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Updated: Jun 19, 2026
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Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Predictive Value of Imaging-Based Classifications for Conservative Management Failure in Isolated Superior Mesenteric
Jin Ling1, Li Hou2, Mingwei Wu3
1Department of General and Vascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China.
JACC. Asia
|June 18, 2026
Summary
Tan's classification best predicts failure in isolated superior mesenteric artery dissection (ISMAD) conservative management. This vascular disease classification aids in timely intervention decisions for patients with ISMAD.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Diagnostic Imaging
Background:
- Isolated superior mesenteric artery dissection (ISMAD) is a rare vascular condition with unclear optimal treatment strategies.
- Existing imaging-based classifications for ISMAD have not been validated for predicting conservative management outcomes.
Purpose of the Study:
- To evaluate and compare the predictive accuracy of eight different classification systems for conservative management failure in ISMAD patients.
Main Methods:
- A multicenter retrospective study of 156 ISMAD patients from China (2009-2023).
- Patients were categorized using eight ISMAD classification systems.
- Performance metrics included model fit, discrimination (C-statistic), reclassification improvement, calibration, and decision curve analysis.
Main Results:
- Patients failing conservative management presented with longer abdominal pain duration and more severe superior mesenteric artery stenosis.
- Tan's classification demonstrated superior performance with the best model fit, highest discrimination (C-statistic = 0.750), and greatest net reclassification improvement (0.593).
- Tan's classification also showed good calibration and the highest net benefit on decision curve analysis.
Conclusions:
- Tan's classification emerged as the most effective system for predicting conservative management failure in ISMAD.
- This classification system holds potential to guide clinical decisions regarding timely interventions for ISMAD.
