Superior mesenteric artery (SMA) dissection is an uncommon type of arterial dissection. It can either be on its own (spontaneous isolated) or occur as part of an extension of an aortic dissection (combined), with the latter being more common. However, spontaneous isolated SMA dissection is considered the most frequently reported type of visceral artery dissection 3,7.
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Epidemiology
Patients often present in middle age (50-70 of age). There is a recognized increased male predilection 10.
Clinical presentation
Patients often present with acute severe abdominal pain, however they may also present with vague abdominal pain, the pain being especially worse after a meal 11. An SMA dissection is considered more symptomatic than a celiac artery dissection 3.
Pathology
Location
In isolated SMA dissections, it usually begins a few centimeters from the SMA origin 4.
Associations
Spontaneous isolated SMA dissection has been reported in association with 10:
trauma
vasculitis
Radiographic features
CT
On non-contrast CT, the SMA is often enlarged. Postcontrast images often show a flap within the vessel in acute situations. In an acute state, there can also be increased attenuation of the fat plane around the SMA 4.
Treatment and prognosis
Different therapeutic approaches are possible ranging from conservative management to 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.
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