Superior mesenteric artery dissection

Superior mesentertic arterialmesenteric artery (SMA) dissection is an uncommon type of arterial dissection. It can either on its own (rarer(spontaneous isolated) or occur as part of an extension of an aortic dissection (combined), with the latter being more common.

A However, spontaneous isolated SMA dissection of the superior mesenteric artery (SMA) is considered the most frequently reported type of visceral artery dissection ^3,7. 

Epidemiology

Patients often present in middle age (50-60-70 of age). There is a recognised increased male predilection.

Associations

• cystic medial necrosis
• fibromuscular dysplasia

Pathology

Location

In isolated SMA dissections it usually begins a few centimeters from the SMA origin ⁴¹⁰.

Clinical presentation

Patients can present with vague abdominal pain, the pain being especially worse after a meal. An SMA dissection is considered more symptomatic than a celiac artery dissection ³.

Pathology

Location

In isolated SMA dissections, it usually begins a few centimetres from the SMA origin ⁴.

Associations

Spontaneous isolated SMA dissection has been reported in association with ¹⁰:

• atherosclerosis
• cystic medial necrosis
• hypertension
• fibromuscular dysplasia
• trauma
• vasculitis

Radiographic features

CT: CTA

On non-contrast CT, the SMA is often enlarged. Post contrastPostcontrast images often show a flap within the vessel in acute situations. In an acute state, there can also be increased increased attenuation of the fat plane around the SMA ⁴. 

Treatment and prognosis

Different therapeutic approaches are possible ranging from conservative management to surgical revascularisation to endovascular surgical revascularization to endovascular therapy ⁸. The prognosis is variable and it can sometimes be fatal.

History and etymology

It was first reported in 1947, Bauersfeld et.al. ¹.

See also

• arterial dissection