Clinical Outcomes of Anticoagulation Therapy in Patients With Symptomatic Spontaneous Isolated Dissection of the Superior Mesenteric Artery

Abstract

The aim of this study was to determine the clinical outcomes of long-term anticoagulation therapy in patients with symptomatic spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) and to evaluate whether conservative treatment with anticoagulation therapy is a safe and effective treatment modality for these patients.In this single center, observational cohort study, data from a prospectively recruiting symptomatic SIDSMA registry, including demographics, risk factors of interest, clinical characteristics and outcomes, and initial and follow-up computed tomography angiography (CTA) findings, were analyzed retrospectively.During an 8-year period, a total of 52 consecutive patients who underwent conservative treatment with the use of long-term anticoagulation were included in this study. Clinical symptoms resolved within 11 days in all except 4 patients (7.7%); 3 received endovascular treatment for persistent symptoms and 1 received surgical repair. The mean duration of anticoagulation therapy was 9 (range: 3–60) months. A follow-up CTA showed complete remodeling in 20 (41.7%) patients, and the mean diameter and the incidence of false lumen thrombosis were also decreased significantly. There was no anticoagulation therapy-related mortality or morbidity except 2 (4.2%) minor bleeding complications, and no symptomatic recurrence or aggravation of the dissection occurred during the mean follow-up period of 47.5 (range: 10–97) months.The present study showed that long-term anticoagulation therapy could result in a high rate of complete remodeling during the natural course of symptomatic SIDSMA. Conservative treatment with long-term anticoagulation therapy could be an optimal treatment strategy for symptomatic SIDSMA.

Clinical Outcomes of Conservative Treatment in Patients with Symptomatic Isolated Spontaneous Renal Artery Dissection and Comparison with Superior Mesenteric Artery Dissection

“…The management strategies were determined according to the patients' symptoms and signs, as well as the initial CTA findings. Conservative medical treatment, which consisted of pain management, strict hypertension control (target systolic and diastolic blood pressures < 140 and < 90 mmHg, respectively), 6 bowel rest, intravenous fluid therapy, nutritional support, and close observation, was initially administered to all patients. Systemic anticoagulation with intravenous heparin followed by oral warfarin therapy was provided for selected patients (78%, 18/23), and anticoagulation was typically continued for 6 months to achieve a target international normalised ratio of 2.0e3.0.…”

“…Full anticoagulation with intravenous heparin followed by oral warfarin therapy was administered in all patients with SSMAD immediately after the diagnosis. 6…”

Presentation, treatment, and outcomes in patients with spontaneous isolated celiac and superior mesenteric artery dissection

“…Treatment options include blood pressure control, antiplatelet therapy, anticoagulation, endovascular stenting, and surgical repair. 7 There have been published reports advocating for both conservative 4,8 and invasive 9 interventions. Optimal medical therapy is also disputed; there is no consensus regarding antiplatelet therapy versus anticoagulation.…”

Medical therapy and intervention do not improve uncomplicated isolated mesenteric artery dissection outcomes over observation alone

“…In general, some combination of antihypertensive, anticoagulation, or antiplatelet drug therapy is recommended. 16 Many authors reported good outcomes using anticoagulation therapy, 9,17 and some have called for anticoagulation as first-line therapy. 18 We found that in symptomatic patients without evidence of ischemia, there was no significant difference in occurrence of LVT or aneurysm in patients treated with medical management vs observation alone.…”

“…5,6 Recent treatment recommendations for symptomatic and asymptomatic patients vary on the basis of the experiences of individual institutions and have been supported mostly by small retrospective reviews and a few larger retrospective reviews. [7][8][9][10][11] Suggested treatments include medical management with or without anticoagulation, surgery, and endovascular intervention. Whereas indications for immediate intervention can be self-evident, the optimal treatment is uncertain for patients with anything less than significant end-organ ischemia.…”