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Updated: Jun 8, 2026
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Inference from clinical and fluid dynamic studies about underlying cause of spontaneous isolated superior mesenteric
Yang Jin Park1, Cheol-Woo Park, Kwang Bo Park
1Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Purpose:
Due to increased use and improvements in diagnostic imaging studies, spontaneous isolated superior mesenteric artery dissection (SISMAD), which is a rare vascular event, has been reported to occur on a more frequent basis. Although there have been some anecdotal case reports describing the underlying pathology of SISMAD, the etiology of the majority of SISMAD is still poorly understood. The purpose of this study was to determine the underlying cause of SISMAD.
Method:
From July 2001 to March 2010, 51 consecutive patients with SISMAD (symptomatic 39, asymptomatic 12) and 38 patients with combined aortic and superior mesenteric artery dissection (CASMAD) were identified in a single institution by retrospective investigations. Diagnosis was dependent on multi-detector helical computed tomography (CT) scan. To find clinical characteristics of SISMAD, we compared demographic, clinical, and lesion (site of entry tear, type, length) characteristics between the two groups. To find any flow dynamic abnormalities at the proximal segment of the superior mesenteric artery (SMA), we conducted flow dynamic studies using computational fluid dynamic models (V.12; ANSYS, Inc., Canonsburg, Pa). Streamline patterns and wall shear stress distributions were tested with computer simulation models using three different branching angles of SMA from the abdominal aorta.
Results:
Compared to CASMAD, SISMAD was more common in men (90.2% vs 71.1%; P = .02), less frequently associated with hypertension (31.4% vs 65.8%; P = .001), and more frequently associated with intra-abdominal cancers (11.8% vs 0%; P = .036). In a fluid dynamic study using computational fluid dynamic models, we found abnormal mechanical stresses at the anterior wall around the convex portion of the SMA.
Conclusion:
Development of SISMAD seems to be less likely the result of hypertension or connective tissue disease but more likely due to hemodynamic force caused by convex curvature.
Insights
Spontaneous isolated superior mesenteric artery dissection (SISMAD) is often linked to abnormal mechanical stresses from the superior mesenteric artery's convex curvature. This vascular event appears less commonly associated with hypertension or connective tissue diseases.
Area of Science:
- Vascular Surgery
- Radiology
- Biomedical Engineering
Background:
- Spontaneous isolated superior mesenteric artery dissection (SISMAD) is a rare vascular event with an incompletely understood etiology.
- Increased use of diagnostic imaging has led to more frequent reports of SISMAD.
- Previous studies have primarily focused on anecdotal case reports, leaving the underlying pathology largely unexplored.
Purpose of the Study:
- To determine the underlying cause of spontaneous isolated superior mesenteric artery dissection (SISMAD).
- To investigate the etiological factors contributing to SISMAD.
- To differentiate SISMAD from combined aortic and superior mesenteric artery dissection (CASMAD).
Main Methods:
- Retrospective analysis of 51 SISMAD patients and 38 CASMAD patients from July 2001 to March 2010.
- Diagnosis confirmed using multi-detector helical computed tomography (CT) scans.
- Flow dynamic studies using computational fluid dynamic models to assess mechanical stresses and streamline patterns at the superior mesenteric artery (SMA) proximal segment.
Main Results:
- SISMAD was more prevalent in men (90.2%) compared to CASMAD (71.1%).
- SISMAD showed lower rates of hypertension (31.4% vs 65.8%) and higher association with intra-abdominal cancers (11.8% vs 0%) than CASMAD.
- Computational fluid dynamic models revealed abnormal mechanical stresses at the anterior wall of the SMA's convex portion.
Conclusions:
- SISMAD development is likely influenced by hemodynamic forces stemming from the SMA's convex curvature.
- Hypertension and connective tissue diseases appear to be less significant etiological factors in SISMAD.
- Abnormal mechanical stresses in the SMA may play a crucial role in the pathogenesis of SISMAD.
