Diagnosis And Treatment Of Spontaneous Isolated Superior Mesenteric Artery Dissection

Objective:To analyze the imaging findings,treatment and follow-up of the patients with spontaneous isolated superior mesenteric artery dissection.Methods:Twenty-five study subjects were collected from the First Affiliated Hospital of Zhejiang University from November 2011 to May 2014.We analyzed the clinical presentation,imaging appearances,classification,treatment and prognosis of the total twenty-five SISMAD patients retrospectively.Results:In all twenty-five patients,SISMAD was categorized into the following three types based on imaging appearances:Three cases were classified as type Ⅰ,fourteen cases were classified as Ⅱ a,seven cases were classified as Ⅱ b type and one case was classified as type Ⅲ.Two patients without the symptom of abdominal pain,whose classification were type I,received the observation treatment.Four of the twenty-three patients who had clinical symptoms took conservative treatment,one of which was classified as type Ⅱ a and three of which were classified as type Ⅱb;eighteen of the twenty-three patients who had clinical symptoms took endovascular treatment,including thirteen cases of type Ⅱa,four cases of type Ⅱb and one case of type Ⅲ.Another one case of type Ⅰ patients,whose abdominal pain was not relieved after conservative treatment,received endovascular treatment subsequently.The patients followed up for 1-43 months;the median follow-up time was 8 months.There was no abdominal pain or other symptoms during the follow-up period.CTA imaging suggested that the lesions had no progress,the stents kept open and non-displaced.Conclusion:1、The clinical symptoms of SISMAD are not specific.CTA can definite diagnosis and clearly show the location of the lesions.2、CTA imaging combined with the severity of the clinical symptoms of the patient,can guide the development of clinical treatment strategy.Patients who had no obvious clinical symptoms and whose imaging classification was type Ⅰ and type Ⅱb,can have conservative treatment.Patients whose imaging classification was type Ⅱa and Ⅲ can have endovascular treatment.Patients,who had a risk of intestinal necrosis or rupture of aneurysm,should be be treated surgically actively.