Optimal management strategy for spontaneous isolated dissection of a visceral artery

Abstract

Objectives To describe our clinical experiences and recommend a management strategy for spontaneous isolated dissection of a visceral artery. Methods A retrospective study of patients from December 2005 to December 2015 was performed. Thirty-two patients had spontaneous isolated dissection of a visceral artery. Clinical features, computed tomography findings, the treatment method, and follow-up results were evaluated. Results There were 28 men and 4 women (mean age, 54 years). Dissection locations were the celiac artery in 10, superior mesenteric artery in 17, and celiac artery and superior mesenteric artery in 5 patients. Celiac artery stenosis existed with spontaneous isolated dissection of a visceral artery at a high rate. After diagnosis, the blood pressure of all patients was immediately controlled to a lower level. Three patients with arterial rupture and one patient with bowel infarction underwent operations for complications. Overall, the treatment of dissection involved drug therapy alone. The last follow-up computed tomography results of the true lumen residual ratio and the length of the dissected artery improved compared to the values on admission; the maximum diameter of the dissected artery did not enlarge. Eleven patients almost completely improved. No patients had any adverse event. Conclusions Most patients with spontaneous isolated dissection of a visceral artery can be first treated conservatively for dissection with strict blood pressure control and surveillance.

Management of Spontaneous Isolated Mesenteric Artery Dissection: A Systematic Review

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

Necessity of revascularization for acute mesenteric ischemia in symptomatic patients with spontaneous isolated dissection of the superior mesenteric artery

“…The CT findings included the true lumen residual ratio (TLRR; i.e., the minimum value of the true lumen size compared to the transverse section of the dissected artery), 2 length of the dissected artery, maximum diameter of the dissected artery, blood flow through the branches of the superior mesenteric artery (SMA) (i.e., the middle colic, inferior pancreaticoduodenal, inferior pancreatic, jejunal, right colic, and ileocolic arteries), and other visceral arteries (i.e., the celiac artery [CA] and inferior mesenteric artery [IMA]), and contrast effect of the bowels. Additionally, to evaluate the effectiveness of TLRR as an indicator for AMI in symptomatic patients with SIDSMA, the TLRR in patients with abnormal laboratory data were compared to those in patients without abnormal laboratory data.…”

“…Several recent studies have reported that most patients with spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) can initially be treated conservatively. [1][2][3][4][5] However, acute mesenteric ischemia (AMI) is a rare but life-threatening complication. [6][7][8] Recent review articles have reported that symptomatic patients managed conservatively have relatively high late secondary intervention rates.…”

Primary conservative treatment for peritonitis-absent symptomatic isolated dissection of the superior mesenteric artery with severely compressed true lumen

“…Although there is still no consensus on the optimal treatment for SIDSMA, with the increasing number of case reports showing that conservative treatment for this uncommon lesion is associated with a good prognosis, both clinically and morphologically, a number of treatment algorithms have been proposed in recent years, mostly based on the retrospective single-center experience. [1][2][3][4][5][6][7] With respect to the timing of the invasive interventions, for patients in groups I, II, and IIIb, a consensus has been reached among the majority of previous reported treatment strategies and algorithms, which recommended invasive procedures as a remedy of the failure of primary conservative treatment (PCT) with or without the antithrombotic therapy in groups I and IIIb [8][9][10][11][12][13] and invasive treatment should be emergently performed in group II, including laparoscopic exploration, endovascular stent placement, and surgical repair with or without bowel resection. 12,[14][15][16][17] However, for patients in group IIIa, distinct controversies still exist about whether the invasive revascularization procedure should be emergently performed in these lesions.…”

“…Although there is still no consensus on the optimal treatment for SIDSMA, with the increasing number of case reports showing that conservative treatment for this uncommon lesion is associated with a good prognosis, both clinically and morphologically, a number of treatment algorithms have been proposed in recent years, mostly based on the retrospective single-center experience. 1–7…”