Diagnostic value of color Doppler sonography for spontaneous isolated superior mesenteric artery dissection

Value of CT angiography in diagnosis and classification of spontaneous isolated superior mesenteric artery dissection and evaluation of its clinical symptoms

BACKGROUND

CT angiography (CTA) is a non-invasive, rapid imaging technology and can accurately examine and evaluate the degree and range of stenosis of diseased vessels and lumens. CTA has been routinely used for early screening of spontaneous isolated superior mesenteric artery dissection (SISMAD). This study further explored the diagnostic value of CTA in the classification of SISMAD and the evaluation of clinical symptoms.

AIM

To assess the value of CTA in the diagnosis of SISMAD and the evaluation of its clinical symptoms.

METHODS

Ninety-five suspected SISMAD patients in our hospital from October 2019 to January 2022 were selected for CTA examination. Clinical results (digital subtraction angiography or surgical results) were used as the "gold standard" to analyze the value of CTA in diagnosing SISMAD, and to compare the measurement parameters of CTA in SISMAD patients with and without clinical symptoms. The correlation between the measurement parameters of CTA and the clinical symptoms of SISMAD patients was analyzed, and the consistency between the classification of SISMAD by CTA and the clinical results was assessed by kappa test.

RESULTS

The area under the curve (AUC) of CTA for the diagnosis of SISMAD was 0.953 (95% confidence interval [CI]: 0.889-0.986), the diagnostic sensitivity and specificity were 90.63% and 100.00%, respectively, and the Yoden index was 0.906. The interlayer length and the degree of true cavity stenosis were greater and the diameter of true cavity was smaller in patients with clinical symptoms than in those without (P < 0.05). The interlayer length and the degree of true cavity stenosis were positively correlated with clinical symptoms, while true cavity diameter was negatively correlated with clinical symptoms (P < 0.05). The consistency between SISMAD classification by CTA and the clinical results was 0.784 (95%CI: 0.577-0.991), and the accuracy was 84.38% (P < 0.05).

CONCLUSION

CTA has high accuracy in the diagnosis and classification evaluation of SISMAD, and the interlayer length, diameter of true cavity, and degree of true cavity stenosis as the measured parameters of CTA are helpful to evaluate the clinical symptoms of patients.

Isolated superior mesenteric artery dissection: An updated review of the literature

Isolated superior mesenteric artery dissection (ISMAD) is a rare but potentially life-threatening cause of acute abdominal pain. Owing to the availability of computed tomography angiography, more cases have been detected during screening for acute abdomen in recent years. With increasing knowledge of ISMAD, a better management strategy is being developed. To enhance our understanding and improve treatment outcomes of ISMAD, a systematic literature review was conducted with a focus on diagnosis and management strategies based on existing evidence.

Diagnosis of spontaneous isolated superior mesenteric artery dissection with ultrasound: A case report

BACKGROUND

Spontaneous isolated superior mesenteric artery dissection (SISMAD) is a rare disease that originates from the superior mesenteric artery, without the presence of aortic and other arterial dissections. Most cases are diagnosed using contrast-enhanced computed tomography (CECT), whereas the application of ultrasound is less common.

CASE SUMMARY

Here, we report a case of SISMAD with sudden epigastric pain that worsened as the main symptom after eating. The patient had a long history of hypertension with unknown blood pressure control but no history of smoking or alcohol consumption. This case was initially diagnosed using ultrasound and the results were later confirmed by CECT. After admission, the patient fasted, followed by parenteral nutrition support and fluid supplementation to maintain electrolyte and acid–base balance. Metoprolol succinate sustained-release tablets and aspirin were given as nonoperative treatments. After 1 wk, the symptoms improved, and the patient was discharged. During telephone follow-up, the patient did not develop similar symptoms.

CONCLUSION

Whether ultrasound can be used as a routine and noninvasive imaging method for the diagnosis of SISMAD needs further exploration.

Management of spontaneous isolated intramural hematoma of the superior mesenteric artery: a single-center experience

PURPOSE

To investigate the clinical course and optimal management for spontaneous isolated intramural hematoma of the superior mesenteric artery (SIHSMA).

METHODS

From January 2015 to October 2020, a total of 31 consecutive patients with SIHSMA were included in this study. The demographics, clinical features, treatment details, imaging information, and outcomes were reviewed.

RESULTS

There were 24 males and 7 females, with a mean age of 54.9 years (SD 6.9 years). Seven patients (7/31, 23%) were associated with ulcer-like projection (ULP), one patient (1/31, 3%) with intramural blood pool (IBP), and the remaining twenty-three patients (23/31, 74%) had no ULP or IBP. All patients were initially managed conservatively and underwent a median follow-up of 25.5 months (IQR 14.5, 39.9), which showed 3 patients (3/31, 10%) subsequently underwent stenting (2 within 7 days and 1 after 1.5 months), 1 patient (1/31, 3%) progressed to a localized dissection 7 months later but remained stable and asymptomatic until the time of writing, and the remaining patients (27/31, 87%) had no progression. In the present cohort, the overall survival was 100% (31/31). The free-from progression and stenting rate under conservative treatment was 87% (27/31). The invasive intervention rate was 10% (3/31). The natural complete regression rate of IMH in patients without ULP was higher than those with ULP (91% [21/23] vs. 29% [2/7], p = .003).

CONCLUSION

The majority of patients with SIHSMA can be managed conservatively. Patients with ULP seemed to have a lower IMH regression rate than those without ULP.

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

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.