Clinical treatment of spontaneous isolated superior mesenteric artery dissection

Objective To summarize the therapeutic experience of spontaneous isolated superior mesenteric artery dissection(SISMAD). Methods The clinical data and follow-up results of 26 SISMAD patients were reviewed and analyzed, including 6 cases with Sakamoto type Ⅰ, 4 cases with Sakamoto type Ⅱ, 10 cases with Sakamoto type Ⅲ, and 6 cases with Sakamoto type Ⅳ. Results In all patients, 12 cases received conservative treatment and 14 cases were given endovascular treatment. All patients had relieved symptoms. The 12 months follow-up showed that there was no statistical difference between the two groups(P>0.05). CT angiography reexamination showed that the superior mesenteric artery had better imaging. Conclusion For SISMAD patients, abdominal CTA examination should be performed as soon as possible to make a definite diagnosis, and to understand the blood supply of the main trunk and branches of superior mesenteric artery. For patients with mild symptoms and no obvious intestinal ischemia, conservative treatment can be used. For those with severe symptoms and intestinal ischemia or poor effect of conservative treatment, it is recommended to firstly apply intraluminal intervention treatment(by bare stent). For those with signs of intestinal necrosis or rupture of dissection, open exploration should be actively performed.