Yoo Young Sup, Choi Soo Jin Na, Lee Ho Kyun
Department of Surgery, Chonnam National University Medical School, Gwangju, Korea.
Division of Vascular and Transplant Surgery, Department of Surgery, Chonnam National University Medical School, Gwangju, Korea.
Ann Surg Treat Res. 2021 Mar;100(3):166-174. doi: 10.4174/astr.2021.100.3.166. Epub 2021 Feb 26.
Initial conservative treatment with selective endovascular or surgical intervention has shown successful outcomes in the treatment of spontaneous isolated superior mesenteric artery dissection (SISMAD). However, the benefits of antithrombotic therapy as a part of conservative treatment have not been clarified. This study aimed to investigate the clinical course of SISMAD patients and determine differences in clinical outcomes between the antithrombotic and no-antithrombotic groups.
We retrospectively reviewed 79 cases of SISMAD that were treated conservatively from January 2004 to December 2019 at Chonnam National University Hospital. Clinical outcomes, including the length of hospital stay, pain resolution time, image remodeling, and maximal remodeling time, were compared between the antithrombotic and no-antithrombotic groups.
There were 30 patients in the no-antithrombotic group and 49 patients in the antithrombotic group. There was no significant difference in clinical characteristics between the 2 groups, except for dyslipidemia (P = 0.011). The follow-up period (32.6 months 14.6 months, P = 0.009) and imaging follow-up period (31.6 months 13.9 months, P = 0.011) were longer in the antithrombotic group than in the no-antithrombotic group. The length of hospital stay (5.1 days 7.7 days, P = 0.002) was significantly shorter in the no-antithrombotic group than in the antithrombotic group because patients in the antithrombotic group required longer hospitalization for warfarin titration.
In patients with SISMAD, conservative treatment without antithrombotic therapy may have clinical benefits such as decreased length of hospital stay compared with conservative treatment with antithrombotic therapy.
选择性血管内或手术干预的初始保守治疗已显示出在治疗自发性孤立性肠系膜上动脉夹层（SISMAD）方面取得了成功的结果。然而，抗血栓治疗作为保守治疗一部分的益处尚未明确。本研究旨在调查SISMAD患者的临床病程，并确定抗血栓组和非抗血栓组之间临床结局的差异。
我们回顾性分析了2004年1月至2019年12月在全南国立大学医院接受保守治疗的79例SISMAD病例。比较了抗血栓组和非抗血栓组的临床结局，包括住院时间、疼痛缓解时间、影像重塑和最大重塑时间。
非抗血栓组有30例患者，抗血栓组有49例患者。除血脂异常外（P = 0.011），两组间临床特征无显著差异。抗血栓组的随访期（32.6个月±14.6个月，P = 0.009）和影像随访期（31.6个月±13.9个月，P = 0.011）均长于非抗血栓组。非抗血栓组的住院时间（5.1天±7.7天，P = 0.002）明显短于抗血栓组，因为抗血栓组的患者因华法林滴定需要更长的住院时间。
对于SISMAD患者，与抗血栓治疗的保守治疗相比，不进行抗血栓治疗的保守治疗可能具有临床益处，如缩短住院时间。
