Symptomatic isolated superior mesenteric artery dissection: focusing on the morphologic type associated with invasive treatment

Kwak, Hyun Kyu; Lee, Byung Soo; Kim, Bohyun; Ahn, Jung Hwan

J Korean Soc Emerg Med > Volume 29(2); 2018 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2018;29(2): 223-230.

자발성 단독 상장간막동맥 박리의 침습적 치료와 관련된 컴퓨터 단층 촬영에 의한 형태학적 분류 및 소견

곽현규¹, 이병수¹, 김보현²

, 안정환¹

¹아주대학교 의과대학 응급의학교실
²아주대학교 의과대학 영상의학교실

Symptomatic isolated superior mesenteric artery dissection: focusing on the morphologic type associated with invasive treatment

Hyun Kyu Kwak¹, Byung Soo Lee¹, Bohyun Kim²

, Jung Hwan Ahn¹

¹Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
²Department of Radiology, Ajou University School of Medicine, Suwon, Korea

Correspondence

Jung Hwan Ahn ,Tel: 031-219-7753, Fax: 031-219-7760, Email: erdrajh@naver.com,

Received: September 4, 2017; Revised: September 5, 2017 Accepted: October 26, 2017. Published online: April 30, 2018.

ABSTRACT

Objective:
This study was conducted to investigate the relationship between invasive treatments and computed tomographic (CT) classification or findings in symptomatic spontaneous isolated superior mesenteric artery dissection (SISMAD).
Method:
This retrospective observational study included 30 patients with SISMAD from Jan 2012 to Dec 2016. Demographic data, risk factor, treatment modalities, and CT findings including morphological classification, dissection length, and true lumen relative diameter (TLRD) were reviewed. The enrolled patients were classified into two groups (conservative management group, CG; invasive management group, IG).
Results:
Based on CT classifications, one patient was type I (CG, n=1; IG, n=0), two were type IIa (CG, n=2; IG, n=0), five were type IIIa (CG, n=5; IG, n=0), 10 were type IIIb (CG, n=9; IG, n=1), and 12 were type IIIc (CG, n=1; IG, n=11). There was a high tendency to undergo invasive treatment among type IIIc (P<0.001). The TLRD, distance from the aorta to dissection point, and dissection length were 18.3% (range, 0%-29.8%), 1.7 cm (range, 0-3.5 cm), and 7.3 cm (range, 4.9-10.0 cm), respectively. There TLRD (CG, 26.8% [range, 22.2%-48.8%]; IG, 0%; P<0.001) and distance from the aorta to dissection point (CG, 1.0 cm [range, 0-2.1 cm]; IG, 3.5 cm [range, 0.8-5.4 cm]; P=0.024) differed significantly between groups. However, there was no significant difference in dissection length between CG and IG (P=0.527).
Conclusion:
The TLRD, distance from the aorta to dissection point, and CT classification such as type IIIc were associated with invasive management. Further studies on extended natural course of the disease from a larger number of subjects are necessary to draw a strong conclusion.

Key words: Abdominal pain; Mesenteric artery; Superior; Dissection; Mesenteric ischemia