Evolution of Computed Tomographic Characteristics of Spontaneous Isolated Superior Mesenteric Artery Dissection During Conservative Management

Koichi Tomita; Hideaki Obara; Yasuhito Sekimoto; Kentaro Matsubara; Susumu Watada; Naoki Fujimura; Shintaro Shibutani; Kazuhito Nagasaki; Shinobu Hayashi; Hirohisa Harada; Atsunori Asami; Norio Uchida; Toshihiro Kakefuda; Yuko Kitagawa

doi:10.1253/circj.CJ-15-1369

Peripheral Vascular Disease

Evolution of Computed Tomographic Characteristics of Spontaneous Isolated Superior Mesenteric Artery Dissection During Conservative Management

Koichi Tomita, Hideaki Obara, Yasuhito Sekimoto, Kentaro Matsubara, Susumu Watada, Naoki Fujimura, Shintaro Shibutani, Kazuhito Nagasaki, Shinobu Hayashi, Hirohisa Harada, Atsunori Asami, Norio Uchida, Toshihiro Kakefuda, Yuko Kitagawa

Author information

Koichi Tomita
Department of Surgery, Keio University School of Medicine
Hideaki Obara
Department of Surgery, Keio University School of Medicine
Yasuhito Sekimoto
Department of Surgery, Keio University School of Medicine
Kentaro Matsubara
Department of Surgery, Keio University School of Medicine
Susumu Watada
Department of Surgery, Kawasaki Municipal Hospital
Naoki Fujimura
Department of Surgery, Keio University School of Medicine
Shintaro Shibutani
Department of Surgery (Vascular Surgery), Saiseikai Yokohamashi Tobu Hospital
Kazuhito Nagasaki
Department of Surgery, Saitama Municipal Hospital
Shinobu Hayashi
Department of Surgery (Vascular Surgery), Saiseikai Yokohamashi Tobu Hospital
Hirohisa Harada
Department of Surgery, Tokyo Dental College Ichikawa General Hospital
Atsunori Asami
Department of Surgery, Saitama Municipal Hospital
Norio Uchida
Department of Surgery, Mito Red Cross Hospital
Toshihiro Kakefuda
Department of Surgery, Kawasaki Municipal Hospital
Yuko Kitagawa
Department of Surgery, Keio University School of Medicine

Keywords: Arterial dissection, Conservative therapy, Long-term outcome, Superior mesenteric artery, Vascular remodeling

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2016 Volume 80 Issue 6 Pages 1452-1459

DOI https://doi.org/10.1253/circj.CJ-15-1369

Editorial (80-6 pp. 1323-1325)

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Abstract

Background:Spontaneous isolated superior mesenteric artery (SMA) dissection is a rare condition, and its clinical and angiographic courses are poorly defined. We aimed to monitor the morphological characteristics of spontaneous isolated SMA dissection using computed tomography (CT) over 2 years of follow-up, including the recovery process via vascular remodeling, and identify the factors that affect vascular remodeling using univariate analysis.Methods and Results:We retrospectively reviewed the medical records and morphological findings of 59 consecutive patients with spontaneous isolated SMA dissection between October 2007 and July 2014, which included 36 symptomatic and 23 asymptomatic patients. Surgical intervention with open laparotomy was required in 3 patients during the follow-up period; 41 patients who received conservative treatment were followed up over 2 years with regular CT. Complete remodeling was achieved in 16 of 25 symptomatic patients who were treated conservatively (64.0%). A patent false lumen and aneurysmal formation on an initial CT scan were identified as negative factors that affected remodeling in patients with spontaneous isolated SMA dissection.Conclusions:Conservative management of spontaneous isolated SMA dissection is associated with a good prognosis, both clinically and morphologically. Surgical intervention is only required in patients with severe intestinal ischemia or rapid aneurysmal enlargement. (Circ J 2016; 80: 1452–1459)

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