Experience of endovascular therapy for spontaneous isolated superior mesenteric artery dissection_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHANG Xiquan , GE Shitang , ZHU Wei , DOU Shubin , GUO Feng

Endovascular Interventional Diagnosis and Treatment Center, No.148 Hospital of Chinese People’s Liberation Army, Zibo, Shandong 255300, P.R.China;

Corresponding author：

ZHANG Xiquan, Email: zyfbb19901024@sina.com

Keywords：

superior mesenteric artery; dissection; aneurysm; stent

DOI：

10.7507/1007-9424.201608067

Video：

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Objective To evaluate the clinical efficacy and safety of endovascular therapy for spontaneous isolated superior mesenteric artery dissection (SISMAD). Methods The clinical data of 17 patients with SISMAD, who were treated at author's hospital during the period from March 2009 to May 2016, were retrospectively analyzed. According to the Sakamoto angiographic classification, patients were divided into typeⅠ (n=3), typeⅡ (n=5), and type Ⅲ (n=9). Three patients with type Ⅰ were treated with conservative treatment first, and then 2 were treated with endovascular therapy as the poor reaction. The other patients were treated with endovascular treatment right a way. Results Conservative treatment was success in 1 case, 16 patients were treated with endovascular treatment, the technical success rate was 100%, one stent was used in 11 patients and two stents were used in 5 patients, and the blood in the true lumen of superior mesenteric artery (SMA) restored, no major complications occurred. Seventeen patients were followed-up for 3-36 months (mean of 19 months) and the followed-up rate was 100%, no abdominal pain occurred in 17 cases, CTA showed that no dissecting aneurysm was observed and the stents were patent of SMA. Conclusion Interventional therapy is a safe and effective method for SISMAD.

Citation： ZHANG Xiquan, GE Shitang, ZHU Wei, DOU Shubin, GUO Feng. Experience of endovascular therapy for spontaneous isolated superior mesenteric artery dissection. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(4): 449-452. doi: 10.7507/1007-9424.201608067 Copy

1.	Gobble RM, Brill ER, Rockman CB,et al. Endovascular treatment of spontaneous dissections of the superior mesenteric artery. J Vasc Surg, 2009, 50(6): 1326-1332.
2.	Bauersfeld SR. Dissecting aneurysm of the aorta: a presentation of 15 cases and a review of recent literature. Ann Intern Med, 1947, 26(6): 873-889.
3.	Sakamoto I, Ogawa Y, Sueyoshi E,et al. Imaging appearances and management of isolated spontaneous dissection of the superior mesenteric artery. Eur J Radiol, 2007, 64(1): 103-110.
4.	Dong Z, Fu W, Chen B,et al. Treatment of symptomatic isolated dissection of superior mesenteric artery. J Vasc Surg, 2013, 57(2 Suppl): 69S-76S.
5.	Nagai T, Torishima R, Uchida A,et al. Spontaneous dissection of the superior mesenteric artery in four cases treated with anticoagulation therapy. Intern Med, 2004, 43(6): 473-478.
6.	Nakamura K, Nozue M, Sakakibara Y,et al. Natural history of spontaneous dissecting of aneurysm of the proximal superior mesenteric artery: report of a case. Surg Today, 1997, 27(3): 272-274.
7.	张森, 王屹, 杜湘珂. 原发性孤立肠系膜上动脉夹层 MSCT 血管造影特点及其与腹痛的关系. 第三军医大学学报, 2011, 33(16): 1768-1770.
8.	Wu XM, Wang TD, Chen MF. Percutaneous endovascular treatment for isolated spontaneous superior mesenteric artery dissection: report of two cases and literature review. Catheter Cardiovasc Interv, 2009, 73(2): 145-151.
9.	庞鹏飞, 孟晓春, 陈俊伟, 等. 自发孤立性肠系膜上动脉夹层七例诊疗分析. 中华放射学杂志, 2013, 47(8): 731-734.
10.	谷鹏, 彭晨, 王伟, 等. 自发性孤立性肠系膜上动脉夹层的诊治: 附 3 例报告. 中国普通外科杂志, 2014, 23(6): 780-784.
11.	李南, 陆清声, 周建, 等. 自发性孤立性肠系膜上动脉夹层的诊断及腔内支架治疗. 中国普通外科杂志, 2012, 21(12): 1485-1488.
12.	Park UJ, Kim HT, Cho WH,et al. Clinical course and angiographic changes of spontaneous isolated superior mesenteric artery dissection after conservative treatment. Surg Today, 2014, 44(11): 2092-2097.
13.	Kim HK, Jung HK, Cho J,et al. Clinical and radiologic course of symptomatic spontaneous isolated dissection of the superior mesenteric artery treated with conservative management. J Vasc Surg, 2014, 59(2): 465-472.
14.	Jibiki M, Inoue Y, Kudo T. Conservative treatment for isolated superior mesenteric artery dissection. Surg Today, 2013, 43(3): 260-263.
15.	李文毅, 金毕, 贾俊亚, 等. 自发性孤立性肠系膜上动脉夹层治疗策略的选择. 中华临床医师杂志(电子版), 2011, 5(9): 2770-2772.
16.	栾景源, 李选, 李天润, 等. 孤立性肠系膜上动脉夹层的腔内治疗. 中华普通外科杂志, 2013, 28(8): 579-581.
17.	邹佳华, 熊斌, 郑传胜, 等. 自发性孤立性肠系膜上动脉夹层的影像特征与介入治疗. 临床放射学杂志, 2013, 32(1): 109-113.
18.	蒋京军, 张小明, 张学民, 等. 自膨式裸支架治疗自发孤立性肠系膜上动脉夹层. 介入放射学杂志, 2015, 24(10): 861-864.
19.	Chu SY, Hsu MY, Chen CM,et al. Endovascular repair of spontaneous isolated dissection of the superior mesenteric artery. Clin Radiol, 2012, 67(1): 32-37.
20.	苏浩波, 顾建平, 楼文胜, 等. 自发性孤立性肠系膜上动脉夹层的 CT 诊断和介入治疗 (附 6 例报道). 临床放射学杂志, 2012, 31(9): 1324-1329.
21.	苏浩波, 顾建平, 楼文胜, 等. 裸支架腔内血管重建术治疗孤立性肠系膜上动脉夹层动脉瘤. 介入放射学杂志, 2011, 20(12): 948-952.
22.	周建国, 李栋林, 何杨燕, 等. 自发性孤立性肠系膜上动脉夹层的腔内治疗. 中华普通外科杂志, 2015, 30(12): 949-951.
23.	Pang P, Jiang Z, Huang M,et al. Value of endovascular stent placement for symptomatic spontaneous isolated superior mesenteric artery dissection. Eur J Radiol, 2013, 82(3): 490-496.
24.	李立强, 张建, 王蓉, 等. 腔内治疗自发性孤立性肠系膜上动脉夹层的进展. 中华普通外科杂志, 2016, 31(1): 82-83.
25.	李南, 陆清声, 景在平. 腔内支架技术治疗自发性孤立性肠系膜上动脉夹层. 中国微创外科杂志, 2014, 14(1): 58-68.
26.	Tomita K, Obara H, Sekimoto Y,et al. Evolution of computed tomographic characteristics of spontaneous isolated superior mesenteric artery dissection during conservative management. Circ J, 2016, 80(6): 1452-1459.

1. Gobble RM, Brill ER, Rockman CB,et al. Endovascular treatment of spontaneous dissections of the superior mesenteric artery. J Vasc Surg, 2009, 50(6): 1326-1332.
2. Bauersfeld SR. Dissecting aneurysm of the aorta: a presentation of 15 cases and a review of recent literature. Ann Intern Med, 1947, 26(6): 873-889.
3. Sakamoto I, Ogawa Y, Sueyoshi E,et al. Imaging appearances and management of isolated spontaneous dissection of the superior mesenteric artery. Eur J Radiol, 2007, 64(1): 103-110.
4. Dong Z, Fu W, Chen B,et al. Treatment of symptomatic isolated dissection of superior mesenteric artery. J Vasc Surg, 2013, 57(2 Suppl): 69S-76S.
5. Nagai T, Torishima R, Uchida A,et al. Spontaneous dissection of the superior mesenteric artery in four cases treated with anticoagulation therapy. Intern Med, 2004, 43(6): 473-478.
6. Nakamura K, Nozue M, Sakakibara Y,et al. Natural history of spontaneous dissecting of aneurysm of the proximal superior mesenteric artery: report of a case. Surg Today, 1997, 27(3): 272-274.
7. 张森, 王屹, 杜湘珂. 原发性孤立肠系膜上动脉夹层 MSCT 血管造影特点及其与腹痛的关系. 第三军医大学学报, 2011, 33(16): 1768-1770.
8. Wu XM, Wang TD, Chen MF. Percutaneous endovascular treatment for isolated spontaneous superior mesenteric artery dissection: report of two cases and literature review. Catheter Cardiovasc Interv, 2009, 73(2): 145-151.
9. 庞鹏飞, 孟晓春, 陈俊伟, 等. 自发孤立性肠系膜上动脉夹层七例诊疗分析. 中华放射学杂志, 2013, 47(8): 731-734.
10. 谷鹏, 彭晨, 王伟, 等. 自发性孤立性肠系膜上动脉夹层的诊治: 附 3 例报告. 中国普通外科杂志, 2014, 23(6): 780-784.
11. 李南, 陆清声, 周建, 等. 自发性孤立性肠系膜上动脉夹层的诊断及腔内支架治疗. 中国普通外科杂志, 2012, 21(12): 1485-1488.
12. Park UJ, Kim HT, Cho WH,et al. Clinical course and angiographic changes of spontaneous isolated superior mesenteric artery dissection after conservative treatment. Surg Today, 2014, 44(11): 2092-2097.
13. Kim HK, Jung HK, Cho J,et al. Clinical and radiologic course of symptomatic spontaneous isolated dissection of the superior mesenteric artery treated with conservative management. J Vasc Surg, 2014, 59(2): 465-472.
14. Jibiki M, Inoue Y, Kudo T. Conservative treatment for isolated superior mesenteric artery dissection. Surg Today, 2013, 43(3): 260-263.
15. 李文毅, 金毕, 贾俊亚, 等. 自发性孤立性肠系膜上动脉夹层治疗策略的选择. 中华临床医师杂志(电子版), 2011, 5(9): 2770-2772.
16. 栾景源, 李选, 李天润, 等. 孤立性肠系膜上动脉夹层的腔内治疗. 中华普通外科杂志, 2013, 28(8): 579-581.
17. 邹佳华, 熊斌, 郑传胜, 等. 自发性孤立性肠系膜上动脉夹层的影像特征与介入治疗. 临床放射学杂志, 2013, 32(1): 109-113.
18. 蒋京军, 张小明, 张学民, 等. 自膨式裸支架治疗自发孤立性肠系膜上动脉夹层. 介入放射学杂志, 2015, 24(10): 861-864.
19. Chu SY, Hsu MY, Chen CM,et al. Endovascular repair of spontaneous isolated dissection of the superior mesenteric artery. Clin Radiol, 2012, 67(1): 32-37.
20. 苏浩波, 顾建平, 楼文胜, 等. 自发性孤立性肠系膜上动脉夹层的 CT 诊断和介入治疗 (附 6 例报道). 临床放射学杂志, 2012, 31(9): 1324-1329.
21. 苏浩波, 顾建平, 楼文胜, 等. 裸支架腔内血管重建术治疗孤立性肠系膜上动脉夹层动脉瘤. 介入放射学杂志, 2011, 20(12): 948-952.
22. 周建国, 李栋林, 何杨燕, 等. 自发性孤立性肠系膜上动脉夹层的腔内治疗. 中华普通外科杂志, 2015, 30(12): 949-951.
23. Pang P, Jiang Z, Huang M,et al. Value of endovascular stent placement for symptomatic spontaneous isolated superior mesenteric artery dissection. Eur J Radiol, 2013, 82(3): 490-496.
24. 李立强, 张建, 王蓉, 等. 腔内治疗自发性孤立性肠系膜上动脉夹层的进展. 中华普通外科杂志, 2016, 31(1): 82-83.
25. 李南, 陆清声, 景在平. 腔内支架技术治疗自发性孤立性肠系膜上动脉夹层. 中国微创外科杂志, 2014, 14(1): 58-68.
26. Tomita K, Obara H, Sekimoto Y,et al. Evolution of computed tomographic characteristics of spontaneous isolated superior mesenteric artery dissection during conservative management. Circ J, 2016, 80(6): 1452-1459.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Experience of endovascular therapy for spontaneous isolated superior mesenteric artery dissection

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