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.	張森, 王屹, 杜湘珂. 原發性孤立腸系膜上動脈夾層 MSCT 血管造影特點及其與腹痛的關系. 第三軍醫大學學報, 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.	龐鵬飛, 孟曉春, 陳俊偉, 等. 自發孤立性腸系膜上動脈夾層七例診療分析. 中華放射學雜志, 2013, 47(8): 731-734.
10.	谷鵬, 彭晨, 王偉, 等. 自發性孤立性腸系膜上動脈夾層的診治: 附 3 例報告. 中國普通外科雜志, 2014, 23(6): 780-784.
11.	李南, 陸清聲, 周建, 等. 自發性孤立性腸系膜上動脈夾層的診斷及腔內支架治療. 中國普通外科雜志, 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, 金畢, 賈俊亞, 等. 自發性孤立性腸系膜上動脈夾層治療策略的選擇. 中華臨床醫師雜志(電子版), 2011, 5(9): 2770-2772.
16.	欒景源, 李選, 李天潤, 等. 孤立性腸系膜上動脈夾層的腔內治療. 中華普通外科雜志, 2013, 28(8): 579-581.
17.	鄒佳華, 熊斌, 鄭傳勝, 等. 自發性孤立性腸系膜上動脈夾層的影像特征與介入治療. 臨床放射學雜志, 2013, 32(1): 109-113.
18.	蔣京軍, 張小明, 張學民, 等. 自膨式裸支架治療自發孤立性腸系膜上動脈夾層. 介入放射學雜志, 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.	蘇浩波, 顧建平, 樓文勝, 等. 自發性孤立性腸系膜上動脈夾層的 CT 診斷和介入治療 (附 6 例報道). 臨床放射學雜志, 2012, 31(9): 1324-1329.
21.	蘇浩波, 顧建平, 樓文勝, 等. 裸支架腔內血管重建術治療孤立性腸系膜上動脈夾層動脈瘤. 介入放射學雜志, 2011, 20(12): 948-952.
22.	周建國, 李棟林, 何楊燕, 等. 自發性孤立性腸系膜上動脈夾層的腔內治療. 中華普通外科雜志, 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.	李立強, 張建, 王蓉, 等. 腔內治療自發性孤立性腸系膜上動脈夾層的進展. 中華普通外科雜志, 2016, 31(1): 82-83.
25.	李南, 陸清聲, 景在平. 腔內支架技術治療自發性孤立性腸系膜上動脈夾層. 中國微創外科雜志, 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. 張森, 王屹, 杜湘珂. 原發性孤立腸系膜上動脈夾層 MSCT 血管造影特點及其與腹痛的關系. 第三軍醫大學學報, 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. 龐鵬飛, 孟曉春, 陳俊偉, 等. 自發孤立性腸系膜上動脈夾層七例診療分析. 中華放射學雜志, 2013, 47(8): 731-734.
10. 谷鵬, 彭晨, 王偉, 等. 自發性孤立性腸系膜上動脈夾層的診治: 附 3 例報告. 中國普通外科雜志, 2014, 23(6): 780-784.
11. 李南, 陸清聲, 周建, 等. 自發性孤立性腸系膜上動脈夾層的診斷及腔內支架治療. 中國普通外科雜志, 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, 金畢, 賈俊亞, 等. 自發性孤立性腸系膜上動脈夾層治療策略的選擇. 中華臨床醫師雜志(電子版), 2011, 5(9): 2770-2772.
16. 欒景源, 李選, 李天潤, 等. 孤立性腸系膜上動脈夾層的腔內治療. 中華普通外科雜志, 2013, 28(8): 579-581.
17. 鄒佳華, 熊斌, 鄭傳勝, 等. 自發性孤立性腸系膜上動脈夾層的影像特征與介入治療. 臨床放射學雜志, 2013, 32(1): 109-113.
18. 蔣京軍, 張小明, 張學民, 等. 自膨式裸支架治療自發孤立性腸系膜上動脈夾層. 介入放射學雜志, 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. 蘇浩波, 顧建平, 樓文勝, 等. 自發性孤立性腸系膜上動脈夾層的 CT 診斷和介入治療 (附 6 例報道). 臨床放射學雜志, 2012, 31(9): 1324-1329.
21. 蘇浩波, 顧建平, 樓文勝, 等. 裸支架腔內血管重建術治療孤立性腸系膜上動脈夾層動脈瘤. 介入放射學雜志, 2011, 20(12): 948-952.
22. 周建國, 李棟林, 何楊燕, 等. 自發性孤立性腸系膜上動脈夾層的腔內治療. 中華普通外科雜志, 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. 李立強, 張建, 王蓉, 等. 腔內治療自發性孤立性腸系膜上動脈夾層的進展. 中華普通外科雜志, 2016, 31(1): 82-83.
25. 李南, 陸清聲, 景在平. 腔內支架技術治療自發性孤立性腸系膜上動脈夾層. 中國微創外科雜志, 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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