Retrospective Analysis Of Diagnosis And Treatment Of Spontaneous Isolated Superior Mesenteric Artery Dissection

Background and Objective:Spontaneous isolated superior mesenteric artery dissection(SISMAD)refers to the lesion limited to the superior mesenteric artery without aortic dissection.It is reported that the symptoms of most patients can be relieved by conservative treatment,but some patients still need endovascular intervention.However,there is no unified standard on when patients need endovascular treatment.In this paper,the clinical data of 68 patients with SISMAD were retrospectively analyzed,and the published literature were reviewed to provide a relevant reference for the treatment of the disease.Methods:From August 2012 to December 2020,90 patients with superior mesenteric artery dissection(SMAD)were treated in the Department of Vascular Surgery of the second Affiliated Hospital of Nanchang University.According to the inclusion and exclusion criteria,a total of 68 patients with SISMAD were included.Statistics of patients’ demographic characteristics,from the onset of symptoms to the time of admission,clinical manifestations,past medical history,imaging findings,operation-related information,postoperative abdominal pain and follow-up CTA,to analyze the difference and prognosis between conservative treatment group and endovascular treatment group.Results:There was no significant statistical difference in age,gender,BMI,clinical manifestation,past medical history,SAA,the distance from SMA opening to the beginning of dissection,and the length of dissection between the conservative treatment group and the endovascular treatment group(P>0.05),but there were significant differences in true lumen stenosis rate and Yun classification between the two groups(P<0.05).Conclusions:1.With the wide application of enhanced CT,the detection rate of SISMAD has increased significantly in recent years.For patients with acute abdominal pain of unknown causes,the possibility of SISMAD should be considered.2.Conservative treatment is effective for most symptomatic SISMAD patients,but some patients with persistent symptoms need endovascular treatment.3.Patients with severe true lumen stenosis,especially those with type Ⅲ of Yun classification,are more inclined to endovascular treatment.4.The patients who received stent implantation may have stent stenosis or occlusion in the long term,but most of them have no obvious symptoms of intestinal ischemia and have a good prognosis.