Jia, Z.

Jiang, G.

Zhao, J.

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Commentary Regarding “Computed Tomography Imaging Features and Classification of Isolated Dissection of the Superior Mesenteric Artery” 

INVITED COMMENTARYCommentary Regarding “Computed Tomography Imaging Features and
Classiﬁcation of Isolated Dissection of the Superior Mesenteric Artery”Z. Jia, J. Zhao, G. Jiang *Department of Interventional Radiography, The Second Hospital of Changzhou Afﬁliated to Nanjing Medical University, Chang Zhou, ChinaIsolated superior mesenteric artery dissection (SMAD) is a
pleiomorphic disease. A systematic approach requires
adequate classiﬁcation. The purpose of classiﬁcation is to
organize patients into groups, which should be clinically
informative in order to assist medical decision making. Four
classiﬁcation systems, which were all devised based on the
imaging appearance of the SMAD, have been proposed over
recent years;1e4 however, no consensus has emerged
regarding which classiﬁcation system should be used.
Sakamoto et al.1 categorized SMAD into four types.
However, they did not consider the type of total thrombotic
occlusion of the SMA. Yun et al.2 categorized SMAD into
three types, but they did not consider thrombosed false
lumen with ulcer-like projection. Zerbib et al.3 categorized
SMAD into six types. However, SMAD with retrograde
propagation of the false lumen to the SMA ostium wasn’t
addressed. Luan and Li4 categorized SMAD into four types,
but they did not consider the true and the false lumen itself,
such as the shape, the thrombosed false lumen, and ste-
nosis of the true lumen.
The main anatomic and physio-pathologic features of
SMADs are the location, extent of the false lumen, and the
distinction between thrombosed or not false and true
lumen. All four classiﬁcation systems take into account
some of these anatomic features. However, they are all
incomplete. What we need is a simple system that allows
exhaustive description of all anatomic types of SMADs and
meets both the capabilities of modern imaging techniquesand the demands of an ever-growing treatment
armamentarium.
REFERENCES
1 Sakamoto I, Ogawa Y, Sueyoshi E, Fukui K, Murakami T,
Uetani M. Imaging appearances and management of isolated
spontaneous dissection of the superior mesenteric artery. Eur J
Radiol 2007;64:103e10.
2 Yun WS, Kim YW, Park KB, Chao SK, Do YS, Lee KB, et al. Clinical
and angiographic follow-up of spontaneous isolated superior
mesenteric artery dissection. Eur J Vasc Endovasc Surg 2009;37:
572e7.
3 Zerbib P, Perot C, Lambert M, Seblini M, Pruvot FR, Chambon JP.
Management of isolated spontaneous dissection of superior
mesenteric artery. Langenbecks Arch Surg 2010;395:437e43.
4 Luan JY, Li X. Computed tomography imaging features and
classiﬁcation of isolated dissection of the superior mesenteric
artery. Eur J Vasc Endovasc Surg 2013;46:232e5.
DOI of original article: http://dx.doi.org/10.1016/j.ejvs.2013.10.023
*Corresponding author. G. Jiang, Department of Interventional Radiog-
raphy, The Second Hospital of Changzhou Afﬁliated to Nanjing Medical
University, Xing Long Road 29#, Chang Zhou, Jiangsu Province 213003,
China.
Email-address: 747094035@qq.com (G. Jiang)
1078-5884/$ e see front matter Crown Copyright  2013 Published by
Elsevier Ltd on behalf of European Society for Vascular Surgery. All rights
reserved.
http://dx.doi.org/10.1016/j.ejvs.2013.10.024CORRESPONDENCEResponse to ‘Re. Computed Tomography Imaging Features
and Classiﬁcation of Isolated Dissection of the Superior
Mesenteric Artery’
We thank Dr. Jia and his colleagues for their comments on
our recently published paper.1 And we agree that a simple
and comprehensive classiﬁcation scheme is needed to
describe the imaging features of the superior mesenteric
artery dissection. However, it is technically difﬁcult to
include all imaging features, such as the location and
length of dissection, and whether the true lumen and false
lumen are thrombosed or occluded, in one classiﬁcation
scheme.
The previous three classiﬁcation schemes are all
based on the view of radial point and whether the truelumen and false lumen are occluded or thrombosed. As
total thrombotic occlusion of the superior mesenteric
artery is not included in Sakamoto’s classiﬁcation
scheme,2 and Zerbib’s classiﬁcation scheme3 is too
complicated to apply in clinical practice, Yun’s classiﬁ-
cation scheme4 seems to be the simplest and most
commonly used one.
From an axial point of view, our classiﬁcation scheme is
based on the location and length of the dissection and cor-
relates with the pain severity. Thus, the dissection of the
superior mesenteric artery can be well described by this
scheme combined with Yun’s classiﬁcation scheme. For
example, when a dissection is limited to the curved part of
the superior mesenteric artery with visible false lumen but
without visible re-entry site, we may describe it as a type B-


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Commentary Regarding “Computed Tomography Imaging Features and Classification of Isolated Dissection of the Superior Mesenteric Artery”

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