Spontaneous Isolated Dissection of Superior Mesenteric Artery: Long-term Outcome of Endovascular Stent Placement

Abstract

Purpose To evaluate the efficacy and long-term outcome of endovascular stent placement (ESP) for the treatment of symptomatic spontaneous isolated dissection of superior mesenteric artery (SIDSMA).

Materials and Methods This retrospective study was conducted on 22 patients (mean 52 years, ranged 43-68) with symptomatic SIDSMA between January 2004 and October 2012. Initial treatment was chosen based on clinical symptom and CT findings. Seven patients underwent ESP as the first-line treatment. Fifteen patients were treated conservatively. The technical results, complications, and clinical outcomes were analyzed.

Results The first-line ESP was technically successful in all 7 patients. Conservative treatment was successful in 12 patients (80.0%). The remaining 3 patients with failed conservative treatment required ESP as second-line treatment. There was no complication associated with the procedures. Abdominal pain completely resolved in all patients without relapse during follow-up (median 48 months, ranged 1-136). The fasting time and hospital stay were significantly shorter in patients treated with first-line ESP (median 1 day, ranged 1-4 and median 4 days, ranged 3-7) than in those treated conservatively (median 4 days, ranged 2-11 and median 7 days, ranged 5-15) (p=0.004 and p=0.002, respectively). Follow-up CT angiogram (median 53 months, ranged 11-99) revealed complete obliteration of false lumen and good stent patency in 9 out of 10 patients who underwent ESP. One patient treated with 2 stents experienced occlusion of distal stent at 99-month follow-up.

Conclusions ESP is an effective treatment in patients with symptomatic SIDSMA. It can be employed as the first-line treatment in selected patients or as second-line treatment when conservative treatment fails. ESP provides rapid symptomatic relief with shorter fasting and hospital stay than conservative treatment as well as satisfactory long-term stent patency.