Ten-year review of isolated spontaneous mesenteric arterial dissections

Morgan, Courtney E.; Mansukhani, Neel A.; Eskandari, Mark K.; Rodríguez, Herón E.

doi:10.1016/j.jvs.2017.08.071

Cited by 39 publications

(48 citation statements)

References 39 publications

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“…Previous studies have reported that patient age at the onset of spontaneous isolated dissection of abdominal visceral arteries was relatively low. Male prevalence has been reported to be high, and Nagai et al reported that the male/female ratio was 4:1 [1][2][3][4][5]. The risk factors of this disease remain to be elucidated; however, hypertension and smoking are considered to be closely involved in its pathogenesis, whereas dyslipidemia and diabetes appear to be less involved.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, a therapeutic strategy for this disease has not been established. Recently, various approaches/therapeutic algorithms have been proposed, including antihypertensive therapy, antithrombotic therapy, endovascular treatment, surgery and conservative observation without medication [1][2][3]. However, the validity of these therapeutic algorithms remains to be established.…”

Section: Introductionmentioning

confidence: 99%

“…A recent series of case reports on spontaneous isolated dissection of abdominal visceral arteries revealed that this disease could manifest various clinical features [1][2][3][4]. Considering the possible diversity of these features, it is important to clarify the clinical conditions of patients with spontaneous isolated dissection of abdominal visceral arteries.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Features of Spontaneous Isolated Dissection of Abdominal Visceral Arteries

et al. 2020

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Background: Spontaneous isolated dissection of abdominal visceral arteries without aortic dissection is rare and its pathology and prognosis are not yet clear; therefore, therapeutic strategies for this disease have not been established. The present multi-institution investigational study analyzed the clinical features of patients with spontaneous isolated dissection of abdominal visceral arteries. Methods: A total of 36 patients diagnosed as spontaneous isolated dissection of abdominal visceral arteries from January 2010 to October 2016 were enrolled. The medical data of the patients were retrospectively reviewed. Imaging characteristics were evaluated. Spontaneous isolated dissection of abdominal visceral arteries was detected on upper abdominal computed tomography examination in almost patients, and was detected on magnetic resonance imaging in one patient. Results: Of the 36 cases, 26 cases involved the superior mesenteric artery dissection, nine involved the celiac artery, two involved the splenic artery, one involved the common hepatic artery, one involved the gastroduodenal artery and one involved the left gastric artery. Among the 36 patients, 20 had hypertension and 14 were current smokers. Additionally, only one patient had diabetes and four patients had dyslipidemia. Moreover, 32 cases complained of pain including abdominal pain and back pain, one had cough and three had no symptoms. Of the 36 patients, 34 cases (94.4%) were treated conservatively, and two (5.6%) required intravascular treatment. All patients were discharged without complications. Conclusions: Our findings indicate that hypertension and smoking might be closely involved in the pathogenesis of spontaneous isolated dissection of abdominal visceral arteries, whereas dyslipidemia and diabetes might be less involved. Additionally, few asymptomatic patients were accidentally diagnosed, indicating that the absence of symptoms cannot be used to rule out the presence of this disease. Randomized clinical trials cannot be performed because a considerable number of cases are required. Therefore, detailed descriptions of clinical features, as provided in our report, are important.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical Features of Spontaneous Isolated Dissection of Abdominal Visceral Arteries

et al. 2020

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“…According to Morgan's report, treatment strategy (clinical observation versus anticoagulation and antiplatelet therapy) should be different in symptomatic and asymptomatic patients. 17 According to the European Society of Vascular Surgery Guidelines (ESVS) in 2017, 75% of 688 patients were managed conservatively, 20% underwent endovascular intervention, and 7.5% underwent surgery. 1,18 A similar pattern of management was observed in the present series.…”

Section: Discussionmentioning

confidence: 99%

Correlation Between Computed Tomography Features and Clinical Presentation and Management of Isolated Superior Mesenteric Artery Dissection

Zhang

Xiang

Yang

et al. 2018

European Journal of Vascular and Endovascular Surgery

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“…In a mean follow-up of 21 months, no late intervention or recurrence was observed. 52 Symptomatic VAD can be treated with open or laparoscopic repair surgery (vascular bypass, resection and anastomosis or ligation) or endovascular therapy. 33,46 Since endovascular therapy (coil embolization or stenting), eventual robotic system-assisted, has some advantages (ie, faster recovery, fewer complications) compared with surgery, its use has increased.…”

Section: Treatmentmentioning

confidence: 99%

Visceral Fibromuscular Dysplasia: From asymptomatic disorder to emergency

Tussenbroek

Devos

Debing

et al. 2018

Eur J Clin Investigation

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Fibromuscular dysplasia (FMD) is an idiopathic, segmental, non-atherosclerotic and non-inflammatory disease of the musculature of arterial walls, leading to stenosis of small and medium-sized arteries, mostly involving renal and cervical arteries. As a result of better and more systematic screening, it appears that involvement of the splanchnic vascular bed is more frequent than originally assumed. We review epidemiology, pathogenesis, clinical picture as well as diagnosis and treatment of visceral artery (VA) FMD. The clinical picture is very diverse, and diagnosis is based on CT-, MR- or conventional catheter-based angiography. Involvement of VAs generally occurs among patients with multi-vessel FMD. Therefore, screening for VA FMD is advised especially in renal artery (RA) FMD and in case of aneurysms and/or dissections. Treatment depends on the clinical picture. However, the level of evidence is low, and much of the common practice is extrapolated from visceral atherosclerotic disease.

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Ten-year review of isolated spontaneous mesenteric arterial dissections

Abstract: Whereas isolated SMAD poses a risk of visceral ischemia, most patients presenting with this diagnosis can be treated nonoperatively with a short course of antiplatelet or anticoagulant therapy. Only a small number of patients require surgical revascularization for bowel ischemia.

Cited by 39 publications

References 39 publications

Clinical Features of Spontaneous Isolated Dissection of Abdominal Visceral Arteries

Clinical Features of Spontaneous Isolated Dissection of Abdominal Visceral Arteries

Correlation Between Computed Tomography Features and Clinical Presentation and Management of Isolated Superior Mesenteric Artery Dissection

Visceral Fibromuscular Dysplasia: From asymptomatic disorder to emergency

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