Clinical and Angiographic Follow-up of Spontaneous Isolated Superior Mesenteric Artery Dissection

Objectives: To observe the clinical features and angiographic findings in patients with a spontaneous isolated superior mesenteric artery dissection (SISMAD) and to identify any correlation between them. Methods: From a single institution, 32 patients (22 symptomatic patients at presentation; mean age 54 years; men 97%) with SISMAD were retrospectively reviewed. All patients were available for clinical follow-up after treatment (conservative, n = 28, 88%, open or endovascular superior mesenteric artery (SMA) reconstruction, n = 4, 12%), and follow-up CT scans were available in 28 patients (mean 22 months, range 1-80 months). Results: We found a positive correlation between pain severity and dissection length (p = 0.03, rho = 0.50, Spearman's partial correlation analysis). After conservative treatment, only one patient (3%) required bowel resection, and there was no difference in outcome between patients who were treated with anticoagulation or anti-platelet therapy and those who were not (p = 1.00, Fisher's exact test). No patients had progression of their lesion on the follow-up CT angiography. Conclusions: In SISMAD patients, dissection length is positively associated with more severe clinical symptoms. After conservative treatment, we observed a benign clinical course and no CT progression of the dissection, even without anticoagulation or anti-platelet therapy. Based on our observation, patients with SISMAD can be treated conservatively without anticoagulation therapy. (C) 2008 European Society for Vascular Surgery. Published by Elsevier Ltd. Ail rights reserved.