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

Abstract

<jats:sec><jats:title>Objectives</jats:title><jats:p> 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. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> 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. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> 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 (Waldχ<jats:sup>2</jats:sup> 13.331; OR 6.945; 95% CI 2.762–10.498; p = 0.014), true lumen residual diameter (TLRD) (Waldχ<jats:sup>2</jats:sup> 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). </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> 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. </jats:p></jats:sec>

Clinical features and management strategy of symptomatic spontaneous isolated celiac artery dissection

“…Positive remodelling was defined as complete remodelling and positive morphological changes. 13 Technical success was defined as successful deployment of intervention content (stents, coils and thrombolytic catheters) to the target locations. 14 Symptom duration was defined as the period from the onset of abdominal pain until disappeared.…”

Current status of spontaneous isolated celiac artery dissection

“…Conservative treatment failure was characterized as the retention or worsening of clinical signs or symptoms, a significant increase in aneurysmal dilation size, or the emergence of peritonitis after conservative treatment. 6 All data were statistically analyzed using SPSS 22.0 (SPSS Inc, Chicago, IL, USA). Nonparametric continuous variables were presented as medians and ranges, and comparisons were conducted using Mann-Whitney test.…”

“…Conservative treatment failure was characterized as the retention or worsening of clinical signs or symptoms, a significant increase in aneurysmal dilation size, or the emergence of peritonitis after conservative treatment. 6…”