WHAT THIS PAPER ADDS Endovascular stenting has been used successfully in the management of symptomatic isolated mesenteric artery dissection (IMAD) aneurysms. However, no study has compared the use of bare stents alone versus stent assisted coiling in IMAD aneurysms. The results of this study indicate that bare stents alone and stent assisted coiling have high technical success rates and demonstrate good mid-term patency in patients with IMAD aneurysms. Bare stents alone may serve as an alternative to stent assisted coiling for the management of IMAD aneurysms. Objective: The aim was to evaluate the outcomes of endovascular treatment with bare stents alone versus stent assisted coiling in isolated mesenteric artery dissection (IMAD) aneurysms. Methods: Patients with an IMAD aneurysm who underwent endovascular stenting between February 2010 and February 2017 at one of three institutions were included in this study. Data regarding technical success, procedure time, symptom resolution, complications, changes in IMAD aneurysm, and stent patency were recorded. Results: A total of 38 patients (35 men) were included, 27 treated with bare stents alone and 11 treated with stent assisted coiling. Technical success was achieved in 100% of patients treated with bare stents and in 81.8% of those treated with stent assisted coiling (p ¼ 0.078). The mean procedure times were 62.6 AE 5.3 min for treatment with bare stents and 116.4 AE 8.4 min for stent assisted coiling (p < 0.001). A total of 23 patients had persistent symptoms before stenting; all symptoms were resolved within 3.0 AE 0.7 days. No procedure related major complications occurred. Over 30.2 AE 18.1 months of follow up, complete resolution of the IMAD aneurysm was achieved in all patients; good stent patency and in stent re-stenosis were achieved in 65.8% and 34.2% patients, respectively. There were no occlusions of the stented arteries. Conclusions: Bare stents alone and stent assisted coiling have high technical success rates and demonstrate good intermediate patency in patients with an IMAD aneurysm. Bare stents alone may serve as an alternative to stent assisted coiling for the management of IMAD aneurysm

Microvascular lesion in diabetic peripheral arterial disease (PAD) still cannot be resolved by current surgical and interventional technique. Endothelial cells have the therapeutic potential to cure microvascular lesion. To evaluate the efficacy and immune-regulatory impact of intra-arterial infusion of autologous CD133+ cells, we recruited 53 patients with diabetic PAD (27 of CD133+ group and 26 of control group). CD133+ cells enriched from patients' PB-MNCs were reinfused intra-arterially. The ulcer healing followed up till 18 months was 100% (3/3) in CD133+ group and 60% (3/5) in control group. The amputation rate was 0 (0/27) in CD133+ group and 11.54% (3/26) in control group. Compared with the control group, TcPO2 and ABI showed obvious improvement at 18 months and significant increasing VEGF and decreasing IL-6 level in the CD133+ group within 4 weeks. A reducing trend of proangiogenesis and anti-inflammatory regulation function at 4 weeks after the cells infusion was also found. These results indicated that autologous CD133+ cell treatment can effectively improve the perfusion of morbid limb and exert proangiogenesis and anti-inflammatory immune-regulatory impacts by paracrine on tissue microenvironment. The CD133+ progenitor cell therapy may be repeated at a fixed interval according to cell life span and immune-regulatory function.

WHAT THIS PAPER ADDS Isolated mesenteric artery dissection (IMAD) is an uncommon but potentially catastrophic condition with variable and unpredictable outcomes. This condition is generally treated successfully by conservative management. Factors that may be associated with the failure of conservative management in patients with symptomatic IMAD have not been explored previously. The results of this study indicate that the risk factors for failed conservative management are type II IMAD (as defined by the Sakamoto classification: meaning that there is an entry tear, but no re-entry, and still no false lumen thrombosis), and !90% luminal stenosis.Objective: The aim of this study was to assess factors associated with conservative management failure in patients with symptomatic isolated mesenteric artery dissection. Methods: Patients with symptomatic isolated mesenteric artery dissection who underwent conservative therapy as first line treatment between February 2010 and May 2018 were included in this retrospective study. Conservative management failure was defined as the persistence or aggravation of symptoms and signs, increasing aneurysmal dilation, or new appearance of a dissecting aneurysm after conservative management. Univariable and multivariable analyses were performed to identify risk factors for failure of conservative management. Results: A total of 123 patients (115 men, 8 women, mean age, 53.7 AE 6.1 years) were included in this study. Conservative management was successful in 89 (72.4%) patients but failed in the remaining 34 (27.6%) patients. Of the 89 for whom conservative management was successful, all of the symptoms were eliminated (n ¼ 81) or relieved (n ¼ 8) within 3.8 AE 0.7 days after conservative management. All of the 34 patients in whom conservative management failed underwent successful endovascular stenting. Failure of conservative management was associated with type II IMADs as defined by the Sakamoto classification (meaning that there is an entry tear, but no re-entry, and still no thrombosis of false lumen, odds ratio: 33.76; 95% confidence interval 8.65e131.85; p < .001) and with !90% luminal stenosis (odds ratio 40.70; 95% confidence interval: 3.76e440.07; p < .01). Conclusions: Conservative management can be used successfully in most patients with symptomatic isolated mesenteric artery dissection. Risk factors for failed conservative treatment were type II IMADs and degree of luminal stenosis !90%.

No abstract

No abstract