Management of isolated dissection of the superior mesenteric artery

Abstract

Purpose

Isolated dissection of the superior mesenteric artery (IDSMA) is an increasingly frequently diagnosed pathology without a predisposing factor. Different therapeutic options including conservative, endovascular, and open surgical treatment are presented in our single-center study. The follow-up is a special task of different specialties.

Methods and Patients

A retrospective analysis of six patients with IDSMA was conducted. Patient demographics, clinical presentation, diagnostic management, and therapeutic treatment were assessed. Furthermore, clinical outcome as well as further changes during follow-up were evaluated.

Results

The majority of the patients were symptomatic with abdominal pain. Of the symptomatic patients, one was managed conservatively, one was treated surgically by patch plasty, and two patients were treated using an endovascular approach. The two asymptomatic patients were each managed conservatively. Conservative therapy was the treatment of choice, especially in asymptomatic and uncomplicated cases with non-persistent symptoms. This was confirmed in our literature review. Computed tomography angiography is the gold standard for follow-up after the acute event or diagnosis. None of our patients needed further treatment after the acute event/detection of IDSMA during the follow-up period with a mean of 68 months. One patient showed significant changes in the diameter of the superior mesenteric artery.

Conclusion

The appropriate diagnosis, treatment, and follow-up of IDSMA must be tailored to the needs of the individual patient and require multidisciplinary decision making.

Key Points

• IDSMA can cause several symptoms, and is mostly seen in smoking, middle-aged men.

• Therapeutic options include conservative management and surgical and interventional methods.

• Conservative management is the most applicable treatment in asymptomatic patients.

• For diagnosis and follow-up, CTA is the gold standard.

• To avoid an excessive cumulative radiation dose, ultrasound monitoring may be adequate.

Citation Format

• Knarr J, Augustin A, Hartung V et al. Management of isolated dissection of the superior mesenteric artery. Fortschr Röntgenstr 2024; 196: 726 – 734

Zusammenfassung

Hintergrund

Die isolierte Dissektion der A. mesenterica superior (IDSMA) ist eine immer häufiger diagnostizierte Pathologie ohne prädisponierenden Faktor. In unserer Single-Center-Studie werden verschiedene Therapieoptionen vorgestellt, darunter die konservative, endovaskuläre und offen-chirurgische Behandlung. Die Nachsorge ist eine besondere Aufgabe der verschiedenen Fachrichtungen.

Methoden und Patienten

Es wurde eine retrospektive Analyse von sechs Patienten mit IDSMA durchgeführt. Bewertet wurden demografische Patientendaten, die klinischen Befunde, das diagnostische Management und die anschließende therapeutische Behandlung. Darüber hinaus wurden die klinische Symptomatik bezüglich des Nachlassens des Schmerzes und weitere Veränderungen während der Nachbeobachtung evaluiert.

Ergebnisse

Die Mehrzahl der Patienten war symptomatisch und litt unter Bauschmerzen. Von den symptomatischen Patienten wurde ein Patient konservativ behandelt, ein Patient wurde chirurgisch mit einer Patchplastik behandelt und zwei Patienten erhielten eine endovaskuläre Therapie. Die beiden asymptomatischen Patienten wurden jeweils konservativ behandelt. Die konservative Therapie war die Behandlung der Wahl, insbesondere bei asymptomatischen und unkomplizierten Fällen mit nicht persistierenden Symptomen. Für die Nachsorge ist die Computertomografie mit Angiografie der Goldstandard. Keiner unserer Patienten benötigte nach dem akuten Ereignis bzw. dem Nachweis einer asymptomatischen IDSMA während der Nachbeobachtungszeit von durchschnittlich 68 Monaten eine weitere Behandlung. Ein Patient wies signifikante Veränderungen des Durchmessers der A. mesenterica superior auf.

Schlussfolgerung

Die angemessene Diagnose, Behandlung und Nachsorge von IDSMA muss auf die Bedürfnisse des einzelnen Patienten zugeschnitten sein und erfordert eine multidisziplinäre Entscheidungsfindung.

Kernaussagen

• IDSMA kann verschiedene Symptome verursachen und tritt meist bei rauchenden Männern mittleren Alters auf.

• Zu den therapeutischen Optionen gehören konservatives Management, chirurgische und interventionelle Methoden.

• Bei asymptomatischen Patienten ist die konservative Behandlung die am besten geeignete Therapie.

• Für die Diagnose und Verlaufskontrolle ist die CTA der Goldstandard.

• Um eine übermäßige kumulative Strahlendosis zu vermeiden, kann eine Ultraschallüberwachung ausreichend sein.

Keywords

abdomen - arteries - vascular - angiography - CT-angiography - stents

Publikationsverlauf

Eingereicht: 11. Mai 2023

Angenommen: 21. November 2023

Artikel online veröffentlicht:
04. Januar 2024

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