Real clinical management of patients with isolated superior mesenteric artery dissection in Japan

• Published in: Journal of cardiology 2018-02, Vol.71 (2), p.155-158
• Main Authors: Mizuno, Atsushi, Iguchi, Hayato, Sawada, Yuuka, Nomura, Hiroshi, Komiyama, Nobuyuki, Watanabe, Sachiko, Yoshikawa, Aki
• Format: Article
• Language: English
• Subjects: Conservative therapy; Ischemia; Operation; Superior mesenteric artery dissection
• ISSN: 0914-5087; 1876-4738
• DOI: 10.1016/j.jjcc.2017.08.006

•Current clinical practice about isolated superior mesenteric artery dissection (ISMAD) patients is reported.•Most hospitals (>95%) did not have more than five cases per year.•Largest single study about ISMAD.•Conservative therapy for ISMAD was reasonable. Due to the rarity of this condition, clinical treatment and outcomes in isolated superior mesenteric artery dissection (ISMAD) patients remain unknown. The primary aim of this retrospective multicenter study was to elucidate the treatment strategies and in-hospital outcomes for ISMAD patients by using administrative data. We retrospectively analyzed patients that were primarily diagnosed with ISMAD using the Diagnosis Procedure Combination data collected at 141 hospitals in Japan in 2015. Patients with comorbidities that included “aneurysm” were excluded. A total of 221 ISMAD without aneurysm patients (male: 90.5%; mean age: 52.5±10.1 years) were enrolled, and 95 (67.4%) of these encountered just one ISMAD case per year. We found only one (0.5%) in-hospital death and length of stay for ISMAD patients was 13.2±9.1 days. One-third of patients received antiplatelet therapy (32.1%) and anticoagulation therapies, such as heparin (38.9%) and warfarin (10.0%). A total of 146 (66.1%) patients received antihypertensive treatment (either orally or via an intravenous route) during hospitalization. Twelve (5.4%) patients underwent surgical procedures during hospitalization as follows: 4 (33.3%) patients underwent bypass surgery, 3 (25.0%) patients underwent exploratory laparotomies, 2 (16.7%) patients underwent bowel resection, 1 (8.3%) patient underwent a thrombectomy, and 2 (16.7%) patients underwent surgical angioplasties. We found that conservative therapy for ISMAD patients without aneurysm is safe and is also associated with a low rate of surgical intervention in clinical practice.