scholarly journals Systematic review and meta-analysis of current evidence in spontaneous isolated celiac and superior mesenteric artery dissection

2018 ◽  
Vol 68 (4) ◽  
pp. 1228-1240.e9 ◽  
Author(s):  
Jiarong Wang ◽  
Yazhou He ◽  
Jichun Zhao ◽  
Ding Yuan ◽  
Hao Xu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Meta Analysis ◽  
Current Evidence ◽  
Artery Dissection ◽  
Superior Mesenteric Artery Dissection

scholarly journals Diagnosis and Management of Isolated Superior Mesenteric Artery Dissection: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 49 (5) ◽  
pp. 400 ◽  
Author(s):  
Waqas Ullah ◽  
Maryam Mukhtar ◽  
Hafez Mohammad Abdullah ◽  
Mamoon Ur Rashid ◽  
Asrar Ahmad ◽  
...  
Keyword(s):  
Systematic Review ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Meta Analysis ◽  
Artery Dissection ◽  
Diagnosis And Management ◽  
Superior Mesenteric Artery Dissection

Treatment Strategies and Outcomes of Symptomatic Spontaneous Isolated Superior Mesenteric Artery Dissection: A Systematic Review and Meta-analysis

2018 ◽  
Vol 25 (5) ◽  
pp. 640-648 ◽  
Author(s):  
Yating Zhu ◽  
Yanghong Peng ◽  
Mingyue Xu ◽  
Yingqi Wei ◽  
Shanshan Wu ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Superior Mesenteric Artery ◽  
Success Rate ◽  
Antithrombotic Therapy ◽  
Mesenteric Artery ◽  
Meta Analysis ◽  
Case Series ◽  
Treatment Modalities ◽  
Artery Dissection ◽  
Superior Mesenteric Artery Dissection

Purpose: To analyze the published treatment experience with symptomatic spontaneous isolated superior mesenteric artery dissection (SISMAD). Methods: A literature search of the PubMed and Cochrane databases was conducted for articles on symptomatic SISMAD published in English from January 2007 to January 2018. Case series reporting on both treatment modalities and outcomes were included, while those on traumatic or iatrogenic SMA dissection or SMA dissection accompanied by aortic or other visceral artery dissection were excluded. Overall event rates for treated symptomatic SISMAD were calculated using pooled analyses. The rate of initial conservative treatment, the success rate, the rate of conversion to intervention, and the failure rate in patients with vs without antithrombotic therapy were calculated for each study and compared using a meta-analysis of proportions. Results: The 25 articles selected encompassed 616 SISMAD cases, of which 514 were symptomatic cases eligible for the analysis. Among the latter, initial treatment consisted of conservative therapy in 447 (87.0%) patients and surgical interventions in 67 (13.0%) patients [45 (8.7%) endovascular procedures and 22 (4.3%) open surgeries]. Among conservative cases, 238 (53.2%) received antithrombotic therapy while 172 (38.5%) did not; 50 (11.2%) cases were converted to intervention [42 (84%) endovascular]. Conservative treatment was initially used in 85.2% of pooled cases with an 84.7% success rate, a 14.3% rate of conversion to intervention, and conservative treatment failure rates of 17.8% and 10.1% in patients treated with vs without antithrombotic therapy, respectively (p=0.103). Conclusion: Conservative treatment appeared safe and effective in >80% of symptomatic SISMAD cases, without apparent benefit for antithrombotic agent use. Initial or secondary intervention was more often endovascular, with favorable success rates and short-term outcomes. Large, prospective randomized trials with long-term follow-up are warranted on the treatment for symptomatic SISMAD.

Spontaneous isolated superior mesenteric artery dissection: Systematic review and meta-analysis

Vascular ◽  
2019 ◽  
Vol 27 (3) ◽  
pp. 324-337 ◽  
Author(s):  
Georgios Karaolanis ◽  
Constantine Antonopoulos ◽  
Diamantis I Tsilimigras ◽  
Dimitrios Moris ◽  
Konstantinos Moulakakis
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Open Repair ◽  
Meta Analysis ◽  
High Rate ◽  
Cochrane Library ◽  
Artery Dissection ◽  
Open Procedure ◽  
Asymptomatic Patients ◽  
Superior Mesenteric Artery Dissection

Objectives Spontaneous isolated superior mesenteric artery dissection (SISMAD) is a rare disease with an incidence of 0.06%. The purpose of the meta-analysis was to identify the outcomes associated with the various treatment options in the management of asymptomatic and symptomatic patients with SISMAD. Methods Eligible studies were selected by searching PubMed, EMBASE, and Cochrane Library. Endpoints were outcome of asymptomatic patients treated conservatively, resolution of symptoms according to the treatment approach, rate of symptomatic patients switched from conservative to the endovascular and/or open repair, characteristics of the dissected lesion, and findings regarding the remodeling of superior mesenteric artery. Results We identified 30 studies including 729 patients. Among them, 608 (83.4%) were symptomatic and were managed with conservative (438/72%), and/or endovascular (139/22.8%) and/or open treatment (31/5%). The remaining were asymptomatic and they were treated solely conservatively. A high rate of resolution of symptoms (92.8%) was noted for patients treated conservatively. Conversion from conservative treatment to either endovascular or open procedure was required in 12.3% and 4.4%, respectively. Resolution of symptoms was observed in 100% for those treated with open procedure and 88.8% for those treated endovascularly. The pooled rate of bowel ischemia in patients treated conservatively was 3.75% (95% confidence interval = 1.15–7.27). Complete remodeling was achieved in 32% and partial in 26% of those who were treated conservatively. Conclusions The majority of symptomatic patients with SISAMD were treated conservatively and showed an uncomplicated course and only a small percentage required conversion to endovascular or open repair. This might highlight the benign course of the disease.

scholarly journals Management of Spontaneous Isolated Mesenteric Artery Dissection: A Systematic Review

2021 ◽  
pp. 145749692110005
Author(s):  
S. Acosta ◽  
F. B. Gonçalves
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Conservative Therapy ◽  
Case Series ◽  
Celiac Artery ◽  
Artery Dissection ◽  
Covered Stents ◽  
Bowel Infarction

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.

scholarly journals Superior mesenteric artery dissection with prolonged abdominal angina treated by laparotomy, endarterectomy, patch angioplasty, and retrograde open mesenteric stenting: a case report

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Shinichi Tanaka ◽  
Atsushi Fukuda ◽  
Eisuke Kawakubo ◽  
Takuya Matsumoto
Keyword(s):  
Case Report ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Artery Dissection ◽  
Surgical Revascularization ◽  
Invasive Treatment ◽  
Case Presentation ◽  
Abdominal Angina ◽  
Patch Angioplasty ◽  
Superior Mesenteric Artery Dissection

Abstract Background Most patients with isolated superior mesenteric artery (SMA) dissection are successfully managed conservatively. However, some patients require more invasive treatment. Case presentation We herein describe a 45-year-old man with isolated SMA dissection. He initially underwent conservative treatment. However, because of persistent abdominal angina, we considered the need for surgical revascularization. He was successfully treated by endarterectomy, patch angioplasty, and retrograde open mesenteric stenting. The abdominal angina was stabilized thereafter. Conclusions The combination of endarterectomy, patch angioplasty, and retrograde open mesenteric stenting is useful for isolated SMA dissection, and long patency can be expected for some patients.

Sign in / Sign up

Export Citation Format

Share Document