Comparative analysis of prevalence, evaluation, management, and rehabilitation outcome of spontaneous isolated visceral artery dissection: a systematic review and meta-analysis of 80 reports

Abstract

Background: Because of relatively little data for management and evaluation surrounding spontaneous isolated visceral artery dissection (IVAD), existing studies have failed to provide comprehensive analysis for the management, evaluation, prevalence, as well as natural course of the disease. Therefore, we collected and analyzed current evidence on spontaneous IVAD with the aim of providing quantitative pooled data for the natural course and treatment standardization of the disease. Methods: A systematic search of PubMed, Embase, the Cochrane Library, and Web of Science up to 1 June 2022, was conducted for relevant studies that investigating the natural course, treatment, classification, and outcomes of IVAD. The primary outcomes were to determine the difference in prevalence, risk factors, and characteristics between different spontaneous IVAD. Two reviewers assessed the trial quality and extracted the data independently. All statistical analyses were performed using the standard statistical procedures provided in Review Manager 5.2 and Stata 12.0. Results: A total of 80 reports with 1040 patients were identified. The pooled results indicated that in IVAD, isolated superior mesenteric artery dissection (ISMAD) was more prevalent, with a pooled prevalence of 60% (95% CI: 50–71%), followed by isolated celiac artery dissection (ICAD) (prevalence: 37%; 95% CI: 27–46%). IVAD was male predominated with a pooled proportion of 80% (95% CI: 72–89%). Similar results were found in ICAD (prevalence: 73%; 95% CI: 52–93%). More IVAD patients were diagnosed with symptoms than ICAD (64 vs. 59%). Regarding to the risk factors, this pooled analysis found smoking and hypertension were the top two conditions in both spontaneous IVAD and ICAD patients, with proportion of 43, 41, 44, and 32%, respectively. It was observed that ICAD appeared shorter dissection length (mean difference: −3.4 cm; 95% CI: −4.9 to −2.0; P<0.0001), higher prevalence of Sakamoto’s classification Π (odds ratio: 5.31; 95% CI: 1.77−15.95; P=0.003) and late progression (odds ratio: 2.84; 95% CI: 1.02−7.87; P=0.05) than ISAMD. Conclusions: Spontaneous IVAD was male predominant and ISMAD was most prevalent followed by ICAD. Smoking and hypertension were the top two conditions in both spontaneous IVAD and ICAD patients. The majority of patients diagnosed with IVAD received observation and conservative treatment and experienced a low proportion of reintervention or progression, especially for ICAD patients. In addition, ICAD and ISMAD had several differences in clinical features and dissection characteristics. Future studies with enough sample size and long follow-up are required to clear the management, long-term outcome, and risk factors of the IVAD prognosis.

Multi-modal imaging for the diagnosis of spontaneous visceral artery dissection: A case report

“…According to a recent systematic review, approximately 60% of patients with CAD exhibited nonspecific clinical symptoms, such as abdominal pain, malaise, and vomiting[ 2 ]. However, SVAD is a potential diagnosis of an acute abdomen that warrants clinical concern among patients who present with persistent abdominal pain[ 8 ].…”

“…The etiology of CAD is obscure. A systematic review revealed that hypertension, smoking, and hyperlipidemia were the top three risk factors for this patient group[ 2 ]. Furthermore, one possible cause is the compression of the median arcuate ligament, which exerts constant friction or stress on the celiac artery from the diaphragm during respiration[ 3 ].…”

“…Digital subtraction angiography is the gold standard for diagnosis; however, it is invasive. Previous studies have shown that most patients were diagnosed by CECT of the abdomen[ 2 , 6 ]. However, in our case, the patient had an ultrasound of the liver, and the physician observed abnormalities in the spectrum of the hepatic artery.…”

“…Spontaneous visceral artery dissection (SVAD), which occurs without accompanying aortic dissection, is a rare condition. According to a recent systematic review, the main risk factors for SVAD are middle-aged male, hypertension or dyslipidemia, and smoking[ 2 ]. Additionally, SVAD may be caused by compression of the median arcuate ligament or a history of abdominal surgery[ 3 , 4 ].…”

“…Most of the previous cases have been diagnosed by contrast-enhanced computed tomography (CECT)[ 2 , 6 ], but the potential of contrast-enhanced ultrasound (CEUS) for early detection of this disease remains underexplored. We used CEUS to identify a case of artery dissection involving the celiac and common hepatic arteries at an early stage.…”