Objective: To investigate the clinical characteristics and therapeutic strategies of spontaneous isolated superior mesenteric artery dissection (SISMAD). Methods: The clinical data of 16 patients with SISMAD treated in Xiangya Hospital during September 2012 to October 2017 were retrospectively analyzed. Of the patients, 12 cases were male and 4 cases were female; the median ages ranged from 47 to 70 years, with a median age of 56.5 years; 14 cases presented with acute-onset abdominal pain or periumbilical pain, and 2 patients were accidently diagnosed by review CT scan for kidney stones and thymus cancer, respectively. The diagnosis in all patients was confirmed by CT scan. The treatment methods included conservative treatment, endovascular revascularization and open surgery. Results: Ten patients were successfully treated by conservative treatment, 5 patients were successfully treated with endovascular revascularization, and one patient received successful revascularization of the superior mesenteric artery by open arteriorrhaphy for suspicious dissection rupture/hemorrhage due to blood pressure decrease during conservative treatment. Follow-up was conducted in all of the 16 patients for 4 to 60 months, with an average period of (28±13) months. No recurrent abdominal pain or symptoms of intestinal ischemia was noted during follow-up. The review CT showed that there was no aneurysmal expansion of the dissection in patients who received conservative treatment, and the stents were patent in patients undergoing successful endovascular therapy. Conclusion: For SISMAD, conservative treatment should be the first treatment option in patients with definite diagnosis and no severe influence of dissection on the blood supply of the superior mesenteric artery and no signs of peritonitis; endovascular revascularization should be considered when there are no signs of ischemic intestinal necrosis or peritonitis, but no obvious relief of the abdominal pain after conservative treatment; open surgery should be immediately performed in those with signs of dissection rupture/hemorrhage, intestinal necrosis, or peritonitis.