Features of Surgical Treatment of Symptomatic Patients with Isolated Superior Mesenteric Artery Dissection (Clinical Cases and Literature Review)

Keywords: aneurysm, visceral ischemia, multispiral computed tomography, anticoagulation, mesenteric blood supply, aorto-mesenteric bypass, prosthesis, endovascular treatment


Introduction. Isolated superior mesenteric artery dissection (ISMAD) is a rare disease with high variability of clinical manifestations: from incidental findings to the development of acute or chronic mesenteric ischemia and the formation of aneurysms with the probability of their rupture. Despite significant world experience, surgical and conservative treatment of patients with ISMAD remains debatable.

The aim. Improvement of the diagnosis and surgical treatment of patients with ISMAD.

Clinical cases.

In the first clinical observation, a 78-year-old patient with chronic visceral ischemia was diagnosed with an aneurysm of the upper mesenteric artery with signs of dissection and malperfusion. Previous unsuccessful attempts of endovascular treatment at another hospital caused the need for open surgical intervention – resection of the aneurysm and upper mesenteric artery reconstruction.


In the second clinical case, a 61-year-old patient had acute abdominal pain syndrome, and based on clinical examination, laboratory and instrumental examination, the diagnosis of acute mesenteric ischemia with signs of dissection of the superior mesenteric artery was confirmed, which determined immediate indications for surgical treatment – resection of the affected segment of superior mesenteric artery and aorta-superior mesenteric bypass.


The surgical interventions contributed to complete regression of clinical symptoms. Follow-up of the patients showed promising long-term results.


Conclusion. Computed tomography angiography is the method of choice in the diagnosis of ISMAD and makes it possible to provide prompt diagnosis, determine treatment tactics and prevent the development of fatal complications. Open surgical intervention in some cases remains the method of choice in the treatment of ISMAD.


  1. Quintana Rivera AM, Ganzarain Valiente L, Ávila Puerta CE, Arruabarrena Oyarbide A, Fonseca Legrand JL. Manejo conservador de tres casos de disección espontánea de la arteria mesentérica superior [Conservative management of three cases of spontaneous dissection of the superior mesenteric artery]. Angiología. 2012;64(1):7-12. Spanish. https://doi.org/10.1016/j.angio.2011.12.004
  2. Foord AG, Lewis RD. Primary dissecting aneurysms of peripheral and pulmonary arteries: dissecting hemorrhage of media. Arch Pathol. 1959;68:553-77. PubMed PMID: 13823854.
  3. Gobble RM, Brill ER, Rockman CB, Hecht EM, Lamparello PJ, Jacobowitz GR, et al. Endovascular treatment of spontaneous dissections of the superior mesenteric artery. J Vasc Surg. 2009;50(6):1326-32. https://doi.org/10.1016/j.jvs.2009.07.019
  4. Bauersfeld SR. Dissecting aneurysm of the aorta; a presentation of 15 cases and a review of the recent literature. Ann Intern Med. 1947;26(6):873-89. https://doi.org/10.7326/0003-4819-26-6-873
  5. Ando M, Ito M, Mishima Y. Spontaneous dissecting aneurysm of the main trunk of the superior mesenteric artery: report of a case. Surg Today. 1995;25(5):468-70. https://doi.org/10.1007/BF00311831
  6. Sheldon PJ, Esther JB, Sheldon EL, Sparks SR, Brophy DP, Oglevie SB. Spontaneous Dissection of the Superior Mesenteric Artery. Cardiovasc Intervent Radiol. 2001;24(5):329-31. https://doi.org/10.1007/s00270-001-2565-0
  7. Watring NJ, Smith CM, Stokes GK, Counselman FL. Spontaneous Superior Mesenteric Artery (SMA) Dissection: An Unusual Cause of Abdominal Pain. J Emerg Med. 2010;39(5):576-8. https://doi.org/10.1016/j.jemermed.2007.05.054
  8. D’hondt S, Van Damme T, Malfait F. Vascular phenotypes in nonvascular subtypes of the Ehlers-Danlos syndrome: a systematic review. Genet Med. 2018;20(6):562-73. https://doi.org/10.1038/gim.2017.138
  9. Ullah W, Mukhtar M, Abdullah HM, Ur Rashid M, Ahmad A, Hurairah A, et al. Diagnosis and Management of Isolated Superior Mesenteric Artery Dissection: A Systematic Review and Meta-Analysis. Korean Circ J. 2019;49(5):400-18. https://doi.org/10.4070/kcj.2018.0429
  10. Karaolanis G, Antonopoulos C, Tsilimigras DI, Moris D, Moulakakis K. Spontaneous isolated superior mesenteric artery dissection: Systematic review and meta-analysis. Vascular. 2019;27(3):324-37. https://doi.org/10.1177/1708538118818625
  11. Olawoye A, Kyaw H, Nwosu IF, Ibeson CE, Miah T, Weindorf B, et al. Isolated Superior Mesenteric Artery Dissection: An Unusual Etiology of Epigastric Pain. Cureus. 2022;14(6):e25683. https://doi.org/10.7759/cureus.25683
  12. Cudnik MT, Darbha S, Jones J, Macedo J, Stockton SW, Hiestand BC. The Diagnosis of Acute Mesenteric Ischemia: A Systematic Review and Meta-analysis. Acad Emerg Med. 2013;20(11):1087-100. https://doi.org/10.1111/acem.12254
  13. Oliva IB, Davarpanah AH, Rybicki FJ, Desjardins B, Flamm SD, Francois CJ, et al. ACR appropriateness criteria® imaging of mesenteric ischemia. Abdom Imaging. 2013;38(4):714-9. https://doi.org/10.1007/s00261-012-9975-2. Erratum in: Abdom Imaging. 2014;39(4):937-9.
  14. Barmeir E, Halachmi S, Croitoru S, Torem S. CT angiography diagnosis of spontaneous dissection of the superior mesenteric artery. AJR Am J Roentgenol. 1998;171(5):1429-30. https://doi.org/10.2214/ajr.171.5.9798897
  15. Takehara Y, Takahashi M, Fukaya T, Kaneko M, Koyano K, Sakaguchi S. Computed Tomography of Isolated Dissecting Aneurysm of Superior Mesenteric Artery. J Comput Assist Tomogr. 1988;12(4):678-80. https://doi.org/10.1097/00004728-198807000-00036
  16. Ambo T, Noguchi Y, Iwasaki H, Kondo J, Matsumoto A, Suzuki H, et al. An isolated dissecting aneurysm of the superior mesenteric artery: report of a case. Surg Today. 1994;24(10):933-6. https://doi.org/10.1007/BF01651014
  17. Han Y, Cho YP, Ko GY, Seo DW, Kim MJ, Kwon H, Kim H, et al. Clinical Outcomes of Anticoagulation Therapy in Patients With Symptomatic Spontaneous Isolated Dissection of the Superior Mesenteric Artery. Medicine (Baltimore). 2016;95(16):e3480. https://doi.org/10.1097/MD.0000000000003480
  18. Li Z, Ding H, Shan Z, Du J, Yao C, Chang G, et al. Initial and Middle-Term Outcome of Treatment for Spontaneous Isolated Dissection of Superior Mesenteric Artery. Medicine (Baltimore). 2015;94(45):e2058. https://doi.org/10.1097/MD.0000000000002058
  19. Yun WS, Kim YW, Park KB, Cho SK, Do YS, Lee KB, et al. Clinical and Angiographic Follow-up of Spontaneous Isolated Superior Mesenteric Artery Dissection. Eur J Vasc Endovasc Surg. 2009;37(5):572-7. https://doi.org/10.1016/j.ejvs.2008.12.010
  20. Li T, Zhao S, Li J, Huang Z, Luo C, Yang L. Value of Multi- detector CT in Detection of Isolated Spontaneous Superior Mesenteric Artery Dissection. Chin Med Sci J. 2017;32(1):28-33. https://doi.org/10.24920/j1001-9242.2007.004
  21. Jia ZZ, Zhao JW, Tian F, Li SQ, Wang K, Wang Y, 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):502-8. https://doi.org/10.1016/j.ejvs.2013.01.039
  22. Cho BS, Lee MS, Lee MK, Choi YJ, Kim CN, Kang YJ, et al. Treatment Guidelines for Isolated Dissection of the Superior Mesenteric Artery Based on Follow-up CT Findings. Eur J Vasc Endovasc Surg. 2011;41(6):780-5. https://doi.org/10.1016/j.ejvs.2010.12.022
  23. Pang P, Jiang Z, Huang M, Zhou B, Zhu K, Shan H. Value of endovascular stent placement for symptomatic spontaneous isolated superior mesenteric artery dissection. Eur J Radiol. 2013;82(3):490-6. https://doi.org/10.1016/j.ejrad.2012.09.005
How to Cite
Kobza, I. I., Orel, Y. H., Orel, H. Y., Mota, Y. S., Kobza, T. I., & Khorkavyi, Y. Z. (2023). Features of Surgical Treatment of Symptomatic Patients with Isolated Superior Mesenteric Artery Dissection (Clinical Cases and Literature Review). Ukrainian Journal of Cardiovascular Surgery, 31(1), 60-65. https://doi.org/10.30702/ujcvs/23.31(01)/KO001-6065