Management Strategy Based on Disease Stages for Patients with Symptomatic Isolated Mesenteric Artery Dissection

Xu, Ye; Wu, Jiawei; Gao, Xuechao; Li, Yiqing; Zheng, Hong; Shang, Dan

doi:10.1016/j.avsg.2019.09.037

Cited by 8 publications

(10 citation statements)

References 21 publications

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“…Complete remodeling (morphological restitution of the artery to its normal condition) at CT follow-up at median time of 22 months (IQR: 13–31) was found in 43% (95% CI: 43–47) of 593 patients in 20 ( 7 , 20 , 22 , 25 , 33 , 34 , 37 , 44 , 58 , 63 , 65 , 69 , 71 , 77 , 78 , 80 , 81 , 85 , 88 , 89 ) studies on symptomatic IMAD treated conservatively.…”

Section: Resultsmentioning

confidence: 99%

“…There were 13 late endovascular ( 5 , 11 , 13 , 16 , 43 , 63 , 68 , 88 , 90 , 96 ) and eight open ( 4 , 13 , 43 , 47 , 67 , 90 , 95 ) vascular procedures at follow-up (range 1–44 months) reported in 15 studies. The indications for late interventions were occlusive arterial disease (n = 6) and post-dissection aneurysm (n = 9).…”

Section: Resultsmentioning

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: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Management of Spontaneous Isolated Mesenteric Artery Dissection: A Systematic Review

Acosta

Gonçalves

2021

Scand J Surg

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“…According to the management strategy based on clinical stages previously reported by our team, during the acute and subacute stages, the major complications were intestinal ischemia or necrosis owing to which cannot provide a time window for patients to establish collateral circulation. 18 In the present study, symptoms in group A of the patients were more severe than those of group B. One reason for this is that there was a time delay between onset of symptoms and admission to the department (150 h in the group A vs. 57 h in the group B; p < 0.001), which results in delayed treatment.…”

Section: Discussionmentioning

confidence: 46%

“…In group A, one patient who presented with septic shock after stent placement died of multiple organ failure. 18 Another patient with peritonitis after stent placement performed small intestine resection; unfortunately, this patient died of short bowel syndrome.…”

Section: Resultsmentioning

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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“…However, the prognostic trend based on conservative management is unclear. According to the management strategy based on clinical stages previously reported by our group, during the acute and subacute stages, 14 the major complications were intestinal ischemia or necrosis. Subsequently, in the chronic stage, the major concern were intractable postprandial abdominal pain and dissecting aneurysm formation, which may be related to SMA remodeling anomalies.…”

Section: Discussionmentioning

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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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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Management Strategy Based on Disease Stages for Patients with Symptomatic Isolated Mesenteric Artery Dissection

Cited by 8 publications

References 21 publications

Management of Spontaneous Isolated Mesenteric Artery Dissection: A Systematic Review

Management of Spontaneous Isolated Mesenteric Artery Dissection: A Systematic Review

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

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

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