Management Strategy of Isolated Spontaneous Dissection of the Superior Mesenteric Artery
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概要
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Objective: Isolated spontaneous dissection of the superior mesenteric artery (SMA) is very rare among of the visceral artery dissection and its treatment is not established. In this paper we present our experiences and consider the treatment of isolated SMA dissection.Methods: A retrospective review of our cases from 2005 was performed. Clinical symptoms, radiologic findings and results were evaluated. There were 14 cases of visceral artery dissection, in which all cases were with SMA dissection. There were 12 males and 2 females with a mean age of 57 years (range 41–78 years).Results: We categorized SMA dissection into the six types according to the Sakamoto's and Zerbib's classification. One patient with type VI underwent emergent endovascular surgery with stent. One patient with type VI received thrombectomy and intimectomy with open surgery. One patient with type II underwent aneurysmectomy due to enlarged dissected SMA 3 months later from onset. The other eleven patients were managed conservatively. At follow-up, the diameter of SMA did not enlarged and the length of the dissection significantly decreased to 20.7 ± 15.7 mm from 38.0 ± 15.1 mm at onset (p <0.01). After treatment, imaging indicated the following changes in classification: type I, one patient; type II, 4 patients; type IV, 4 patients; complete remodeling, one patient, all without any event during the follow-up period of 5–82 months.Conclusion: Most patients with isolated visceral artery dissection occurred in superior mesenteric artery and can be treated conservatively; however, endovascular or surgical procedures including laparotomy are indicated when there is suspicion of severe mesenteric ischemia. Because the dissection configuration will change, long term follow-up is necessary. (*English translation of Jpn J Vasc Surg 2013; 22: 695-701)
著者
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Satokawa Hirono
Department Of Cardiovascular Surgery Faculty Of Medicine Fukushima Medical University
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Takase Shinya
Department Of Cardiovascular Surgery Faculty Of Medicine Fukushima Medical University
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Yokoyama Hitoshi
Department Of Cardiovascular Surgery Faculty Of Medicine Fukushima Medical University
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Midorikawa Hirofumi
Department Of Cardiovascular Surgery Fukushima Medical College
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SETO Yuki
Department of Cardiovascular Surgery, Fukushima Medical University School of Medicine
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Maehara Kazuhira
Department Of Hematology/oncology Internal Medicine Iwate Medical University
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Gotoh Mitsukazu
Department Of Organ Regenerative Surgery Fukushima Medical University
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KOGURE MICHIHIKO
Department of Surgery I, Fukushima Medical University School of Medicine
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Saito Tomiyoshi
Department of Circulatory Internal Medicine, Shirakawa Kosei General Hospital, Shirakawa, Fukushima, Japan
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Maehara Kazuhira
Department of Circulatory Internal Medicine, Shirakawa Kosei General Hospital, Shirakawa, Fukushima, Japan
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Seto Yuki
Department of Cardiovascular Surgery, Fukushima Medical University, School of Medicine, Fukushima, Fukushima, Japan
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