissection in seven (15.2%) patients. No patient showed dissection progression on follow-up angiogram. During the follow-up period, 10 (26.3%) patients reported nonspecific, mild abdominal discomfort, however, no patient developed recurrent abdominal pain following conservative treatment. There was no mortality related with SISMAD.
After conservative treatment of SISMAD, we have observed that the majority of patients showed improvement or no change on both angiogram and clinical examination. We believe this observation supports an approach of conservative treatment for patients with SISMAD.
自发性孤立性肠系膜上动脉夹层（SISMAD）的最佳治疗方法尚未确定，部分原因是这种罕见的血管疾病的自然病程尚未得到充分确立。我们试图通过观察接受保守治疗的患者来确定 SISMAD 的自然病程。
在 58 例连续 SISMAD 患者中，纳入 46 例接受保守治疗和定期 CT 血管造影（CTA）随访的患者进行本研究。我们对 SISMAD 患者的一线治疗是保守治疗（n = 53），对持续存在腹痛或有肠缺血迹象的患者，保留介入治疗（n = 1 例血管内治疗，n = 4 例手术治疗）。我们回顾性地研究了多排螺旋 CT 扫描上夹层和肠系膜上动脉通畅性的长度、类型或重塑的变化。为了评估临床病程，通过门诊询问患者是否存在持续性或复发性腹部症状。
在 23.0（中位数，范围 6.5-74.2）个月的随访中，CT 血管造影显示 19 例（41.3%）假腔大小的范围缩小，20 例（43.5%）无变化，11 例（23.9%）夹层长度缩小，7 例（15.2%）完全重塑。在随访期间，没有患者出现夹层进展。在随访期间，10 例（26.3%）患者报告有非特异性、轻度腹部不适，但没有患者在接受保守治疗后出现复发性腹痛。没有与 SISMAD 相关的死亡。
在 SISMAD 接受保守治疗后，我们观察到大多数患者在血管造影和临床检查上都有改善或无变化。我们认为这种观察结果支持对 SISMAD 患者采取保守治疗的方法。
