The patient is hemodynamically stable, with no clinical or imaging evidence of ruptured superior mesenteric artery dissection and no signs of mesenteric ischemia. An endovascular-first strategy was pursued as initial management — as is increasingly common in this stable presentation — but did not achieve the required treatment goals.
The prior step involved endovascular revascularization, which may have included angiography with stenting, intralesional thrombolysis with urokinase, balloon angioplasty, or embolotherapy.
That approach failed to achieve relief from mesenteric ischemia and prevention of progression of the dissection. This protocol defines the next step after that failure.
When endovascular options have not achieved the required goals, management moves to open surgical revascularization via laparotomy. The specific operative strategy is individually tailored — the extent and type of surgery depends on the viability of the bowel, the type of dissection, and the reversibility of circulation. The complete structured algorithm, including all operative options and their indications, is available in the full protocol.
Successful resolution of symptoms. Published series report symptom resolution for surgically managed SMA dissection across a range of follow-up periods.