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. 2022 Mar 25;15(1):1-7.
doi: 10.3400/avd.ra.21-00055.

Isolated Superior Mesenteric Artery Dissection: A Novel Etiology and a Review

Rakan Nasser Eldine  1 , Hassan Dehaini  1 , Jamal Hoballah  1 , Fady Haddad  1
Affiliations

Isolated Superior Mesenteric Artery Dissection: A Novel Etiology and a Review

Rakan Nasser Eldine et al. Ann Vasc Dis. .

Abstract

Isolated superior mesenteric artery dissection (ISMAD) is a rare pathology with multifactorial etiology. The aim of this article is to provide a narrative review of the latest literature about ISMAD. Case reports, series, and recent meta-analyses were included. This review is introduced with a brief case report of a rare etiology of ISMAD, followed by a discussion of its etiology, clinical presentation, diagnosis, classification, and treatment, and we report a new cause of ISMAD, that is, blunt abdominal trauma. The etiology of ISMAD is multifactorial, consisting of anatomic, genetic, and systemic components. ISMAD is more common among middle-aged males and in East Asia. Its clinical presentation ranges from asymptomatic to mesenteric ischemia, albeit mortality remains <1%. It is diagnosed and classified mostly by computed tomography angiography, and there are five classification systems for ISMAD, though traumatic etiology may be added. The treatment of ISMAD is mostly conservative, with a success rate exceeding 90%. Endovascular stenting is second line, reserved so far for failed medical management, though its role is expanding to include earlier management of symptomatic patients, while open surgical repair is left for acute mesenteric ischemia with bowel compromise.

Keywords: ISMAD; blunt trauma; dissection; endovascular; superior mesenteric artery.

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Conflict of interest statement

Disclosure StatementAll authors have no conflict of interest to declare.

Figures

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Fig. 1 (A) A patent artery. (B) Arterial dissection with patent true and false lumen. (C) Arterial dissection with patent true lumen and thrombosed false lumen.
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Fig. 2 (A) Computed tomography angiography showing a stenosed superior mesenteric artery with distal perfusion. There is no embolus nor atherosclerotic changes surrounding the lesion. (B) Nonselective angiography showing isolated superior mesenteric artery dissection (ISMAD). (C) Selective angiography showing ISMAD.
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Fig. 3 (A) Angiography post-stenting showing patent superior mesenteric artery (SMA). (B) computed tomography angiography 6 months post repair. The SMA is patent, but there is evidence of minimal intimal hyperplasia.
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Fig. 4 (A) Duplex ultrasound 2 years post repair. There is increased velocity in the proximal superior mesenteric artery (SMA), indicating stent stenosis. (B) Duplex ultrasound 2 years post repair. The velocity is normal in the distal SMA, indicating patency and normal perfusion.
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Fig. 5 Li’s classification system of isolated superior mesenteric artery dissection with a proposed addition of subclass t to indicate traumatic etiology.
See this image and copyright information in PMC

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