Spontaneous and isolated dissection of the superior mesenteric artery: proposal of a management algorithm.

Background: Spontaneous and isolated dissection of the superior mesenteric artery (SIDSMA) is a rare pathology, and the treatment of symptomatic forms is not consensual. The objective of this study was to analyze the management of a series of patients presenting a symptomatic SIDSMA within a structure taking care of intestinal vascular emergencies.

Methods: From January 2010 to January 2014, the patients presenting a symptomatic SIDSMA were included retrospectively. The clinical and radiologic data as well as the treatment and the follow-up were analyzed.

Results: Nine patients were included. Among them, 2 patients presenting with acute mesenteric ischemia were revascularized surgically in emergency, and 1 patient presenting a rupture of a superior mesenteric artery aneurysm had an arteriography followed by medical care. The 6 other patients received medical treatment. Among these, 2 patients developed mesenteric angina requiring surgical revascularization during the follow-up.

Conclusions: The revascularization of spontaneous and isolated dissections of the superior mesenteric artery is indicated in the cases complicated with acute mesenteric ischemia, aneurysmal rupture, or in the event of appearance of mesenteric angina or aneurysmal evolution. It should also be discussed in the event of failure of the medical treatment.