Outcomes of Spontaneous Isolated Superior Mesenteric Artery Dissection Without Antithrombotic Use

Publication date: Available online 8 December 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Hyangkyoung Kim, Hojong Park, Sang Jun Park, Bong Won Park, Jae Chol Hwang, Young Woo Seo, Hong Rae Cho
ObjectivesThis study aimed to show the intention to treat results of treatment for spontaneous isolated superior mesenteric artery dissection (SISMAD) without anticoagulation or antiplatelet agents and the follow-up results of SISMAD according to the configuration on computed tomography (CT) scans.DesignRetrospective, observational single centre studyMethodsAll cases of SISMAD were enrolled consecutively from 2006 onwards. There were 25 symptomatic and four asymptomatic patients in whom SISMAD was found incidentally. The SISMAD patients were treated using a consistent therapeutic strategy without antithrombotics. SISMAD was categorized into four types based on the configuration on CT scans by Yun's classification. Follow-up CT was performed at 3 months, 6 months, and yearly thereafter.ResultsThe median follow-up duration was 57 months (13–129 months). Improvement or complete resolution on CT scans, with no symptom recurrence, was seen in 27 patients. The non-invasive approach failed in three cases and two patients underwent further intervention. No patient died during the follow-up.ConclusionsWeighing the risks versus benefits of antithrombotics and considering the benign nature of SISMAD, conservative treatment without antithrombotics might be sufficient in patients without evidence of bowel ischaemia or infarction on initial CT scan.



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