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Objective: This study investigated the status of isolated superior mesenteric artery (SMA) dissection in the most populous country, China., Methods: The Chinese-language literature published before December 2014 was reviewed. All case reports and series were included. If multiple reports originated from the same hospital and included overlapping time frames, only the most recent report was included. The clinical characteristics, imaging features, and treatment were analyzed. "Symptom relief" was used as the outcome measure., Results: A total of 622 patients (88.5% male) with isolated SMA dissection were found in the Chinese-language literature. Patients were a mean age of 55.4 years. Analysis of the demographic data showed that isolated SMA dissection was most reported from the developed areas of China. The most common symptom (91.1%) was abdominal pain, and 42.7% patients had hypertension as a complication. Contrast-enhanced computed tomography was used to diagnose 95.2% of patients. The mean distance from the SMA ostium to the beginning of the dissection was 20.1 mm (range, 0-65.0 mm). The mean length of dissection was 63.1 mm (range, 10.7-205.9 mm). The percentages of patients who underwent primary conservative, surgical, and endovascular treatments were 63.2%, 3.2% and 33.6%, respectively. As primary management, the symptom relief rate of conservative management, with or without anticoagulation, was 62.6% and 86.5%, respectively. The best result of conservative treatment was achieved in cases of Yun type I and Luan classification type B. The symptom relief rate of surgical and endovascular treatment was 100% and 95.2%, respectively., Conclusions: The incidence of isolated SMA dissection may not be as rare as previously reported. Endovascular treatment of isolated SMA dissection is commonly used in China as a first-line treatment., (Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Objectives: To analyze computed tomography (CT) imaging features of isolated dissection of the superior mesenteric artery (SMA)., Methods: The imaging findings of 20 consecutive patients with isolated dissection of the SMA were retrospectively evaluated and categorized according to a new imaging classification: Type A, dissections localized at the curved part of the SMA and extended proximally; Type B, dissections limited to the curved part; Type C or D, dissections localized at the curved part and extended distally without or with involved ileocolic or distal ileal arteries. The relationship between classification and symptoms and treatment effect is discussed, and prior reported cases where CT images were available were classified and analyzed., Results: The dissections were around the curved part of the SMA in all 20 patients. In symptomatic patients, the true lumen was more stenosed, the dissection started nearer the SMA ostium, and the dissection was longer. The best effect of conservative treatment was achieved in Type B cases. When dissection extended distally, the effect progressively worsened from Type B to Type D., Conclusions: The new classification is useful for describing the imaging features of isolated dissection of the SMA., (Copyright © 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)

Objective: We report our experience in the treatment of isolated superior mesenteric artery dissection and review the clinical and imaging features reported in the literature., Methods: A retrospective study was conducted of 18 consecutive patients with isolated superior mesenteric artery dissection who presented at the Peking University Third Hospital between September 2008 and May 2012. Their clinical characteristics, including age, sex, medical history, risk factors, symptoms, diagnostic imaging modality, and treatment, were analyzed. Also reviewed were 278 patients with isolated superior mesenteric artery dissection reported in the English language literature. The epidemiology, mechanism, clinical presentation, imaging features, and treatment were discussed., Results: There were 14 men and four women with a mean age of 55.6 years (range, 41-84 years). Four patients were asymptomatic, and 14 presented with acute-onset abdominal pain. The diagnosis was established by contrast-enhanced computed tomography in 17 patients and ultrasound imaging in one patient. All dissections were located at the anterior wall and around the convex curvature of the superior mesenteric artery. The decision to intervene was based on symptoms. Three asymptomatic patients underwent successful conservative management, and one asymptomatic patient with an aneurysmal dilated false lumen underwent endovascular stent placement. For the 14 symptomatic patients, definitive treatment included catheter-directed infusion of a vasodilator in four and stent placement combined with catheter-directed infusion of a vasodilator in 10, of whom one patient underwent hybrid stent placement. No complications or deaths occurred. During the mean 14.9-month (range, 1-40 month) follow-up period, all patients were asymptomatic, and patency of the superior mesenteric artery was demonstrated by contrast-enhanced computed tomography scan., Conclusions: Conservative management can be applied to asymptomatic patients with isolated superior mesenteric artery dissection. For symptomatic patients, stent placement is the definitive treatment if there is no arterial rupture or intestinal necrosis. Self-expanding bare stents that completely cover the curvature of the superior mesenteric artery are recommended. Catheter-directed infusion of a vasodilator can be an effective accessional process after stent placement., (Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)