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      Dolor abdominal secundario a disección espontánea de arteria mesentérica superior complicada Translated title: Abdominal pain at complicated spontaneous superior mesenteric artery dissection

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          Abstract

          Resumen La disección espontánea de la arteria mesentérica superior (AMS) es una entidad que se describe como un desgarro o rotura de la íntima y de las capas internas de la media permitiendo el paso de sangre creando una luz falsa en la capa media. El diagnóstico clínico se establece tras la aparición de dolor abdominal súbito en pacientes con factores de riesgo cardiovascular y su manejo puede ser endovascular o mediante cirugía a cielo abierto, dependiendo de diversos factores que mencionaremos. La clasificación se describió en base a los hallazgos por TAC. Se presenta el caso de un paciente de 48 años con disección espontánea de la AMS.

          Translated abstract

          Abstract Spontaneous dissection of the superior mesenteric artery is described as a tear or rupture of the intima and the inner layers of the stocking, allowing the passage of blood creating a false light in the middle layer. The clinical diagnosis is established after the appearance of sudden abdominal pain in patients with cardiovascular risk factors and its management can be endovascular or by open surgery, depending on factors that we will mention. The classification was described based on the CT findings. We present the case of a 48-year-old patient with spontaneous AMS dissection.

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          Imaging appearances and management of isolated spontaneous dissection of the superior mesenteric artery.

          The objective of our study was to report the clinical and imaging features of isolated dissection of the superior mesenteric artery (SMA) and describe our imaging classification of this disease entity. We retrospectively analyzed clinical presentation, imaging appearances and outcome of the 12 patients who were diagnosed as having spontaneous dissection of the SMA from 1991 to 2005 in our institution or its affiliated two hospitals. There were 11 males and 1 female with a mean age of 50 years (range, 43-61 years). The diagnosis of isolated dissection was established with CT within 24h of the onset. We categorized SMA dissection into the following four types based on imaging appearances: type I, patent false lumen with both entry and re-entry (four patients), type II, 'cul-de-sac' shaped false lumen without re-entry (one patient), type III, thrombosed false lumen with ulcer like projection (ULP), which is defined as a localized blood-filled pouch protruding from the true lumen into the thrombosed false lumen (five patients) and type IV, completely thrombosed false lumen without ULP (two patients). One patient with type II underwent urgent surgery because of small bowel ischemia. One patient with type III underwent urgent embolotherapy for the treatment of rupture of a branch of the SMA. The remaining 10 patients were initially managed conservatively. In one of the conservatively treated patient, ULP had progressively dilated, and it was treated with stent placement and coil packing 22 months after the onset. The remaining nine patients were conservatively managed without any event during the follow-up period of 7-72 months. Most of the patients with isolated SMA dissection can initially be managed conservatively if there are no clinical and imaging signs indicating ruptured SMA branches or bowel ischemia.
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            Diagnosis and Management of Isolated Superior Mesenteric Artery Dissection: A Systematic Review and Meta-Analysis

            The objective of this study was to analyze the three different management modalities for isolated superior mesenteric artery (SMA) dissection. We did a comprehensive literature search and found 703 articles on the initial search, out of which 111 articles consisting of 145 patients were selected for analysis. The mean age was 55.7 years (standard deviation,9.7;33–85) and 80.6% were male. These patients were managed conservatively (41.3%), endovascularly (28.1%) or surgically (30%). The median follow-up was 10 months (interquartile range [IQR], 4–18 months), 12 months (IQR, 6–19 months) and 14 months (IQR, 6–20 months) respectively. Contrast-enhanced computed tomography (CT) was the most commonly used diagnostic tool in the conservative group (43.8%), while conventional CT scan was the most widely used in endovascular (58.1%) and surgical group (50%). 17% percent of the conservative group had SMA angiography for diagnosis, while this was less than 3% in the other groups. Of these patients, 96.7%, 97.4%, and 100.0% recovered successfully in the conservative, endovascular, and surgical groups respectively. There was no significant difference in the mortality between the three groups (Pearson χ2=0.482). This suggests a conservative and endovascular approach could be used in most patients, which can reduce costs and surgery-related morbidity and mortality. Surgical management should be reserved for cases having infarction or widespread bowel ischemia and in cases where other treatment modalities fail.
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              Spontaneous isolated dissection of the superior mesenteric artery.

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                Author and article information

                Journal
                angiologia
                Angiología
                Angiología
                Arán Ediciones S.L. (Madrid, Madrid, Spain )
                0003-3170
                1695-2987
                April 2021
                : 73
                : 2
                : 100-102
                Affiliations
                [3] Granada orgnameHospital Universitario Clínico San Cecilio orgdiv1Servicio de Angiología, Cirugía Vascular y Endovascular España
                [2] Granada orgnameHospital Universitario Virgen de las Nieves orgdiv1Servicio de Cirugía General España
                [1] Granada orgnameHospital Universitario Clínico San Cecilio orgdiv1Servicio de Cirugía General España
                Article
                S0003-31702021000200010 S0003-3170(21)07300200010
                10.20960/angiologia.00174
                a85d708d-9685-4129-bf02-aaac242f179f

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 15 June 2020
                : 03 November 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 6, Pages: 3
                Product

                SciELO Spain

                Categories
                Casos Clínicos

                Arterial dissection,Abdominal pain,Acute mesenteric ischemia,Disección arterial,Dolor abdominal,Isquemia mesentérica aguda

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