Endovascular Stent-Graft Repair of Spontaneous Isolated Dissection of the Superior Mesenteric Artery

Didi Wen, Zhankui Wang, Jing Yu, Wenlong Zhang, Xiaobin Yang, Hua He, Xuexin Zhang, Ying Lin, Rui An, Minwen Zheng, Jian Xu

The aim of this study was to determine the short-term clinical outcomes, safety, and efficacy of covered stents implantation for patients with spontaneous isolated dissection of the superior mesenteric artery (SMA). Between October 2013 and December 2016, 12 patients (mean age, 50.0 ± 6.2 years; range 38-62 years) with spontaneous isolated dissection of SMA received endovascular treatment with the placement of covered stents at our institution. Patients' clinical characteristics were analyzed including sex, age, medical history, risk factors, symptoms, and diagnostic imaging modality. The technical and clinical successes of covered stents placement were retrospectively analyzed. Standard follow-up protocol included abdominal computed tomography angiography and clinical examinations at 1, 3, 6, and 12 months and annually thereafter to confirm patients' general condition. All dissections were located at the anterior wall and around the convex curvature of SMA. The mean length of the SMA dissection was 37.8 ± 31.5 mm (range 6.9-105.0 cm). Immediate technical success was defined as normal blood flow in the SMA and no contrast medium in the false lumen achieved in all patients. The mean duration of follow-up was 26.9 ± 7.2 months (range 16-36 months). Abdominal CT angiography demonstrated that no patients experienced endoleak or stent stenosis during follow-up. For symptomatic spontaneous isolated dissection of SMA in patients without aneurysms rupture and bowel necrosis, endovascular treatment with covered stents may be a safe and effective treatment option with a good short-term outcome.