Abstract:

Objective

To explore the relationship between the clinical and imaging features of superior mesenteric artery dissection （SMAD） with totally true lumen occlusion and its prognosis， and provide evidence for screening high-risk patients and making individualized treatment.

Methods

The data of symptomatic SMAD patients with totally true lumen occlusion admitted to the Department of Vascular Surgery of Subei People's Hospital from January 2012 to January 2018 were collected， and the relationship between the disease characteristics， clinical prognosis， outcome and imaging changes was retrospectively analyzed.

Results

Among the 23 patients， 22 （95.65%） were relieved from symptoms after conservative treatment， with an average relief time of （3.96±1.61） days.One patient suffered from bloody stool， abdominal pain and abdominal distension at admission and received emergency surgery.However， it was observed that the pain score and abdominal pain relief time of 13 patients with obvious arch of Riolan formation were

significantly lower than the 9 patients without obvious arch of Riolan upon admission.The average follow-up

time was （78.83±15.90） months.During the follow-up period， recurrence of abdominal pain was observed in only one patient， and was alleviated after conservative treatment.CTA revealed recanalization of the true lumen in 12 patients （arch of Riolan was visible in 9 cases） and complete occlusion of the true lumen in 11 patients.However， significantly collateral circulation compensation was observed in the patients with true lumen occlusion， and arch of Riolan was visible in 9 cases.

Conclusion

The establishment of arch of Riolan and other collateral vessels can contribute to alleviate the symptoms and avoid intestinal ischemic necrosis in SMAD patients with totally true lumen occlusion.

Key words: Superior mesenteric artery dissection, Arch of Riolan, Totally true lumen occlusion, Clinical prognosis, Imaging changes