- The patient is a 50-year-old man from Trà Vinh province with a history of hypertension who presented with long-term upper abdominal pain. Imaging studies revealed a dissection of the superior mesenteric artery (SMA). - SMA dissection is uncommon but can occur due to atherosclerosis, cystic medial necrosis, or connective tissue disorders. Patients usually present with acute epigastric pain or abdominal symptoms within 4 weeks. - Treatment options range from conservative management to surgical revascularization to endovascular therapy depending on the severity of the case. The prognosis can vary but SMA dissection can sometimes prove fatal if not properly treated.

1. PHÌNH TÁCH VÁCH ĐỘNG MẠCH
MẠC TREO TRÀNG TRÊN
BS Lê Văn Tài
BS Trần Châu Nhân
Trung Tâm Y Khoa MEDIC
Case report

2. Bệnh án
• Bệnh nhân nam 50 tuổi,
quê Trà Vinh.
• Bệnh sử: cao huyết áp,
cao nhất 15 cm Hg, đau
thượng vị kéo dài, Hp test
(+), bệnh nhân cũ của
MEDIC, đã điều trị hết Hp.
Cách đây 1 tháng đau
bụng nhiều, không tiêu
chảy, không sốt, nhập BV
tĩnh điều trị 10 ngày với
chẩn đoán viêm dạ dày,
viêm ruột, xuất viện được
20 ngày, còn đau TV nên
tái khám MEDIC.

3. Hình ảnh SA

8. Hình MSCT

11. BÀN LUẬN
• It was first reported in 1947, Bauersfeld
et.al.
• Superior mesentertic arterial (SMA)
dissection is an uncommon type of arterial
dissection. It can either on its own (rarer) or
occur as part of an extension of an aortic
dissection.
• In isolated SMA dissections it usually begins
a few centimeters from the SMA origin.

12. • The etiology of the disease has not yet
been established, but atherosclerosis,
cystic medial necrosis, fibromuscular
dysplasia, congenital connective tissue
disorders, mycotic infection and trauma
have been implicated, often associated with
untreated hypertension.
• Patients often present in middle age (50-60
of age). There is a recognised increased
male predilection.

13. • Patients can present asymptomatic, vague
abdominal pain, the pain being especially
worse after a meal.
• Most patients present with acute epigastric
pain, which is considered to be caused by
the dissection itself or intestinal ischemia or
intraperitoneal hemorrhage.
• Other common symptoms are nausea,
vomiting, melena, and abdominal distention.
These patients present acutely with
symptom duration of <4 weeks.

14. • Gray-scale: revealed an aneurysmal
dilatation of the SMA a few centimeters
from the SMA's origin, with an echogenic
linear membrane (an intimal flap) within the
aneurysm.
• Color Doppler: Flow reversal, bi-directional
flow and forward flow may occur in the false
lumen during the cardiac cycle or absence
of a signal in a total occlusion.
• On non-contrast CT, the SMA is often
enlarged. Post contrast images often show a
flap within the vessel in acute situations.

15. • Different therapeutic approaches are
possible ranging from conservative
management to surgical revascularisation
to endovascular therapy.
• The prognosis is variable and it can
sometimes be fatal.

18. Longitudinal (A) and transverse (B) sonograms of the SMA aneurysm
show the intimal flap (arrow).
A B

19. A. Color Doppler image of the SMA dissecting aneurysm with checkered
flow pattern. Flow is antegrade in the anterior (true lumen) compartment
and retrograde in the posterior (false lumen) compartment.
B. Contrast-enhanced CT shows the intimal flap in the SMA as a thin
band of low density (arrow).
A B

20. Lateral view on selective
angiography, with the
catheter (arrow) in the
SMA, demonstrates the
dissection and
intimal flap (arrowheads).

31. (A) Abdominal CT with contrast in cross-section view revealed SMA dissection (white
arrow). (B) Selective angiogram of SMA via left
high radial approach with 7F Kimney guiding catheter showed aneurismal dilatation
from the SMA ostium followed by narrow lumen. (C) IVUS
disclosed that an intimal flap (white arrow) brought about true lumen and false lumen
which was corresponding to a narrow portion on the
angiogram.
A
B C

32. (A) After express SD stent deployment, the stent balloon was used for
Wallstent dilatation. (B) IVUS disclosed apposite stent position.
(C) Angiography after deployment of two stents for the dissection
revealed widened true lumen and complete recanalization of the SMA.
A
B c

33. THANK YOU VERY MUCH!