Factors Associated with Failed Conservative Management in Symptomatic Isolated Mesenteric Artery Dissection

Jia, Zhongzhi; Chen, Wenhua; Su, Haobo; Shi, Hongcan; Xu, Qin; Ni, Guoqing; Qi, Chunjian; Gu, Jianping

doi:10.1016/j.ejvs.2019.03.039

Cited by 21 publications

(22 citation statements)

References 19 publications

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“…13,18 In contrast, due to the high pressure caused by the saclike false lumen, type IIa (without a re-entry tear) prognosis may rupture by dilation or compress the true lumen, which consistent with the previous report. 7 In present study, although no dissecting aneurysm ruptures occurred, type IIa had more tendency to change to negative remodeling ( p = 0.02). Hence, these risks are widely cited as the main indication for long-term surveillance in IMADs.…”

Section: Discussioncontrasting

confidence: 40%

“…Failure of conservative management was defined as the persistence or aggravation of symptoms and signs, increasing size of aneurysmal dilation, or appearance of peritonitis after conservative management. 7 The general epidemiological data, clinical manifestations, first-episode symptoms, imaging findings, and treatment strategy selection were obtained from the medical records.…”

Section: Methodsmentioning

confidence: 99%

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Outcomes and radiographic findings of symptomatic isolated mesenteric artery dissection with conservative management

Gao

Shang

et al. 2020

Vascular

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Objectives The aim of this study was to evaluate the computed tomography follow-up outcomes and radiographic findings of symptomatic isolated mesenteric artery dissection (IMAD) after conservative management. Methods In this retrospective study, 130 consecutive patients with symptomatic IMAD from three institutions were enrolled from January 2011 to December 2019. The general epidemiological data, clinical manifestations, first-episode symptoms, imaging findings, and treatment strategy selection were analyzed from the medical records. Results Among 130 patients diagnosed with symptomatic IMAD, positive remodeling of the SMA was achieved in 75.38% (98/130), and negative remodeling of the SMA was achieved in 24.62% (32/130). In the positive remodeling group, complete remodeling was achieved 39.23% (51/130) (type I 6 patients, type IIa 10 patients, type IIb 35 patients), in which type IIb was the most ( p = 0.004). Moreover, of the 32 patients in whom negative remodeling of the SMA was achieved, significant differences were observed between the type IIa with respect to dissecting aneurysm formation ( p = 0.04).Of the seven factors analyzed with a logistic regression model identified three factors significantly associated with negative remodeling: length of dissection (Waldχ2 13.331; OR 6.945; 95% CI 2.762–10.498; p = 0.014), true lumen residual diameter (TLRD) (Waldχ2 9.626; OR 7.85; 95% CI 1.892–19.063; p = 0.022), and branch involvement (Waldχ2 11.812; OR 7.247; 95% CI 1.245–14.830; p = 0.011). Conclusion The prognosis of most symptomatic IMAD has a tendency to positive remodeling after conservative management, in which the initial type IIb classification is common. In contrast, risk factors for negative remodeling were type IIa, length of dissection, TLRD, and branch involvement. Patients with these morphological characteristics may not benefit from conservative management.

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Section: Discussioncontrasting

confidence: 40%

Section: Methodsmentioning

confidence: 99%

Outcomes and radiographic findings of symptomatic isolated mesenteric artery dissection with conservative management

Gao

Shang

et al. 2020

Vascular

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“…13 In addition, the presence or absence of re-entry points is considered in the classification of IMAD, and IMAD subtypes are predictive of the failure of conservative treatment. 14,15 Thus, accurate demonstration of these morphologic characteristics during follow up is crucial. In this study, CDU plus CEUS and CTA demonstrated consistent results in the depiction of these characteristics.…”

Section: Discussionmentioning

confidence: 99%

“…5 Additionally, luminal stenosis !90% has been shown to be a risk factor for the failure of conservative treatment. 15 Therefore, accurate measurements of the diameter of the dissecting aneurysm and the minimum B C inner diameter (which is used to calculate the degree of luminal stenosis) are needed for clinical decision making regarding management and the prediction of outcomes. In this study, CDU plus CEUS and CTA demonstrated good consistency in these measurements.…”

Section: Discussionmentioning

confidence: 99%

Combination of Colour Duplex and Contrast Enhanced Ultrasound as an Alternative to Computed Tomography Angiography in Isolated Mesenteric Artery Dissection Surveillance

Wang

et al. 2019

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS The combination of colour duplex ultrasound (CDU) and contrast enhanced ultrasound (CEUS) was found to be successful in showing the morphological characteristics of isolated mesenteric artery dissection (IMAD), and ultrasound imaging also allowed the detection and assessment of peak systolic velocity at the point of the minimum inner diameter. CDU plus CEUS was as successful as computed tomography angiography alone in the follow up for patients with IMAD, without the need for radiation exposure or iodine containing contrast use. Objectives: The aim was to investigate the effectiveness of colour duplex ultrasound (CDU) plus contrast enhanced ultrasound (CEUS) vs. computed tomography angiography (CTA) for surveillance in patients with isolated mesenteric artery dissection (IMAD). Methods: Patients who underwent CDU, CEUS, and CTA for surveillance of IMAD between January 2012 and May 2019 were included in the study. The accuracy of CDU, CEUS, and CTA for determining the morphological characteristics of IMAD was analysed. Results: A total of 42 patients undergoing 76 total imaging examinations during follow up were included. Both CTA and CDU plus CEUS demonstrated the thrombosed false lumen for 28 (36.8%) examinations and the dissecting aneurysm for 20 (26.3%) examinations (both k ¼ 1.0). The diameter of the dissecting aneurysm was 5.03 AE 1.25 mm using CDU and CEUS vs. 5.27 AE 1.23 mm on CTA (coefficient of consistency, 0.997; p < .001). The entry points were visualised by CDU and CEUS for 20 (26.3%) examinations and by CTA for 14 (18.4%) examinations (k ¼ 0.769); no re-entry points were visualised by CDU and CEUS for any examinations but re-entry points were visualised by CTA for two (2.6%) examinations. The minimum inner diameter was 2.80 AE 1.30 mm on CDU and CEUS vs. 2.52 AE 1.29 mm on CTA (coefficient of consistency, 0.999; p < .001). The peak systolic velocities were 128.2 AE 13.0 cm/s at diagnosis and 98.7 AE 4.9 cm/s after one month (p < .001). Conclusions: The combination of CDU and CEUS can be used in place of CTA for the surveillance of IMAD.

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“…Failure of conservative management was defined as the persistence or aggravation of symptoms and signs, increasing size of aneurysmal dilation, or appearance of local peritonitis after conservative management. 11 Persistent symptoms were defined as no change in or the aggravation of symptoms after a week of conservative treatment with antithrombotic agents. 12 Technical success was defined as successful deployment of intervention content (stents, coils and thrombolytic catheters) to the target locations.…”

Section: Methodsmentioning

confidence: 99%

Mid-term outcomes of symptomatic isolated superior mesenteric artery dissection with endovascular management

Shang

et al. 2020

Vascular

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Objectives The clinical outcomes, safety, and efficacy of endovascular management are explored for symptomatic isolated superior mesenteric artery dissection (ISMAD). Methods In this retrospective study, 51 consecutive patients with symptomatic ISMAD received endovascular management from three institutions between January 2011 and December 2019.These patients were categorized into group A (endovascular treatment was used as the first-line therapy) and group B(endovascular treatment was used as the second-line therapy). The general epidemiological data, clinical manifestations, first-episode symptoms, treatment process, imaging findings, follow-up outcomes were analyzed from the medical records. Results A total of 51 patients with endovascular management were collected in this study. Significant differences were observed between the two groups with respect to the course (150 h vs. 57 h; p < 0.001), intestinal ischemia (26.32% vs. 6,25%; p = 0.04) and dissection length (45.26 ± 13.78 mm vs. 63.37 ± 12.73 mm; p < 0.001). Technical success rate was 90.2% (46/51). There was significant difference in the MOD (42.27 ± 23.41 min vs. 76.63 ± 28.62 min p < 0.001), MPSRT (4.67 ± 2.65 h vs. 7.32 ± 2.49 h, p = 0.02), LOS (9.52 ± 3.72 days vs. 11.86 ± 4.13 days; p = 0.01) between the two groups. The bleeding complication rate was 7.84% (one patient in group A and three patients in group B). A total of 48 (94.12%, 48/51) patients were followed up for a median of 36.51 months (range, 4–87 months). Positive events of the SMA were achieved in 81.25% (39/48), and negative events of the SMA were achieved in 18.75% (8/48) based on the follow-up contrast-enhanced CT scan. Conclusions Endovascular management of symptomatic ISMAD has a high technical success rate and efficient at controlling symptoms. Furthermore, as more positive events occur, endovascular management should be encouraged early when pain persists after conservative management or there are signs of disease progression.

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Factors Associated with Failed Conservative Management in Symptomatic Isolated Mesenteric Artery Dissection

Cited by 21 publications

References 19 publications

Outcomes and radiographic findings of symptomatic isolated mesenteric artery dissection with conservative management

Outcomes and radiographic findings of symptomatic isolated mesenteric artery dissection with conservative management

Combination of Colour Duplex and Contrast Enhanced Ultrasound as an Alternative to Computed Tomography Angiography in Isolated Mesenteric Artery Dissection Surveillance

Mid-term outcomes of symptomatic isolated superior mesenteric artery dissection with endovascular management

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