孤立型腸系膜上動脈夾層的14例回顧分析

Five-year Review of Isolated Superior Mesenteric Arterial Dissections(ISMAD)

目的為了檢查出現孤立性自發性腸系膜上動脈夾層的患者的自然病史和預後。方法2014~2019年診斷為孤立性自發性腸系膜上動脈夾層的患者進行回顧性綜述數據分析,包括人口統計學、臨床數據、放射學評估、治療和結果。結果14名患者在沒有主動脈夾層的情況下發現孤立性自發性腸系膜上動脈夾層,所有患者都是由電腦斷層掃描所診斷。年齡為48歲(42歲~68歲),79%為男性;86%的患者出現腹痛和背痛等症狀;14%無症狀。所有患者於診斷早期都只接受藥物治療,追蹤期間沒有患者需要後期介入手術治療或復發。結論雖然孤立性自發性腸系膜上動脈夾層存在内臟缺血的風險,但大多數患者可以用短期抗凝藥物治療而不必手術治療。

Objective Isolated superior mesenteric artery dissection(ISMAD)is a rareclinical condition.However,it has been increasingly noted on diagnostic imaging.The purpose of this study was to examine the natural history and outcomes of patients presenting with isolated superior mesenteric artery dissection(ISMAD).Methods This was a retrospective review of patients presenting with the diagnosis of ISMAD between 2014 and 2019.Data analysis included demographics,clinical data,radiologic reviewand outcomes.Results A total of 14 patients were found to have SMA dissection without accompanying aorticdissection diagnosed on computed tomography.The mean age was 48 years(range,42-68 years);79%were male.The majority(86%)presented with symptoms including abdominal pain,back pain,and chest pain;the remaining 14%were asymptomatic.All patients received medical treatment initially without intervention.No other late interventions or recurrences were noted during followup.Conclusion Although isolated SMAD poses a risk of visceral ischemia,most patients presenting with this diagnosis canbe treated nonoperatively with a short course of antiplatelet or anticoagulant therapy.