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.
FoordAGLewisRD.Primary dissecting aneurysms of peripheral and pulmonary arteries: dissecting hemorrhage of media. Arch Pathol1959;
68: 553–577.
2.
BauersfeldSR.Dissecting aneurysm of the aorta; a presentation of 15 cases and a review of the recent literature. Ann Intern Med1947;
26: 873–889.
3.
LuanJYGuanXLiXet al.
Isolated superior mesenteric artery dissection in China. Journal of Vasc Surg2016;
63: 530–536.
4.
ChoYPKoGYKimHKet al.
Conservative management of symptomatic spontaneous isolated dissection of the superior mesenteric artery. Br J Surg2009;
96: 720–723.
5.
AhnHYChoBSMunYSet al.
Treatment results for spontaneous isolated superior mesenteric artery dissection according to our previous guidelines and collective literature review. Ann Vasc Surg2014;
28: 1595–1601.
6.
SakamotoIOgawaYSueyoshiEet al.
Imaging appearances and management of isolated spontaneous dissection of the superior mesenteric artery. Eur J Radiol2007;
64: 103–110.
7.
KimYW. Current understandings of spontaneous isolated superior mesenteric artery dissection. Vasc Specialist Int 32: 37–43.
8.
YunWSKimYWParkKBet al.
Clinical and angiographic follow-up of spontaneous isolated superior mesenteric artery dissection. Eur J Vasc Endovasc Surg2009;
37: 572–577.
9.
GarrettHEJr.Options for treatment of spontaneous mesenteric artery dissection. J Vasc Surg2014;
59: 1433–1439; e1431–e1432.
10.
WritingCBjorckMKoelemayMet al.
Editor’s choice – Management of the diseases of mesenteric arteries and veins: clinical practice guidelines of the European Society of Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg2017;
53: 460–510.
11.
LiberatiAAltmanDGTetzlaffJet al.
The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ2009;
339: b2700.
12.
LiNLuQSZhouJet al.
Endovascular stent placement for treatment of spontaneous isolated dissection of the superior mesenteric artery. Ann Vasc Surg2014;
28: 445–451.
13.
LuanJYLiXLiTRet al.
Vasodilator and endovascular therapy for isolated superior mesenteric artery dissection. J Vasc Surg2013;
57: 1612–1620.
14.
WuZYiJXuHet al.
The significance of the angle between superior mesenteric artery and aorta in spontaneous isolated superior mesenteric artery dissection. Ann Vasc Surg2017;
45: 117–126.
15.
RousselAPellencQCorcosOet al.
Spontaneous and isolated dissection of the superior mesenteric artery: proposal of a management algorithm. Ann Vasc Surg2015;
29: 475–481.
16.
SatokawaHTakaseSSetoYet al.
Management strategy of isolated spontaneous dissection of the superior mesenteric artery. Ann Vasc Dis2014;
7: 232–238.
17.
JibikiMInoueYKudoT.Conservative treatment for isolated superior mesenteric artery dissection. Surg Today2013;
43: 260–263.
18.
OkamuraKMorizumiSKawataMet al.
Conservative therapy as a primary treatment for spontaneous isolated dissection of the superior mesenteric artery. Ann Vasc Surg2014;
28: 1939–1945.
19.
SunYChenZZhangX.Application of endovascular stent placement as a remedy for spontaneous isolated superior mesenteric artery dissection. Vascular2014;
22: 350–355.
20.
DongZNingJFuWet al.
Failures and lessons in the endovascular treatment of symptomatic isolated dissection of the superior mesenteric artery. Ann Vasc Surg2016;
31: 152–162.
21.
HanYChoYPKoGYet al.
Clinical outcomes of anticoagulation therapy in patients with symptomatic spontaneous isolated dissection of the superior mesenteric artery. Medicine (Baltimore)2016;
95: e3480.
22.
HeoSHKimYWWooSYet al.
Treatment strategy based on the natural course for patients with spontaneous isolated superior mesenteric artery dissection. J Vasc Surg2017;
65: 1142–1151.
23.
KimHKJungHKChoJet al.
Clinical and radiologic course of symptomatic spontaneous isolated dissection of the superior mesenteric artery treated with conservative management. J Vasc Surg2014;
59: 465–472.
24.
KimuraYKatoTNagaoKet al.
Outcomes and radiographic findings of isolated spontaneous superior mesenteric artery dissection. Eur J Vasc Endovasc Surg2017;
53: 276–281.
25.
LiTZhaoSLiJet al.
Value of multi-detector CT in detection of isolated spontaneous superior mesenteric artery dissection. Chin Med Sci J2017;
32: 28–33.
26.
LiZDingHShanZet al.
Initial and middle-term outcome of treatment for spontaneous isolated dissection of superior mesenteric artery. Medicine (Baltimore)2015;
94: e2058.
27.
LvPHZhangXCWangLFet al.
Management of isolated superior mesenteric artery dissection. World J Gastroenterol2014;
20: 17179–17184.
28.
ParkUJKimHTChoWHet al.
Clinical course and angiographic changes of spontaneous isolated superior mesenteric artery dissection after conservative treatment. Surg Today2014;
44: 2092–2097.
29.
RongJJQianAMSangHFet al.
Immediate and middle term outcome of symptomatic spontaneous isolated dissection of the superior mesenteric artery. Abdom Imaging2015;
40: 151–158. DOI: 10.1007/s00261-014-0182-1.
30.
TomitaKObaraHSekimotoYet al.
Evolution of computed tomographic characteristics of spontaneous isolated superior mesenteric artery dissection during conservative management. Circ J2016;
80: 1452–1459.
31.
JiaZZZhaoJWTianFet al.
Initial and middle-term results of treatment for symptomatic spontaneous isolated dissection of superior mesenteric artery. Eur J Vasc Endovasc Surg2013;
45: 502–508.
32.
LiDLHeYYAlkaleiAMet al.
Management strategy for spontaneous isolated dissection of the superior mesenteric artery based on morphologic classification. J Vasc Surg2014;
59: 165–172.
33.
MinSIYoonKCMinSKet al.
Current strategy for the treatment of symptomatic spontaneous isolated dissection of superior mesenteric artery. J Vasc Surg2011;
54: 461–466.
34.
ChoBSLeeMSLeeMKet al.
Treatment guidelines for isolated dissection of the superior mesenteric artery based on follow-up CT findings. Eur J Vasc Endovasc Surg2011;
41: 780–785.
35.
ZerbibPPerotCLambertMet al.
Management of isolated spontaneous dissection of superior mesenteric artery. Langenbecks Arch Surg2010;
395: 437–443.
36.
GobbleRMBrillERRockmanCBet al.
Endovascular treatment of spontaneous dissections of the superior mesenteric artery. J Vasc Surg2009;
50: 1326–1332.
37.
ChuSYHsuMYChenCMet al.
Endovascular repair of spontaneous isolated dissection of the superior mesenteric artery. Clin Radiol2012;
67: 32–37.
38.
PangPJiangZHuangMet al.
Value of endovascular stent placement for symptomatic spontaneous isolated superior mesenteric artery dissection. Eur J Radiol2013;
82: 490–496.
39.
KimHParkHParkSJet al.
Outcomes of spontaneous isolated superior mesenteric artery dissection without antithrombotic use. Eur J Vasc Endovasc Surg2018;
55: 132–137.
40.
SiseMJ.Acute mesenteric ischemia. Surg Clin North Am2014;
94: 165–181.
41.
DewitteABiaisMCoquinJet al.
Diagnosis and management of acute mesenteric ischemia. Ann Fr Anesth Reanim2011;
30: 410–420.
42.
JiaZHuangYShiHet al.
Comparison of CTA and DSA in the diagnosis of superior mesenteric artery dissecting aneurysm. Vascular2018;
26: 346–351.
