Management strategy for spontaneous isolated dissection of the superior mesenteric artery based on morphologic classification Dong-lin Li, MD, Yang-yan.

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Presentation transcript:

Management strategy for spontaneous isolated dissection of the superior mesenteric artery based on morphologic classification Dong-lin Li, MD, Yang-yan He, MD, Adel M. Alkalei, MD, Xu-dong Chen, MD, Wei Jin, MD, Ming Li, MD, Hong-kun Zhang, MD, PhD, Ting-bo Liang, MD, PhD Journal of Vascular Surgery Volume 59, Issue 1, Pages 165-172 (January 2014) DOI: 10.1016/j.jvs.2013.07.014 Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 1 Morphologic classification of spontaneous isolated dissection of the superior mesenteric artery (SIDSMA). Type I, patent false lumen with both entry and re-entry; type II, “cul-de-sac” shaped false lumen without re-entry (subdivided into IIa, patent true lumen; IIb, severe stenosis of the true lumen; and IIc, occlusion of the true lumen); type III, thrombosed false lumen with an ulcer-like projection (ULP) (subdivided into IIIa, patent true lumen; IIIb, severe stenosis of the true lumen; and IIIc, occlusion of the true lumen); type IV, completely thrombosed false lumen without an ULP (subdivided into IVa, patent true lumen; IVb, severe stenosis of the true lumen; and IVc, occlusion of the true lumen); and type V, dissecting aneurysm. Journal of Vascular Surgery 2014 59, 165-172DOI: (10.1016/j.jvs.2013.07.014) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 2 Entry site classification of spontaneous isolated dissection of the superior mesenteric artery (SIDSMA): zone 1, from orifice to 1 cm proximal to the SMA curvature; zone 2, from 1 cm proximal to 1 cm distal to the SMA curvature; and zone 3, from distal to 1 cm distal to the SMA curvature. Number of patients in each zone from this study: six patients in zone 1, 27 patients in zone 2, and nine patients in zone 3. pts, Patients. Journal of Vascular Surgery 2014 59, 165-172DOI: (10.1016/j.jvs.2013.07.014) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 3 A 68-year-old man with type IIa spontaneous isolated dissection of the superior mesenteric artery (SIDSMA). Computed tomography (CT) scans (A) demonstrated patent true lumen and observation treatment was applied. The false lumen progressed to a pseudoaneurysm (B) 30 months later, and the patient received endovascular coil embolization and stenting (C, D). Journal of Vascular Surgery 2014 59, 165-172DOI: (10.1016/j.jvs.2013.07.014) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 4 A 48-year-old man with type IIb spontaneous isolated dissection of the superior mesenteric artery (SIDSMA). Computed tomography (CT) scans (A) and angiography (B) demonstrated the true lumen with severe stenosis and the false lumen without re-entry sites. Follow-up CT scans after endovascular stenting revealed patent stent with gradual resolution of the false lumen (C, 3 months postoperation; D, 12 months postoperation). Journal of Vascular Surgery 2014 59, 165-172DOI: (10.1016/j.jvs.2013.07.014) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 5 Management strategy based on clinical manifestation and morphologic classification for patients with symptomatic spontaneous isolated dissection of the superior mesenteric artery (SIDSMA). CT, Computed tomography. Journal of Vascular Surgery 2014 59, 165-172DOI: (10.1016/j.jvs.2013.07.014) Copyright © 2014 Society for Vascular Surgery Terms and Conditions