In Reply to: Case 1199_10 -- Spontaneous Dissection of the Superior Mesenteric Artery posted by Editor on November 02, 1999 at 10:43:01:
This is a rare and interesting problem. It seems that it is rather risky to just wait and see if the problem will have a benign course. If it does not have a benign course the treatment options may be very limited after progression of the dissection up and down. I would have treated this individual when he first presented symptomatically in consultation with a vascular surgeon. A stent would be a second option although not as first choice.
Here are two abstracts that are relevant:
Solis MM; Ranval TJ; McFarland DR; Eidt JF. Surgical treatment of superior mesenteric artery dissecting aneurysm and simultaneous celiac artery compression.
Annals of Vascular Surgery, 1993 Sep, 7(5):457-62.
Abstract: Spontaneous dissections of visceral arteries are rare, but when they do occur, they most commonly involve the superior mesenteric artery (SMA). We present a case of intestinal ischemia caused by a spontaneous dissection of the SMA in a patient with simultaneous celiac artery occlusion. The patient was a 45-year-old woman who presented with intestinal angina of sudden onset. Arteriography revealed the classic findings of SMA dissection and occlusion of the celiac artery. The patient underwent repair of both visceral vessels and made a full recovery. The 18 previously reported cases
of isolated, spontaneous dissection of the SMA are reviewed. No previous case has been associated with celiac compression syndrome. The reported experience with symptomatic dissections of the SMA would suggest that prompt surgical repair is indicated and yields excellent results.
Yasuhara H; Shigematsu H; Muto T. Self-limited spontaneous dissection of the main trunk of the superior mesenteric artery. Journal of Vascular Surgery, 1998 Apr, 27(4):776-9.
Abstract: Spontaneous dissection of the splanchnic arteries is rare and reportedly carries a high risk of mortality. Two cases with spontaneous dissection of the main trunk of the superior mesenteric artery followed by a self-limited clinical course are presented. Current management strategies, including bypass operation, patch angioplasty, and conservative treatments, are discussed. Emphasis is placed on the role of nonsurgical management with careful follow-up with the use of new technologies such as duplex and computed tomography scanning.