Progress of intraluminal treatment for isolated superior mesenteric artery dissection_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

MAN Jiahao ¹ ,  TANG Bo ²

1. Department of Vascular Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China;
2. Department of General Surgery, University-Town Hospital of Chongqing Medical University, Chongqing 401331, P. R. China;

Corresponding?author：

TANG Bo, Email: 300374@hospital.cqmu.edu.cn

Keywords：

superior mesenteric artery; aneurysm; dissection; stent; treatment; review

DOI：

10.7507/1007-9424.202405055

Video：

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Objective To explore the current research status of endovascular treatment for isolated superior mesenteric artery dissection (ISMAD) so as to provide a reference for vascular surgeons and patients in selecting treatment methods. Method The recent domestic and international literature on the endovascular treatment for ISMAD was collected and summarized. Results The current endovascular treatment methods for ISMAD mainly included catheter-directed thrombolysis and stent placement. For the ISMAD patients with true intraluminal thrombus formation, true luminal occlusion, and partial embolization of branch vessels, the catheter-directed thrombolysis was performed by continuously pumping urokinase locally to dissolve thrombus and improve distal blood supply. The stent placement mainly included two main types: bare stent placement and covered stent placement, both aiming to promote true lumen recanalization, false lumen thrombosis, and vascular remodeling through mechanical support and blood flow redirection. The bare stents had unique advantages such as being well-developed, offering a wide range of options, and having stable performance. However, covered stents were superior to bare stents in terms of mid-term patency rate and in-stent restenosis. Conclusions With the development of technology, endovascular treatment has become an indispensable method for ISMAD patients. Extensive multicenter cases reports from both domestic and international studies have supported the safety and efficacy of endovascular treatment. Catheter-directed thrombolysis and stent placement (bare stent and covered stent) offer targeted solutions for various types of ISMAD patients, providing more minimally invasive and effective treatment.

Citation： MAN Jiahao, TANG Bo. Progress of intraluminal treatment for isolated superior mesenteric artery dissection. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(9): 1147-1152. doi: 10.7507/1007-9424.202405055 Copy

1.	Foord AG, Lewis RD. Primary dissecting aneurysms of peripheral and pulmonary arteries: dissecting hemorrhage of media. Arch Pathol, 1959, 68: 553-577.
2.	中國醫師協會介入醫師分會外周血管介入專業委員會. 孤立性腸系膜上動脈夾層診治專家共識. 中華放射學雜志, 2021, 55(4): 352-358.
3.	Garrett HE. Options for treatment of spontaneous mesenteric artery dissection. J Vasc Surg, 2014, 59(5): 1433-1439.
4.	Leung DA, Schneider E, Kubik-Huch R, et al. Acute mesenteric ischemia caused by spontaneous isolated dissection of the superior mesenteric artery: treatment by percutaneous stent placement. Eur Radiol, 2000, 10(12): 1916-1919.
5.	Bj?rck M, Koelemay M, Acosta S, et al. Editor’s choice—Management of the diseases of mesenteric arteries and veins: Clinical practice guidelines of the European Society of Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg, 2017, 53(4): 460-510.
6.	李孝成, 劉佳. 自發性孤立性腸系膜上動脈夾層的治療現狀. 海南醫學, 2022, 33(7): 935-938.
7.	Yun WS, Kim YW, Park KB, et al. Clinical and angiographic follow-up of spontaneous isolated superior mesenteric artery dissection. Eur J Vasc Endovasc Surg, 2009, 37(5): 572-577.
8.	Yu SH, Hii IH, Wu IH. Comparison of superior mesenteric artery remodeling and clinical outcomes between conservative or endovascular treatment in spontaneous isolated superior mesenteric artery dissection. J Clin Med, 2022, 11(2): 465. doi: 10.3390/jcm11020465.
9.	Jia ZZ, Zhao JW, Tian F, et al. Initial and middle-term results of treatment for symptomatic spontaneous isolated dissection of superior mesenteric artery. Eur J Vasc Endovasc Surg, 2013, 45(5): 502-508.
10.	Kim J, Yoon CJ, Seong N, et al. Spontaneous dissection of superior mesenteric artery: long-term outcome of stent placement. J Vasc Interv Radiol, 2017, 28(12): 1722-1726.
11.	Wen D, Wang Z, Yu J, et al. Endovascular stent-graft repair of spontaneous isolated dissection of the superior mesenteric artery. Cardiovasc Intervent Radiol, 2018, 41(5): 692-698.
12.	Ahn HY, Cho BS, Mun YS, et al. Treatment results for spontaneous isolated superior mesenteric artery dissection according to our previous guidelines and collective literature review. Ann Vasc Surg, 2014, 28(7): 1595-1601.
13.	Kim HK, Jung HK, Cho J, et al. Clinical and radiologic course of symptomatic spontaneous isolated dissection of the superior mesenteric artery treated with conservative management. J Vasc Surg, 2014, 59(2): 465-472.
14.	Kim YW. Current understandings of spontaneous isolated superior mesenteric artery dissection. Vasc Specialist Int, 2016, 32(2): 37-43.
15.	Qiu C, Wu Z, He Y, et al. Endovascular therapy versus medical treatment for spontaneous isolated dissection of the superior mesenteric artery. Cochrane Database Syst Rev, 2022, 9(9): CD014703. doi: 10.1002/14651858.
16.	Luan JY, Guan X, Li X, et al. Isolated superior mesenteric artery dissection in China. J Vasc Surg, 2016, 63(2): 530-536.
17.	Huber TS, Bj?rck M, Chandra A, et al. Chronic mesenteric ischemia: Clinical practice guidelines from the Society for Vascular Surgery. J Vasc Surg, 2021, 73(1S): 87S-115S. doi: 10.1016/j.jvs.2020.10.029.
18.	Mirza AK, Oderich GS, Sandri GA, et al. Outcomes of upper extremity access during fenestrated-branched endovascular aortic repair. J Vasc Surg, 2019, 69(3): 635-643.
19.	Peck MA, Conrad MF, Kwolek CJ, et al. Intermediate-term outcomes of endovascular treatment for symptomatic chronic mesenteric ischemia. J Vasc Surg, 2010, 51(1): 140-147.
20.	Oderich GS, Tallarita T, Gloviczki P, et al. Mesenteric artery complications during angioplasty and stent placement for atherosclerotic chronic mesenteric ischemia. J Vasc Surg, 2012, 55(4): 1063-1071.
21.	Xu L, Shao J, Zhang D, et al. Long-term outcomes of conservative treatment and endovascular treatment in patients with symptomatic spontaneous isolated superior mesenteric artery dissection: a single-center experience. BMC Cardiovasc Disord, 2020, 20(1): 256. doi: 10.1186/s12872-020-01532-y.
22.	Fu YF, Cao C, Shi YB, et al. Endovascular bare stenting for isolated superior mesenteric artery dissection. Vasc Endovascular Surg, 2020, 54(1): 12-16.
23.	倪國慶, 蘇浩波, 顧建平, 等. 孤立性腸系膜上動脈夾層腔內治療及其中遠期療效. 介入放射學雜志, 2019, 28(6): 525-530.
24.	王超臣, 孫羽東, 魏小龍, 等. 孤立性腸系膜上動脈夾層的分型和治療進展. 中華外科雜志, 2023, 61(1): 81-85.
25.	倪建琦, 范欣鑫, 何長生, 等. 薄壁裸支架治療自發孤立性腸系膜上動脈夾層32例臨床分析. 中華外科雜志, 2023, 61(11): 1001-1004.
26.	Haben C, Park WM, Bena JF, et al. Improving midterm results justify the continued use of bare-metal stents for endovascular therapy for chronic mesenteric ischemia. J Vasc Surg, 2020, 71(1): 111-120.
27.	李文崗, 劉斌, 陳福真. 自發性孤立性腸系膜上動脈夾層的診斷與治療. 中華消化外科雜志, 2015, 14(9): 712-716.
28.	Zhang L, Yin CP, Li HY, et al. Multiple overlapping bare stents for endovascular visceral aneurysm repair: a potential alternative endovascular strategy to multilayer stents. Ann Vasc Surg, 2013, 27(5): 606-612.
29.	Baldino G, Mortola P, Cambiaso M, et al. Endovascular treatment with flow-diverting stents of symptomatic superior mesenteric artery after dissection aneurysm. J Vasc Surg Cases Innov Tech, 2017, 3(1): 30-34.
30.	Jia Z, Su H, Chen W, et al. Endovascular treatment of patients with isolated mesenteric artery dissection aneurysm: bare stents alone versus stent assisted coiling. Eur J Vasc Endovasc Surg, 2019, 57(3): 400-406.
31.	Ozaki T, Kimura M, Yoshimura N, et al. Endovascular treatment of spontaneous isolated dissecting aneurysm of the superior mesenteric artery using stent-assisted coil embolization. Cardiovasc Intervent Radiol, 2006, 29(3): 435-437.
32.	Yamaguchi H, Murata S, Ueda T, et al. New technique for false lumen coiling of spontaneous isolated superior mesenteric artery dissection. CVIR Endovasc, 2021, 4(1): 35. doi: 10.1186/s42155-021-00225-7.
33.	倪國慶, 彭鵬, 王劍, 等. 孤立性腸系膜上動脈夾層的兩種腔內治療策略對比研究. 中華放射學雜志, 2022, 56(12): 1365-1370.
34.	Shi Y, Ni G, Zhao B, et al. Management of symptomatic spontaneous isolated superior mesenteric artery dissection: a single centre experience with mid term follow up. Eur J Vasc Endovasc Surg, 2020, 60(6): 863-871.
35.	Qiu C, He Y, Li D, et al. Mid-term results of endovascular treatment for spontaneous isolated dissection of the superior mesenteric artery. Eur J Vasc Endovasc Surg, 2019, 58(1): 88-95.
36.	Zhou Y, Ryer EJ, Garvin RP, et al. Outcomes of endovascular treatments for in-stent restenosis in patients with mesenteric atherosclerotic disease. J Vasc Surg, 2019, 69(3): 833-842.
37.	Mwipatayi BP, Thomas S, Wong J, et al. A comparison of covered vs bare expandable stents for the treatment of aortoiliac occlusive disease. J Vasc Surg, 2011, 54(6): 1561-1570.
38.	Mwipatayi BP, Sharma S, Daneshmand A, et al. Durability of the balloon-expandable covered versus bare-metal stents in the Covered versus Balloon Expandable Stent Trial (COBEST) for the treatment of aortoiliac occlusive disease. J Vasc Surg, 2016, 64(1): 83-94.
39.	Girault A, Pellenc Q, Roussel A, et al. Midterm results after covered stenting of the superior mesenteric artery. J Vasc Surg, 2021, 74(3): 902-909.
40.	Oderich GS, Erdoes LS, Lesar C, et al. Comparison of covered stents versus bare metal stents for treatment of chronic atherosclerotic mesenteric arterial disease. J Vasc Surg, 2013, 58(5): 1316-1323.
41.	Jia Z. Regarding “Endovascular stent-graft repair of spontaneous isolated dissection of the superior mesenteric artery”. Cardiovasc Intervent Radiol, 2018, 41(5): 821. doi: 10.1007/s00270-018-1905-4.
42.	Xu Y, Li X, Shang D, et al. Mid-term outcomes of symptomatic isolated superior mesenteric artery dissection with endovascular management. Vascular, 2021, 29(2): 301-310.
43.	Kim E, Sebastiao BG, Lee A, et al. Safety and effectiveness of vascular closure devices in interventional radiological procedures. Interv Neuroradiol, 2023, 29(5): 525-531.
44.	Ierardi AM, Coppola A, Renzulli M, et al. Effectiveness and safety of different vascular closure devices: multicentre prospective observational study. Cardiovasc Intervent Radiol, 2023, 46(7): 827-834.
45.	Capodanno D, Alfonso F, Levine GN, et al. ACC/AHA versus ESC guidelines on dual antiplatelet therapy: JACC guideline comparison. J Am Coll Cardiol, 2018, 72(23 Pt A): 2915-2931.
46.	Huo Y, Jeong YH, Gong Y, et al. 2018 update of expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI. Sci Bull (Beijing), 2019, 64(3): 166-179.
47.	Terlouw LG, Moelker A, Abrahamsen J, et al. European guidelines on chronic mesenteric ischaemia—joint United European Gastroenterology, European Association for Gastroenterology, Endoscopy and Nutrition, European Society of Gastrointestinal and Abdominal Radiology, Netherlands Association of Hepatogastroenterologists, Hellenic Society of Gastroenterology, Cardiovascular and Interventional Radiological Society of Europe, and Dutch Mesenteric Ischemia Study group clinical guidelines on the diagnosis and treatment of patients with chronic mesenteric ischaemia. United European Gastroenterol J, 2020, 8(4): 371-395.
48.	王成, 王哲, 李鳳賀, 等. 30例自發性孤立性腸系膜上動脈夾層的血流動力學分析. 重慶醫科大學學報, 2020, 45(9): 1371-1376.
49.	Peng Y, Li R, Tang G, et al. Correlation of Riolan’s arch diameter to treatment choice in patients with isolated superior mesenteric artery dissection. Abdom Radiol (NY), 2022, 47(10): 3628-3637.

1. Foord AG, Lewis RD. Primary dissecting aneurysms of peripheral and pulmonary arteries: dissecting hemorrhage of media. Arch Pathol, 1959, 68: 553-577.
2. 中國醫師協會介入醫師分會外周血管介入專業委員會. 孤立性腸系膜上動脈夾層診治專家共識. 中華放射學雜志, 2021, 55(4): 352-358.
3. Garrett HE. Options for treatment of spontaneous mesenteric artery dissection. J Vasc Surg, 2014, 59(5): 1433-1439.
4. Leung DA, Schneider E, Kubik-Huch R, et al. Acute mesenteric ischemia caused by spontaneous isolated dissection of the superior mesenteric artery: treatment by percutaneous stent placement. Eur Radiol, 2000, 10(12): 1916-1919.
5. Bj?rck M, Koelemay M, Acosta S, et al. Editor’s choice—Management of the diseases of mesenteric arteries and veins: Clinical practice guidelines of the European Society of Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg, 2017, 53(4): 460-510.
6. 李孝成, 劉佳. 自發性孤立性腸系膜上動脈夾層的治療現狀. 海南醫學, 2022, 33(7): 935-938.
7. Yun WS, Kim YW, Park KB, et al. Clinical and angiographic follow-up of spontaneous isolated superior mesenteric artery dissection. Eur J Vasc Endovasc Surg, 2009, 37(5): 572-577.
8. Yu SH, Hii IH, Wu IH. Comparison of superior mesenteric artery remodeling and clinical outcomes between conservative or endovascular treatment in spontaneous isolated superior mesenteric artery dissection. J Clin Med, 2022, 11(2): 465. doi: 10.3390/jcm11020465.
9. Jia ZZ, Zhao JW, Tian F, et al. Initial and middle-term results of treatment for symptomatic spontaneous isolated dissection of superior mesenteric artery. Eur J Vasc Endovasc Surg, 2013, 45(5): 502-508.
10. Kim J, Yoon CJ, Seong N, et al. Spontaneous dissection of superior mesenteric artery: long-term outcome of stent placement. J Vasc Interv Radiol, 2017, 28(12): 1722-1726.
11. Wen D, Wang Z, Yu J, et al. Endovascular stent-graft repair of spontaneous isolated dissection of the superior mesenteric artery. Cardiovasc Intervent Radiol, 2018, 41(5): 692-698.
12. Ahn HY, Cho BS, Mun YS, et al. Treatment results for spontaneous isolated superior mesenteric artery dissection according to our previous guidelines and collective literature review. Ann Vasc Surg, 2014, 28(7): 1595-1601.
13. Kim HK, Jung HK, Cho J, et al. Clinical and radiologic course of symptomatic spontaneous isolated dissection of the superior mesenteric artery treated with conservative management. J Vasc Surg, 2014, 59(2): 465-472.
14. Kim YW. Current understandings of spontaneous isolated superior mesenteric artery dissection. Vasc Specialist Int, 2016, 32(2): 37-43.
15. Qiu C, Wu Z, He Y, et al. Endovascular therapy versus medical treatment for spontaneous isolated dissection of the superior mesenteric artery. Cochrane Database Syst Rev, 2022, 9(9): CD014703. doi: 10.1002/14651858.
16. Luan JY, Guan X, Li X, et al. Isolated superior mesenteric artery dissection in China. J Vasc Surg, 2016, 63(2): 530-536.
17. Huber TS, Bj?rck M, Chandra A, et al. Chronic mesenteric ischemia: Clinical practice guidelines from the Society for Vascular Surgery. J Vasc Surg, 2021, 73(1S): 87S-115S. doi: 10.1016/j.jvs.2020.10.029.
18. Mirza AK, Oderich GS, Sandri GA, et al. Outcomes of upper extremity access during fenestrated-branched endovascular aortic repair. J Vasc Surg, 2019, 69(3): 635-643.
19. Peck MA, Conrad MF, Kwolek CJ, et al. Intermediate-term outcomes of endovascular treatment for symptomatic chronic mesenteric ischemia. J Vasc Surg, 2010, 51(1): 140-147.
20. Oderich GS, Tallarita T, Gloviczki P, et al. Mesenteric artery complications during angioplasty and stent placement for atherosclerotic chronic mesenteric ischemia. J Vasc Surg, 2012, 55(4): 1063-1071.
21. Xu L, Shao J, Zhang D, et al. Long-term outcomes of conservative treatment and endovascular treatment in patients with symptomatic spontaneous isolated superior mesenteric artery dissection: a single-center experience. BMC Cardiovasc Disord, 2020, 20(1): 256. doi: 10.1186/s12872-020-01532-y.
22. Fu YF, Cao C, Shi YB, et al. Endovascular bare stenting for isolated superior mesenteric artery dissection. Vasc Endovascular Surg, 2020, 54(1): 12-16.
23. 倪國慶, 蘇浩波, 顧建平, 等. 孤立性腸系膜上動脈夾層腔內治療及其中遠期療效. 介入放射學雜志, 2019, 28(6): 525-530.
24. 王超臣, 孫羽東, 魏小龍, 等. 孤立性腸系膜上動脈夾層的分型和治療進展. 中華外科雜志, 2023, 61(1): 81-85.
25. 倪建琦, 范欣鑫, 何長生, 等. 薄壁裸支架治療自發孤立性腸系膜上動脈夾層32例臨床分析. 中華外科雜志, 2023, 61(11): 1001-1004.
26. Haben C, Park WM, Bena JF, et al. Improving midterm results justify the continued use of bare-metal stents for endovascular therapy for chronic mesenteric ischemia. J Vasc Surg, 2020, 71(1): 111-120.
27. 李文崗, 劉斌, 陳福真. 自發性孤立性腸系膜上動脈夾層的診斷與治療. 中華消化外科雜志, 2015, 14(9): 712-716.
28. Zhang L, Yin CP, Li HY, et al. Multiple overlapping bare stents for endovascular visceral aneurysm repair: a potential alternative endovascular strategy to multilayer stents. Ann Vasc Surg, 2013, 27(5): 606-612.
29. Baldino G, Mortola P, Cambiaso M, et al. Endovascular treatment with flow-diverting stents of symptomatic superior mesenteric artery after dissection aneurysm. J Vasc Surg Cases Innov Tech, 2017, 3(1): 30-34.
30. Jia Z, Su H, Chen W, et al. Endovascular treatment of patients with isolated mesenteric artery dissection aneurysm: bare stents alone versus stent assisted coiling. Eur J Vasc Endovasc Surg, 2019, 57(3): 400-406.
31. Ozaki T, Kimura M, Yoshimura N, et al. Endovascular treatment of spontaneous isolated dissecting aneurysm of the superior mesenteric artery using stent-assisted coil embolization. Cardiovasc Intervent Radiol, 2006, 29(3): 435-437.
32. Yamaguchi H, Murata S, Ueda T, et al. New technique for false lumen coiling of spontaneous isolated superior mesenteric artery dissection. CVIR Endovasc, 2021, 4(1): 35. doi: 10.1186/s42155-021-00225-7.
33. 倪國慶, 彭鵬, 王劍, 等. 孤立性腸系膜上動脈夾層的兩種腔內治療策略對比研究. 中華放射學雜志, 2022, 56(12): 1365-1370.
34. Shi Y, Ni G, Zhao B, et al. Management of symptomatic spontaneous isolated superior mesenteric artery dissection: a single centre experience with mid term follow up. Eur J Vasc Endovasc Surg, 2020, 60(6): 863-871.
35. Qiu C, He Y, Li D, et al. Mid-term results of endovascular treatment for spontaneous isolated dissection of the superior mesenteric artery. Eur J Vasc Endovasc Surg, 2019, 58(1): 88-95.
36. Zhou Y, Ryer EJ, Garvin RP, et al. Outcomes of endovascular treatments for in-stent restenosis in patients with mesenteric atherosclerotic disease. J Vasc Surg, 2019, 69(3): 833-842.
37. Mwipatayi BP, Thomas S, Wong J, et al. A comparison of covered vs bare expandable stents for the treatment of aortoiliac occlusive disease. J Vasc Surg, 2011, 54(6): 1561-1570.
38. Mwipatayi BP, Sharma S, Daneshmand A, et al. Durability of the balloon-expandable covered versus bare-metal stents in the Covered versus Balloon Expandable Stent Trial (COBEST) for the treatment of aortoiliac occlusive disease. J Vasc Surg, 2016, 64(1): 83-94.
39. Girault A, Pellenc Q, Roussel A, et al. Midterm results after covered stenting of the superior mesenteric artery. J Vasc Surg, 2021, 74(3): 902-909.
40. Oderich GS, Erdoes LS, Lesar C, et al. Comparison of covered stents versus bare metal stents for treatment of chronic atherosclerotic mesenteric arterial disease. J Vasc Surg, 2013, 58(5): 1316-1323.
41. Jia Z. Regarding “Endovascular stent-graft repair of spontaneous isolated dissection of the superior mesenteric artery”. Cardiovasc Intervent Radiol, 2018, 41(5): 821. doi: 10.1007/s00270-018-1905-4.
42. Xu Y, Li X, Shang D, et al. Mid-term outcomes of symptomatic isolated superior mesenteric artery dissection with endovascular management. Vascular, 2021, 29(2): 301-310.
43. Kim E, Sebastiao BG, Lee A, et al. Safety and effectiveness of vascular closure devices in interventional radiological procedures. Interv Neuroradiol, 2023, 29(5): 525-531.
44. Ierardi AM, Coppola A, Renzulli M, et al. Effectiveness and safety of different vascular closure devices: multicentre prospective observational study. Cardiovasc Intervent Radiol, 2023, 46(7): 827-834.
45. Capodanno D, Alfonso F, Levine GN, et al. ACC/AHA versus ESC guidelines on dual antiplatelet therapy: JACC guideline comparison. J Am Coll Cardiol, 2018, 72(23 Pt A): 2915-2931.
46. Huo Y, Jeong YH, Gong Y, et al. 2018 update of expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI. Sci Bull (Beijing), 2019, 64(3): 166-179.
47. Terlouw LG, Moelker A, Abrahamsen J, et al. European guidelines on chronic mesenteric ischaemia—joint United European Gastroenterology, European Association for Gastroenterology, Endoscopy and Nutrition, European Society of Gastrointestinal and Abdominal Radiology, Netherlands Association of Hepatogastroenterologists, Hellenic Society of Gastroenterology, Cardiovascular and Interventional Radiological Society of Europe, and Dutch Mesenteric Ischemia Study group clinical guidelines on the diagnosis and treatment of patients with chronic mesenteric ischaemia. United European Gastroenterol J, 2020, 8(4): 371-395.
48. 王成, 王哲, 李鳳賀, 等. 30例自發性孤立性腸系膜上動脈夾層的血流動力學分析. 重慶醫科大學學報, 2020, 45(9): 1371-1376.
49. Peng Y, Li R, Tang G, et al. Correlation of Riolan’s arch diameter to treatment choice in patients with isolated superior mesenteric artery dissection. Abdom Radiol (NY), 2022, 47(10): 3628-3637.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Progress of intraluminal treatment for isolated superior mesenteric artery dissection

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