Outcomes and Radiographic Findings of Isolated Spontaneous Superior Mesenteric Artery Dissection

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Diagnostic Imaging

Background:

• Isolated spontaneous superior mesenteric artery (SMA) dissection is a rare condition.
• Understanding the differences and similarities between symptomatic and asymptomatic cases is crucial for appropriate management.
• Computed tomography angiography (CTA) is the primary diagnostic tool.

Purpose of the Study:

• To investigate the clinical features, treatment strategies, and prognosis of patients with symptomatic versus asymptomatic isolated SMA dissection.
• To evaluate factors influencing vascular remodeling and patient outcomes.

Main Methods:

• Retrospective analysis of 35 patients with isolated SMA dissection diagnosed via CTA.
• Comparison of clinical characteristics, management, and outcomes between symptomatic (n=19) and asymptomatic (n=16) groups.
• Assessment of vascular remodeling and clinical events during follow-up.

Main Results:

• Symptomatic and asymptomatic groups were similar except for age (younger in symptomatic group).
• Most symptomatic patients were managed conservatively; one required endovascular intervention, another switched to surgery.
• No in-hospital mortality was observed. Complete false lumen remodeling occurred in 31% of cases, associated with symptoms and absence of initial false lumen blood flow.

Conclusions:

• Asymptomatic SMA dissection shares characteristics with symptomatic cases, differing mainly in age.
• The presence of symptoms and lack of initial false lumen blood flow predict complete false lumen remodeling.
• Long-term outcomes were favorable in both groups, with no SMA-related deaths or recurrent symptoms requiring intervention.