Diagnosis and treatment of spontaneous isolated superior mesenteric artery dissection: analysis of seven patients

Objective: To analyze the CT manifestations of spontaneous isolated superior mesenteric artery dissection (SISMAD) and evaluate the feasibility and efficacy of endovascular stent placement therapy. Methods: Seven male patients (mean age, 48 years; range, 36-62 years) who suffered from SISMAD received endovascular stent placement in our institution. All patients were diagnosed by computed tomographic angiography (CTA). Follow-up was performed with CTA at the first, third and sixth month after discharge. The CT manifestations, clinical results, complications, and follow-up outcomes were reviewed. Results: An intimal flap separating the proximal portion of the SMA into stenotic true and dilated false lumina could be seen on all patients' CTA images. Patient No.1 had a concomitant celiac trunk dissection and patient No.2 had a celiac trunk saccular aneurysm. Endovascular stent placement was successfully performed for 7 patients with complete relief of clinical symptoms. Eleven self-expanding stents (6-8 mm in diameter and 30-40 mm in length) were deployed in the SMAs. One stent was used in 3 patients and two stents were used in 4 patients. The concomitant dissection and aneurysm in the celiac trunks were thought to be at risk of rupture, so a self-expanding stent and a covered stent were deployed in the celiac trunks during the same session respectively. During the follow-up period (median, 28 months; range, 16-42 months), false lumina were thrombosed and disappeared in 6 patients by the end of the third month. One patient who had mild recurrent abdominal pain during the first follow-up month became asymptomatic with continued antiplatelet and anticoagulation therapy for 3 months. CTA showed that the mural thrombosis resulted in stenosis in the proximal segment of the SMA. No thrombosis or stenosis was found in the lumina of the stents. Conclusion: Endovascular stent placement is a safe and feasible treatment for SISMAD. (authors)