Conservative management of spontaneous isolated superior mesenteric artery dissection: A case report

Management of isolated dissection of the superior mesenteric artery

PURPOSE

 Isolated dissection of the superior mesenteric artery (IDSMA) is an increasingly frequently diagnosed pathology without a predisposing factor. Different therapeutic options including conservative, endovascular, and open surgical treatment are presented in our single-center study. The follow-up is a special task of different specialties.

METHODS AND PATIENTS

 A retrospective analysis of six patients with IDSMA was conducted. Patient demographics, clinical presentation, diagnostic management, and therapeutic treatment were assessed. Furthermore, clinical outcome as well as further changes during follow-up were evaluated.

RESULTS

 The majority of the patients were symptomatic with abdominal pain. Of the symptomatic patients, one was managed conservatively, one was treated surgically by patch plasty, and two patients were treated using an endovascular approach. The two asymptomatic patients were each managed conservatively. Conservative therapy was the treatment of choice, especially in asymptomatic and uncomplicated cases with non-persistent symptoms. This was confirmed in our literature review. Computed tomography angiography is the gold standard for follow-up after the acute event or diagnosis. None of our patients needed further treatment after the acute event/detection of IDSMA during the follow-up period with a mean of 68 months. One patient showed significant changes in the diameter of the superior mesenteric artery.

CONCLUSION

 The appropriate diagnosis, treatment, and follow-up of IDSMA must be tailored to the needs of the individual patient and require multidisciplinary decision making.

KEY POINTS

  · IDSMA can cause several symptoms, and is mostly seen in smoking, middle-aged men.. · Therapeutic options include conservative management and surgical and interventional methods.. · Conservative management is the most applicable treatment in asymptomatic patients.. · For diagnosis and follow-up, CTA is the gold standard.. · To avoid an excessive cumulative radiation dose, ultrasound monitoring may be adequate..