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Spontaneous Isolated Dissection of Superior Mesenteric Artery: Long-term Outcome of Endovascular Stent Placement : 자발적 단독성 상장간막동맥 박리에서 혈관 내 스텐트 삽입술의 효과 및 장기적 결과

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Authors

김정훈

Advisor
윤창진
Major
의과대학 임상의과학과
Issue Date
2017-02
Publisher
서울대학교 대학원
Keywords
superior mesenteric arterydissectionendovascular procedurestentlong-term outcome
Description
학위논문 (석사)-- 서울대학교 대학원 : 임상의과학과, 2017. 2. 윤창진.
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.
Language
English
URI
https://hdl.handle.net/10371/132480
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