Abstract：
UNASSIGNED: Spontaneous isolated superior mesenteric artery dissection (SISMAD) is a rare vascular disease, the treatment strategies for which remain debated. This retrospective study aimed to compare the outcomes of conservative and endovascular treatments in patients with SISMAD.
UNASSIGNED: Fifty-eight patients with SISMAD confirmed by computed tomography angiography admitted to our hospital between November 2017 and May 2021 and received confirmed conservative (n=43) or endovascular (n=15) treatment. The patient demographics, imaging analysis, and follow-up results were analyzed and compared.
UNASSIGNED: The cohort included 54 males and 4 females with a mean age of 52 years. Abdominal pain was the major complaint (49/58, 84.5%), followed by chest pain (2/58, 3.4%). The mean follow-up was 9.1±7.9 months. The 2 main Sakamoto types were type III (27/58, 46.6%) and type IV (16/58, 27.6%). Most patients in both groups had angle 1 (aortomesenteric angle) and angle 2 (superior mesenteric artery [SMA] course) of over 80°. About 67.3% of patients had long length of dissection (>60 mm). The median distance between the SMA root and the dissection entry site was 1.5 cm, mostly (84.5% of the patients) in the curved segment of the SMA. Telephone follow-ups found that most patients survived pain-free, and none underwent intestinal resection. Only 4 patients, 2 in each group, had recurrent abdominal pain during follow-up and received stenting treatment to achieve complete vascular remodeling. Importantly, we found that the conservative and endovascular therapies achieved similar high remodeling rates (94% and 100%, respectively; p=0.335). The conservative group achieved satisfying vascular remodeling (partial, 35%; complete, 59%), making it as safe and effective a treatment as endovascular therapy.
UNASSIGNED: Initial conservative management is safe and effective in patients with SISMAD. A high technical success rate and favorable short-term outcomes were associated with endovascular procedures as secondary interventions. It would be helpful to conduct large-scale, prospective, randomized controlled trials with long-term follow-up for SISMAD.
CONCLUSIONS: 1. This research provided more detail clinical information, such as evaluation of abdominal pain and measurements of SMA angles, which is all relevant to treatment. 2. What\'s more, the most surprising results of follow-up part shown that conservative treatment could reached the remodeling rate as high as endovascular treatment, which was relatively low in other studies. It helps us share our treatment experience with clinicians. 3. In addition, we get limited knowledge about this rare disease, it\'s encouraging us to do more researches based on the results we had.
UNASSIGNED: Fifty-eight patients with SISMAD confirmed by computed tomography angiography admitted to our hospital between November 2017 and May 2021 and received confirmed conservative (n=43) or endovascular (n=15) treatment. The patient demographics, imaging analysis, and follow-up results were analyzed and compared.
UNASSIGNED: The cohort included 54 males and 4 females with a mean age of 52 years. Abdominal pain was the major complaint (49/58, 84.5%), followed by chest pain (2/58, 3.4%). The mean follow-up was 9.1±7.9 months. The 2 main Sakamoto types were type III (27/58, 46.6%) and type IV (16/58, 27.6%). Most patients in both groups had angle 1 (aortomesenteric angle) and angle 2 (superior mesenteric artery [SMA] course) of over 80°. About 67.3% of patients had long length of dissection (>60 mm). The median distance between the SMA root and the dissection entry site was 1.5 cm, mostly (84.5% of the patients) in the curved segment of the SMA. Telephone follow-ups found that most patients survived pain-free, and none underwent intestinal resection. Only 4 patients, 2 in each group, had recurrent abdominal pain during follow-up and received stenting treatment to achieve complete vascular remodeling. Importantly, we found that the conservative and endovascular therapies achieved similar high remodeling rates (94% and 100%, respectively; p=0.335). The conservative group achieved satisfying vascular remodeling (partial, 35%; complete, 59%), making it as safe and effective a treatment as endovascular therapy.
UNASSIGNED: Initial conservative management is safe and effective in patients with SISMAD. A high technical success rate and favorable short-term outcomes were associated with endovascular procedures as secondary interventions. It would be helpful to conduct large-scale, prospective, randomized controlled trials with long-term follow-up for SISMAD.
CONCLUSIONS: 1. This research provided more detail clinical information, such as evaluation of abdominal pain and measurements of SMA angles, which is all relevant to treatment. 2. What\'s more, the most surprising results of follow-up part shown that conservative treatment could reached the remodeling rate as high as endovascular treatment, which was relatively low in other studies. It helps us share our treatment experience with clinicians. 3. In addition, we get limited knowledge about this rare disease, it\'s encouraging us to do more researches based on the results we had.
摘要：
■自发性孤立性肠系膜上动脉夹层（SISMAD）是一种罕见的血管疾病，仍有争议的治疗策略。这项回顾性研究旨在比较SISMAD患者保守治疗和血管内治疗的结果。
■在2017年11月至2021年5月期间，我院收治了58例经计算机断层扫描血管造影证实的SISMAD患者，并接受了经证实的保守（n=43）或血管内（n=15）治疗。病人的人口统计，成像分析,并对随访结果进行分析比较。
■该队列包括54名男性和4名女性，平均年龄为52岁。腹痛是主要主诉（49/58，84.5%），其次是胸痛(2/58,3.4%)。平均随访时间为9.1±7.9个月。2种主要类型为III型（27/58，46.6％）和IV型（16/58，27.6％）。两组中大多数患者的角度1（主动脉肠系膜角度）和角度2（肠系膜上动脉[SMA]病程）均超过80°。约67.3%的患者有较长的夹层长度(>60mm)。SMA根与解剖入口部位的中值距离为1.5cm,大部分（84.5%的患者）在SMA的弯曲段。电话随访发现，大多数患者无痛幸存下来，没有人接受肠切除术。只有4个病人,每组2个,在随访期间有复发性腹痛，并接受支架治疗以实现完全血管重塑。重要的是,我们发现，保守治疗和血管内治疗取得了相似的高重塑率（94%和100%，分别为；p=0.335)。保守组实现了令人满意的血管重塑(部分，35%；完成，59%），使其与血管内治疗一样安全有效。
■对于SISMAD患者，初始保守治疗是安全有效的。高的技术成功率和良好的短期结果与血管内手术作为次要干预措施相关。这将有助于进行大规模，prospective,对SISMAD进行长期随访的随机对照试验。
结论：1.这项研究提供了更详细的临床信息，例如评估腹痛和测量SMA角度，这都与治疗有关。2.更重要的是，随访部分最令人惊讶的结果表明，保守治疗可以达到与血管内治疗一样高的重塑率，这在其他研究中相对较低。它帮助我们与临床医生分享我们的治疗经验。3.此外,我们对这种罕见疾病的了解有限，它鼓励我们做更多的研究基于我们的结果。
■在2017年11月至2021年5月期间，我院收治了58例经计算机断层扫描血管造影证实的SISMAD患者，并接受了经证实的保守（n=43）或血管内（n=15）治疗。病人的人口统计，成像分析,并对随访结果进行分析比较。
■该队列包括54名男性和4名女性，平均年龄为52岁。腹痛是主要主诉（49/58，84.5%），其次是胸痛(2/58,3.4%)。平均随访时间为9.1±7.9个月。2种主要类型为III型（27/58，46.6％）和IV型（16/58，27.6％）。两组中大多数患者的角度1（主动脉肠系膜角度）和角度2（肠系膜上动脉[SMA]病程）均超过80°。约67.3%的患者有较长的夹层长度(>60mm)。SMA根与解剖入口部位的中值距离为1.5cm,大部分（84.5%的患者）在SMA的弯曲段。电话随访发现，大多数患者无痛幸存下来，没有人接受肠切除术。只有4个病人,每组2个,在随访期间有复发性腹痛，并接受支架治疗以实现完全血管重塑。重要的是,我们发现，保守治疗和血管内治疗取得了相似的高重塑率（94%和100%，分别为；p=0.335)。保守组实现了令人满意的血管重塑(部分，35%；完成，59%），使其与血管内治疗一样安全有效。
■对于SISMAD患者，初始保守治疗是安全有效的。高的技术成功率和良好的短期结果与血管内手术作为次要干预措施相关。这将有助于进行大规模，prospective,对SISMAD进行长期随访的随机对照试验。
结论：1.这项研究提供了更详细的临床信息，例如评估腹痛和测量SMA角度，这都与治疗有关。2.更重要的是，随访部分最令人惊讶的结果表明，保守治疗可以达到与血管内治疗一样高的重塑率，这在其他研究中相对较低。它帮助我们与临床医生分享我们的治疗经验。3.此外,我们对这种罕见疾病的了解有限，它鼓励我们做更多的研究基于我们的结果。
