Distal Edge Stenosis After Stent Placement for Isolated Superior Mesenteric Artery Dissection: Mechanisms and Risk Factor Analysis

Hang, Cheng; Chen, Wenhua; Su, Haobo; Jia, Zhongzhi; Qi, Chunjian; Gu, Jianping

doi:10.1007/s00270-019-02244-3

Cited by 17 publications

(10 citation statements)

References 16 publications

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“…Endovascular therapy with stenting is inherently associated with increased proportion of complete remodeling of the dissection compared to conservative therapy ( 65 ). However, stented patients may need life-long antiplatelet agent to prevent stent thrombosis ( 65 ), and some patients will inevitably develop in-stent restenosis ( 21 ). Instead, conservative management of IMAD without any antithrombotic medication is a fairly good option, since the chances of complete remodeling after conservative therapy was 43% after a median CTA follow-up time of 22 months in the present review.…”

Section: Discussionmentioning

confidence: 99%

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Management of Spontaneous Isolated Mesenteric Artery Dissection: A Systematic Review

Acosta

Gonçalves

2021

Scand J Surg

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Background and Aims: There are increasing reports on case series on spontaneous isolated mesenteric artery dissection, that is, dissections of the superior mesenteric artery and celiac artery, mainly due to improved diagnostic capacity of high-resolution computed tomography angiography performed around the clock. A few case–control studies are now available, while randomized controlled trials are awaited. Material and Methods: The present systematic review based on 97 original studies offers a comprehensive overview on risk factors, management, conservative therapy, morphological modeling of dissection, and prognosis. Results and Conclusions: Male gender, hypertension, and smoking are risk factors for isolated mesenteric artery dissection, while the frequency of diabetes mellitus is reported to be low. Large aortomesenteric angle has also been considered to be a factor for superior mesenteric artery dissection. The overwhelming majority of patients can be conservatively treated without the need of endovascular or open operations. Conservative therapy consists of blood pressure lowering therapy, analgesics, and initial bowel rest, whereas there is no support for antithrombotic agents. Complete remodeling of the dissection after conservative therapy was found in 43% at mid-term follow-up. One absolute indication for surgery and endovascular stenting of the superior mesenteric artery is development of peritonitis due to bowel infarction, which occurs in 2.1% of superior mesenteric artery dissections and none in celiac artery dissections. The most documented end-organ infarction in celiac artery dissections is splenic infarctions, which occurs in 11.2%, and is a condition that should be treated conservatively. The frequency of ruptured pseudoaneurysm in the superior mesenteric artery and celiac artery dissection is very rare, 0.4%, and none of these patients were in shock at presentation. Endovascular therapy with covered stents should be considered in these patients.

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Section: Discussionmentioning

confidence: 99%

“…Original reports or reports from multi-center collaborations were included. Ninety-seven studies ( 1 …”

Section: Methodsmentioning

confidence: 99%

Management of Spontaneous Isolated Mesenteric Artery Dissection: A Systematic Review

Acosta

Gonçalves

2021

Scand J Surg

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“…Hang et al reported distal edge stenosis in 44.4% (20/45) of patients treated with stent placement for SISMAD and found that the stent to vessel diameter ratio and angulation at the distal edge were independent risk factors. 26 Considering the convex curvature and tapering diameter of the SMA trunk, traditional stents may not be suitable for the SMA. A flexible stent with a tapered shape might be a good choice.…”

Section: Discussionmentioning

confidence: 99%

Management of Symptomatic Spontaneous Isolated Superior Mesenteric Artery Dissection: A Single Centre Experience with Mid Term Follow Up

Shi

Zhao

et al. 2020

European Journal of Vascular and Endovascular Surgery

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“…Endovascular treatment was also chosen as a first line treatment for uncomplicated SISMAD in several other studies. 26,27 Though endovascular treatment showed good mid-term results in these studies, longer observation from 20,22,28 Based on our study, conservative treatment as an easy and effective approach could still be consider as the first line treatment for most SISMAD patients, especially for type I and type II patients.…”

Section: Discussionmentioning

confidence: 70%

“…Optimal treatment of SISMAD has not reached a consensus yet. Serval studies showed high failure rate of conservative treatment, 5,20,22,23 however in these studies, initial conservative treatment was less than 5 days some were even less than 3 days. 5 Dalman et al 24 reported a quantitative analysis that indicated a 270% gain in flow volume at postprandial phase in SMA by PC-MRI.…”

Section: Discussionmentioning

confidence: 85%

Long-term outcome of spontaneous isolated superior mesenteric artery dissection in different angiographic types

Liu

Shu

et al. 2022

Vascular

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Objective This study aimed to compare the follow-up and outcomes of spontaneous isolated superior mesenteric artery dissection (SISMAD) in different angiographic types and to determine the optimal therapeutic options for SISMAD patients. Methods This is a retrospective study of 61 SISMAD patients between December 2010 and January 2019 in a single center. Data analysis consisted of demographics, clinical data, radiology review, treatment, follow-up, and outcomes. Results A total of 61 SISMAD patients were reviewed in this study. Median age was 53 (quartile, 47.5–63.0), 90.2% were males with hypertension (50.8%), dyslipidaemia (54.1%), and smoking history (60.7%). Among all, 43 patients underwent periodic follow-up of computed tomography (CT) angiography for follow-up analysis. 11 (25.6%) patients showed “No Change” during follow-up, including 6 type I patients. 23 patients (53.5%) were “Partially Remodelled” and 18 of them were type II patients. 7 “Completely Remodelled” patients (16.3%) were all in type II group. Two type III patients (4.6%) died after the emergent surgical intervention within 30 days. Conclusions Different SISMAD angiographic types present with variant progression. Type I SISMAD may be inclined to remain “unchanged.” Type II SISMAD shows a clear trend to remodeling, especially type IIb patients. The progression of type III SISMAD varies in the extent of collateral bypasses.

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Distal Edge Stenosis After Stent Placement for Isolated Superior Mesenteric Artery Dissection: Mechanisms and Risk Factor Analysis

Cited by 17 publications

References 16 publications

Management of Spontaneous Isolated Mesenteric Artery Dissection: A Systematic Review

Management of Spontaneous Isolated Mesenteric Artery Dissection: A Systematic Review

Management of Symptomatic Spontaneous Isolated Superior Mesenteric Artery Dissection: A Single Centre Experience with Mid Term Follow Up

Long-term outcome of spontaneous isolated superior mesenteric artery dissection in different angiographic types

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