Management Strategy of Isolated Spontaneous Dissection of the Superior Mesenteric Artery

• Satokawa Hirono

  Department of Cardiovascular Surgery, Fukushima Medical University, School of Medicine, Fukushima, Fukushima, Japan

• Takase Shinya

  Department of Cardiovascular Surgery, Fukushima Medical University, School of Medicine, Fukushima, Fukushima, Japan

• Seto Yuki

  Department of Cardiovascular Surgery, Fukushima Medical University, School of Medicine, Fukushima, Fukushima, Japan

• Yokoyama Hitoshi

  Department of Cardiovascular Surgery, Fukushima Medical University, School of Medicine, Fukushima, Fukushima, Japan

• Gotoh Mitsukazu

  Department of 1st Surgery, Fukushima Medical University, School of Medicine, Fukushima, Fukushima, Japan

• Kogure Michihiko

  Department of 1st Surgery, Fukushima Medical University, School of Medicine, Fukushima, Fukushima, Japan

• Midorikawa Hirofumi

  Department of Cardiovascular Surgery, Minami Tohoku General Hospital, Kooriyama, Fukushima, Japan

• Saito Tomiyoshi

  Department of Circulatory Internal Medicine, Shirakawa Kosei General Hospital, Shirakawa, Fukushima, Japan

• Maehara Kazuhira

  Department of Circulatory Internal Medicine, Shirakawa Kosei General Hospital, Shirakawa, Fukushima, Japan

抄録

Objective: Isolated spontaneous dissection of the superior mesenteric artery (SMA) is very rare among of the visceral artery dissection and its treatment is not established. In this paper we present our experiences and consider the treatment of isolated SMA dissection.Methods: A retrospective review of our cases from 2005 was performed. Clinical symptoms, radiologic findings and results were evaluated. There were 14 cases of visceral artery dissection, in which all cases were with SMA dissection. There were 12 males and 2 females with a mean age of 57 years (range 41–78 years).Results: We categorized SMA dissection into the six types according to the Sakamoto’s and Zerbib’s classification. One patient with type VI underwent emergent endovascular surgery with stent. One patient with type VI received thrombectomy and intimectomy with open surgery. One patient with type II underwent aneurysmectomy due to enlarged dissected SMA 3 months later from onset. The other eleven patients were managed conservatively. At follow-up, the diameter of SMA did not enlarged and the length of the dissection significantly decreased to 20.7 ± 15.7 mm from 38.0 ± 15.1 mm at onset (p <0.01). After treatment, imaging indicated the following changes in classification: type I, one patient; type II, 4 patients; type IV, 4 patients; complete remodeling, one patient, all without any event during the follow-up period of 5–82 months.Conclusion: Most patients with isolated visceral artery dissection occurred in superior mesenteric artery and can be treated conservatively; however, endovascular or surgical procedures including laparotomy are indicated when there is suspicion of severe mesenteric ischemia. Because the dissection configuration will change, long term follow-up is necessary. (*English translation of Jpn J Vasc Surg 2013; 22: 695-701)

収録刊行物

• Annals of Vascular Diseases

  Annals of Vascular Diseases 7 (3), 232-238, 2014

  Annals of Vascular Diseases 編集委員会

キーワード

• visceral artery dissection
• spontaneous isolated dissection of superior mesenteric artery
• endovascular treatment
• abdominal open surgery

詳細情報

• CRID: 1390282680250361600
• NII論文ID: 130004678769
• DOI: 10.3400/avd.oa.14-00071
• ISSN: 18816428
• ISSN: 1881641X
• Web Site: https://www.jstage.jst.go.jp/article/avd/7/3/7_oa.14-00071/_pdf
• Web Site: https://search.jamas.or.jp/link/ui/2015229341
• 本文言語コード: en
• データソース種別:
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  • Crossref
  • CiNii Articles
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