A modified endovascular technique for treating spontaneous isolated superior mesenteric artery dissection and the early to medium-term outcomes

PURPOSE: The spontaneous isolated dissection of superior mesenteric artery (SIDSMA) is a rare medical condition and the treatment remains controversial. This study is to present our refined technique with a Flexor introducer to facilitate stent advancement and its early to medium-term outcomes. METHODS: A total of 16 patients diagnosed with SIDSMA and repaired with endovascular stenting from January 2012 to December 2017 were retrospectively identified. All patients were male, and the average age was 56 years old (range from 48 to 72 years old). Diagnosis was preoperatively confirmed using computed tomography angiography and their morphologic features were measured. A long Flexor introducer was delivered to the true lumen of dissected superior mesenteric artery prior to coaxially advancing a stent. Patient demographics, endovascular procedures and postoperative outcomes were collected for analysis. RESULTS: Total technical success was 87.5%. Endovascular attempt was unsuccessful in two patients with extensive thrombus, and the guidewire failed to pass through the true lumen. The remaining 14 SMA dissections were successfully repaired with the modified method. Four patients were repaired using bare stents and 10 with covered stents. The average operative duration was 44 ± 18 minutes. Abdominal pain was relieved postoperatively in all cases except one patient with no identified reasons. The median follow-up duration was 17 months (2–63 months). No procedure- or dissection-related symptoms was present during follow up, and postoperative computed tomography angiography showed all stented SMAs were patent. CONCLUSIONS: Coaxial delivery of stents within the introducer can yield high technical success and good clinical outcomes in early to medium term. Extensive thrombus inside SIDSMA is the exclusive cause for endovascular failure with this technique.