Isolated superior mesenteric artery dissection

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Isolated superior mesenteric artery dissection
Illustration of the superior mesenteric artery
Synonyms	ISMAD
Pronounce	N/A
Specialty	N/A
Symptoms	Abdominal pain, nausea, vomiting
Complications	Bowel ischemia, Aneurysm
Onset	Typically in middle-aged adults
Duration	Variable
Types	N/A
Causes	Spontaneous or trauma
Risks	Hypertension, Atherosclerosis, Connective tissue disorder
Diagnosis	CT angiography, MRI, Ultrasound
Differential diagnosis	Mesenteric ischemia, Aortic dissection
Prevention	Control of risk factors
Treatment	Anticoagulation, Endovascular stenting, Surgery
Medication	N/A
Prognosis	Generally good with treatment
Frequency	Rare
Deaths	N/A

Medical condition

Isolated superior mesenteric artery dissection (ISMAD) is a rare vascular condition characterized by the dissection of the superior mesenteric artery (SMA) without involvement of other major arteries. The SMA is a critical artery that supplies blood to a large portion of the intestines, including the small intestine and part of the large intestine.

Pathophysiology

The pathophysiology of ISMAD involves a tear in the intimal layer of the SMA, leading to the formation of a false lumen. This can result in compromised blood flow to the intestines, potentially causing mesenteric ischemia. The exact cause of the dissection is not always clear, but it may be associated with factors such as hypertension, atherosclerosis, and connective tissue disorders.

Clinical Presentation

Patients with ISMAD may present with a variety of symptoms, ranging from mild abdominal pain to severe, acute abdominal distress. The pain is often located in the epigastric region and may be associated with nausea and vomiting. In some cases, the condition may be asymptomatic and discovered incidentally during imaging studies for other reasons.

Diagnosis

The diagnosis of ISMAD is typically made using imaging techniques such as computed tomography angiography (CTA) or magnetic resonance angiography (MRA). These imaging modalities can reveal the presence of a dissection flap and the extent of the false lumen.

Management

Management of ISMAD depends on the severity of the condition and the symptoms presented. Conservative treatment, including anticoagulation and antihypertensive therapy, is often sufficient for asymptomatic or mildly symptomatic cases. In more severe cases, endovascular interventions such as stenting or surgical revascularization may be necessary to restore adequate blood flow.

Prognosis

The prognosis for patients with ISMAD is generally favorable, especially for those who receive appropriate medical management. Most patients respond well to conservative treatment, and the risk of complications such as bowel infarction is low when the condition is promptly diagnosed and managed.

See Also

• Superior mesenteric artery
• Mesenteric ischemia
• Aortic dissection
• Vascular surgery