Long-Term Outcome of Spontaneous Isolated Dissection of the Superior Mesenteric Artery.

Abstract

Objectives: We aimed to elucidate the long-term outcomes of acute symptomatic spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) to inform optimal decision-making during the acute phase.

Methods: We retrospectively collected and analyzed data from 14 consecutive patients diagnosed with SIDSMA by using computed tomography angiography (CTA) between January 2010 and August 2024.

Results: The cohort comprised 13 males and 1 female, with a mean age of 59.36 ± 14.90 years. All patients presented with acute abdominal pain, and some experienced vomiting. Thirteen patients received conservative treatment, while only 1 patient underwent open surgery with extra-anatomical bypass; this patient required no further intervention 10 years postoperatively. One of the patients, whose abdominal pain worsened with food intake, showed SMA stenosis and decreased intestinal blood flow. His symptoms improved after heparin anticoagulation therapy followed by direct oral anticoagulant therapy. Over a follow-up period of 7.20 ± 3.21 years, none of the patients experienced recurrent SIDSMA-related abdominal pain, and all survived without the need for additional invasive treatment.

Conclusions: Conservative treatment effectively manages SIDSMA over the long term without reintervention. Early diagnosis and management of intestinal ischemia are essential for optimal treatment outcomes.