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Updated: Jun 4, 2026
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Treatment guidelines for isolated dissection of the superior mesenteric artery based on follow-up CT findings
1Department of Surgery, Eulji University School of Medicine and Eulji University Hospital, 1306 Dunsan-dong, Seo-gu, Daejeon, South Korea. sunjoe@eulji.ac.kr
Insights
Most patients with superior mesenteric artery dissection (SMAD) can be managed conservatively. Advanced treatments like stenting or surgery are reserved for severe cases or treatment failures, ensuring positive outcomes.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Gastroenterology
Background:
- Treatment guidelines for isolated superior mesenteric artery dissection (SMAD) are not well-established.
- SMAD is a rare condition affecting the main artery supplying the small intestine.
Purpose of the Study:
- To report a single-center experience with SMAD.
- To propose evidence-based treatment guidelines for SMAD.
Main Methods:
- Retrospective review of 30 patients diagnosed with SMAD between November 2004 and December 2009.
- Analysis of patient demographics, clinical presentation, radiographic findings, and treatment outcomes.
Main Results:
- The study included 30 patients (26 men, 4 women; mean age 55.1 years).
- Common presentations included abdominal pain (17 patients) or asymptomatic discovery (13 patients).
- Radiographic findings revealed intimal flaps with false lumens (20 patients) and intramural hematomas (10 patients).
- Treatments comprised observation (18), anticoagulation (5), stenting (6), and surgery (1).
- All patients remained asymptomatic during follow-up (mean 38.3 months), with radiographic improvement or resolution in 8/11 patients.
- Conservative management was successful in most cases.
Conclusions:
- Conservative treatment is effective for the majority of SMAD patients.
- Surgical or percutaneous interventions should be reserved for patients with severe mesenteric ischemia or those refractory to initial conservative management.
- The proposed guidelines emphasize a tailored approach to SMAD management.
Objectives:
The treatment guidelines for isolated superior mesenteric artery dissection (SMAD) are not well established. The purpose of this study was to report a single-centre series of SMAD and propose treatment guidelines.
Materials And Methods:
Between November 2004 and December 2009, 30 patients were diagnosed with SMAD. We retrospectively reviewed their medical records.
Results:
The subjects included 26 men and four women, with a mean age of 55.1 years. The chief complaint was abdominal pain in 17 patients, whereas 13 patients were asymptomatic. The mean follow-up was 38.3 months. The radiographic findings included intimal flap with a false lumen in 20 patients and intramural haematoma in 10 patients. The treatments included observation in 18 patients, anticoagulation in five patients, stenting in six patients and surgery in one patient. During follow-up (mean 15.6 months), there was no change in the computed tomography scans of seven patients, improvement was observed in four patients and complete resolution was observed in four patients. All patients, including the symptomatic patients, remained asymptomatic during follow-up.
Conclusions:
Most patients with SMAD can be successfully managed with conservative treatment. Surgical treatment or percutaneous intervention can be reserved for patients with severe mesenteric ischaemia and those for whom the initial conservative treatment fails.
