Mid-Term Results of Endovascular Treatment for Spontaneous Isolated Dissection of the Superior Mesenteric Artery

Abstract

Objectives: Endovascular treatment (EVT) is an alternative method to treat spontaneous isolated dissection of the superior mesenteric artery (SIDSMA). Although its short-term results are promising, few mid-term results have been reported. This study reports the five year follow up of EVT for SIDSMA.

Methods: A total of 128 consecutive patients with SIDSMA admitted to the study hospital between 2011 and 2016 were enrolled in this retrospective study. Their demographic information, clinical findings, EVT outcomes, and follow up results were analysed.

Results: Conservative treatment and pre-operative preparation were given immediately after admission, then digital subtraction angiography was performed. Stents were deployed in 112 out of 128 patients. The 16 patients who did not receive stents then continued conservative treatment. Peri-procedural complications occurred in three patients, including one death and two pseudoaneurysms at puncture sites. Mean follow up was 29.7 months (range 6-60 months) in patients with stents and 31.4 months (range 14-45 months) in patients without stents. During follow up, the overall complete remodelling rate in the stent group was 88.3%. Most took place within three months of stenting. The cumulative primary stent patency rate was 99.1%, and the cumulative event free survival rate was 99.0%, 95.8%, and 95.8% at one, three, and five years in patients with stents, compared with 62.5% at both one and three years in patents without stents (p < .001).

Conclusions: EVT for SIDSMA is clinically successful. The event free survival rate, primary patency, and complete remodelling are satisfactory during mid-term follow up. Endovascular treatment is an effective approach for SIDSMA.

Keywords: Endovascular treatment; Remodelling; Spontaneous isolated dissection of the superior mesenteric artery.