Conservative management of three cases of spontaneous dissection of the superior mesenteric artery

Objectives: Spontaneous dissection of the superior mesenteric artery (SMA) is a very rare condition, and due to its rarity, its risk factors, aetiology and natural history are not well established. There is no consensus on the optimal therapeutic strategy. Material: Three cases of SMA dissection are presented: Patient 1: a 61 year-old male operated on for a type A aortic dissection who, one month later had an urgent computed tomography (CT) scan due to abdominal pain that showed SMA dissection with no signs of intestinal involvement. Patient 2: a 51 year-old male who had a spontaneous right retroperitoneal haematoma with active bleeding, performing embolisation of lumbar L3-L4 arteries. Asymptomatic SMA dissection was observed in the CT diagnosis, as well as a dissecting aneurysm of the right common iliac artery. Patient 3: diagnosed with SMA dissection with no signs of intestinal ischaemia by means of an urgent CT, requested due to a sudden episode of epigastric pain. Methodology: A series of three patients with different medical-surgical histories, who after performing an urgent CT were diagnosed with SMA dissection. The three patients were conservatively managed with anticoagulants. Results: After a mean follow-up of 24 months, the three patients remain asymptomatic and with stability of the lesions. Conclusions: Conservative management using indefinite anticoagulant treatment is feasible in isolated SMA dissections, being a useful alternative to surgery or endovascular treatment, provided there is no evidence of bleeding or intestinal infarction. (C) 2010 SEACV. Published by Elsevier Espana, S.L. All rights reserved.