Article Data

  • Views 2637
  • Dowloads 177

Original Research

Open Access

Clinical features of isolated superior mesenteric artery dissection in the emergency department: a single center retrospective study

  • Xiang-Min Li1,†
  • Guo-Qing Huang1,†
  • Li-Ping Zhou1
  • Xiao-Ye Mo1
  • Ai-Min Wang1
  • Fang-Jie Zhang1

1Department of Emergency Medicine, Xiangya Hospital, Central South University, 410008 Changsha, Hunan, China

DOI: 10.22514/sv.2021.225 Vol.18,Issue 1,January 2022 pp.129-135

Submitted: 08 December 2020 Accepted: 05 January 2021

Published: 08 January 2022

*Corresponding Author(s): Fang-Jie Zhang E-mail: zhangfj@csu.edu.cn

† These authors contributed equally.

Abstract

Isolated superior mesenteric artery dissection (ISMAD) is a relatively rare disease and often lacks specificity in its clinical presentation, diagnosing it in emergency departments quickly and accurately is a challenge. The study was conducted to understand the basic characteristics of ISMAD including age of onset, risk factors, gender difference and whether D-dimer can be used as a biomarker for its detection. We retrospectively analyzed patients with ISMAD admitted to the emergency department of Xiangya Hospital of Central South University from September 1, 2017 to September 30, 2020. The data included the patient’s basic information and the first laboratory test results after admission, including routine blood, liver function, renal function and coagulation function tests. Statistical analysis of results was done using GraphPad Prism 5. There were a total of 17 (15 male and 2 female) patients with a mean age of 52.53 ± 7.11 years diagnosed with ISMAD. Out of these, 7 (41%) patients had history of hypertension, 7 (41%) had history of smoking and/or alcohol intake, and almost all patients experienced significant abdominal pain and fullness. Four patients (24%) were initially misdiagnosed. The laboratory test results of renal, liver function tests and myocardial enzymology were in their normal ranges. In coagulation results, the positive rates of fibrinogen degradation products (FDP) and D-dimer were 29% and 35%, respectively. We compared these ISMAD results with our previous results for acute aortic dissection (AAD). D-dimer and FDP levels were lower in the ISMAD than in the AAD patients (P = 0.0004, P = 0.0325, respectively), and negative rates of D-dimer and FDP in ISMAD (65%, 71%) were higher than in AAD patients (14%, 24%) (P < 0.0001, P = 0.0003, respectively). In our study, ISMAD mostly occurred in middle-aged male patients with known hypertension or active smoking status. Misdiagnosis was common (24% of cases). Since D-dimer and FDP levels proved to be of limited diagnostic value, an abdominal Computed Tomography (CT) scan should be conducted in patients with unclear abdominal pain at an early stage of their diagnostic workup.


Keywords

Abdominal pain; Isolated superior mesenteric artery dissection; D-dimer; Fibrinogen degradation product


Cite and Share

Xiang-Min Li,Guo-Qing Huang,Li-Ping Zhou,Xiao-Ye Mo,Ai-Min Wang,Fang-Jie Zhang. Clinical features of isolated superior mesenteric artery dissection in the emergency department: a single center retrospective study. Signa Vitae. 2022. 18(1);129-135.

References

[1] Luan JY, Guan X, Li X, Wang CM, Li TR, Zhang L, et al. Isolated superior mesenteric artery dissection in China. Journal of Vascular Surgery. 2016; 63: 530-536.

[2] Bauersfeld SR. Dissecting aneurysm of the aorta; a presentation of 15 cases and a review of the recent literature. Annals of Internal Medicine. 1974; 26: 873-889.

[3] Jia Z, Tu J, Jiang G. The classification and management strategy of spontaneous isolated superior mesenteric artery dissection. Korean Circulation Journal. 2017; 47: 425.

[4] Wu Z, Yi J, Xu H, Guo W, Wang L, Chen D, et al. The significance of the angle between superior mesenteric artery and aorta in spontaneous isolated superior mesenteric artery dissection. Annals of Vascular Surgery. 2017; 45: 117-126.

[5] Karaolanis G, Antonopoulos C, Tsilimigras DI, Moris D, Moulakakis K. Spontaneous isolated superior mesenteric artery dissection: systematic review and meta-analysis. Vascular. 2019; 27: 324-337.

[6] Park YJ, Park C, Park KB, Roh YN, Kim D, Kim Y. Inference from clinical and fluid dynamic studies about underlying cause of spontaneous isolated superior mesenteric artery dissection. Journal of Vascular Surgery. 2011; 53: 80-86.

[7] Park YJ, Park KB, Kim D, Do YS, Kim D, Kim Y. Natural history of spontaneous isolated superior mesenteric artery dissection derived from follow-up after conservative treatment. Journal of Vascular Surgery. 2011; 54: 1727-1733.

[8] Tanaka Y, Tada H, Takeda Y, Iino K, Hayashi K, Takemura H, et al. Spontaneous isolated superior mesenteric artery dissection requiring emergent surgery. Internal Medicine. 2018; 57: 2681-2684.

[9] Olson JD. D-dimer: an overview of hemostasis and fibrinolysis, assays, and clinical applications. Advances in Clinical Chemistry. 2015; 69: 1-46.

[10] Nazerian P, Mueller C, Soeiro ADM, Leidel BA, Salvadeo SAT, Giachino F, et al. Diagnostic accuracy of the aortic dissection detection risk score plus D-dimer for acute aortic syndromes: the ADvISED prospective multicenter study. Circulation. 2019; 137: 250-258.

[11] Zhang F, Li X, Zhang J, Wang A, Zhou L, Li X. Levels of D-dimer, fibrinogen, and fibrinogen degradation product in patients with acute chest pain. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2018; 44: 1209-13.

[12] Ullah W, Mukhtar M, Abdullah HM, Ur Rashid M, Ahmad A, Hurairah A, et al. Diagnosis and management of isolated superior mesenteric artery dissection: a systematic review and meta-analysis. Korean Circulation Journal. 2019; 49: 400-418.

[13] Zhang X, Xiang P, Yang Y, Chen J, Guan J, Liu M, et al. Correlation between computed tomography features and clinical presentation and management of isolated superior mesenteric artery dissection. European Journal of Vascular and Endovascular Surgery. 2018; 56: 911-917.

[14] Suzuki S, Furui S, Kohtake H, Sakamoto T, Yamasaki M, Furukawa A, et al. Isolated dissection of the superior mesenteric artery: CT findings in six cases. Abdominal Imaging. 2004; 29: 153-157.

[15] Cho BS, Lee MS, Lee MK, Choi YJ, Kim CN, Kang YJ, et al. Treatment guidelines for isolated dissection of the superior mesenteric artery based on follow-up CT findings. European Journal of Vascular and Endovascular Surgery. 2011; 41: 780-785.

[16] Bima P, Pivetta E, Nazerian P, Toyofuku M, Gorla R, Bossone E, et al. Systematic review of aortic dissection detection risk score plus D-dimer for diagnostic rule-out of suspected acute aortic syndromes. Academic Emergency Medicine. 2020; 27: 1013-1027.

[17] Sato N, Takahashi H, Shibata A. Fibrinogen/fibrin degradation products and D-dimer in clinical practice: interpretation of discrepant results. American Journal of Hematology. 1995; 48: 168-174.

[18] Tanaka Y, Yoshimuta T, Kimura K, Iino K, Tamura Y, Sakata K, et al. Clinical characteristics of spontaneous isolated visceral artery dissection. Journal of Vascular Surgery. 2018; 67: 1127-1133.


Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.3 (2023) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time

Conferences

Top