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Ullah W, Mukhtar M, Abdullah HM, Ur Rashid M, Ahmad A, Hurairah A, Sarwar U, Figueredo VM. Diagnosis and Management of Isolated Superior Mesenteric Artery Dissection: A Systematic Review and Meta-Analysis. Korean Circ J 2019; 49:400-418. [PMID: 31074212 PMCID: PMC6511528 DOI: 10.4070/kcj.2018.0429] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/11/2019] [Accepted: 03/13/2019] [Indexed: 12/17/2022] Open
Abstract
The objective of this study was to analyze the three different management modalities for isolated superior mesenteric artery (SMA) dissection. We did a comprehensive literature search and found 703 articles on the initial search, out of which 111 articles consisting of 145 patients were selected for analysis. The mean age was 55.7 years (standard deviation,9.7;33-85) and 80.6% were male. These patients were managed conservatively (41.3%), endovascularly (28.1%) or surgically (30%). The median follow-up was 10 months (interquartile range [IQR], 4-18 months), 12 months (IQR, 6-19 months) and 14 months (IQR, 6-20 months) respectively. Contrast-enhanced computed tomography (CT) was the most commonly used diagnostic tool in the conservative group (43.8%), while conventional CT scan was the most widely used in endovascular (58.1%) and surgical group (50%). 17% percent of the conservative group had SMA angiography for diagnosis, while this was less than 3% in the other groups. Of these patients, 96.7%, 97.4%, and 100.0% recovered successfully in the conservative, endovascular, and surgical groups respectively. There was no significant difference in the mortality between the three groups (Pearson χ²=0.482). This suggests a conservative and endovascular approach could be used in most patients, which can reduce costs and surgery-related morbidity and mortality. Surgical management should be reserved for cases having infarction or widespread bowel ischemia and in cases where other treatment modalities fail.
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Affiliation(s)
- Waqas Ullah
- Department of Internal Medicine, Abington Hospital - Jefferson Health, Abington, PA, USA.
| | - Maryam Mukhtar
- Department of Internal Medicine, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Hafez Mohammad Abdullah
- Department of Internal Medicine, University of South Dakota Sanford School of Medicine, SD, USA
| | - Mamoon Ur Rashid
- Department of Internal Medicine, Florida Hospital Orlando, Orlando, FL, USA
| | - Asrar Ahmad
- Department of Internal Medicine, Abington Hospital - Jefferson Health, Abington, PA, USA
| | - Abu Hurairah
- Department of Gastroenterology, Advent Health Orlando, FL, USA
| | - Usman Sarwar
- Department of Internal Medicine, Abington Hospital - Jefferson Health, Abington, PA, USA
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Lin MS, Lin LC, Li HY, Lin CH, Chao CC, Hsu CN, Lin YH, Chen SC, Wu YW, Kao HL. Procedural Safety and Potential Vascular Complication of Endovascular Recanalization for Chronic Cervical Internal Carotid Artery Occlusion. Circ Cardiovasc Interv 2008; 1:119-25. [PMID: 20031666 DOI: 10.1161/circinterventions.108.772350] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Patients with chronic cervical internal carotid artery occlusion (ICAO) and cerebral ischemia may benefit from revascularization. The feasibility of endovascular recanalization for chronic ICAO has been reported recently, but its safety is still unproven. We report the follow-up results of 54 chronic ICAO patients who underwent endovascular recanalization, focusing on potential vascular complications and corresponding management.
Methods and Results—
Endovascular recanalization for chronic ICAO was attempted in 54 consecutive patients (48 men; 69.2�9.8 years old) with either recurrent neurological deficit or objective ipsilateral hemisphere ischemia. Mean duration from occlusion documentation to the procedure was 237�327 days (range, 56 to 1424 days). Adverse events while in the hospital and during the 3-month follow-up were recorded. Successful recanalization was achieved in 35 of 54 patients (65%). Three-month cumulative stroke and death rate was 4% (2 of 54), including 1 in-hospital fatal nonipsilateral stroke and 1 in-hospital minor ipsilateral stroke secondary to systemic hypotension. Vascular complications developed in 3 of 54 patients (6%), including 1 late pseudoaneurysm formation 3 months after recanalization, 1 immediate carotid-cavernous fistula after recanalization, and 1 minor extravasation at carotid bifurcation after failed recanalization. However, no clinical sequela was noted with close follow-up and adequate management.
Conclusion—
Certain immediate or delayed vascular complications may develop during or after the endovascular recanalization for chronic ICAO. Although periprocedural death and stroke rate is limited in our study, further study combining neuroimaging tools and cognitive function evaluation is mandatory to assess its utility and appropriateness in patients with chronic ICAO.
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Affiliation(s)
- Mao-Shin Lin
- From the Departments of Internal Medicine (M.-S.L., L.-C.L., H.-Y.L., Y.-H.L., H.-L.K.) and Neurology (C.-C.C.), National Taiwan University Hospital, Taipei, Taiwan; Division of Cardiovascular Surgery, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan (C.-H.L.); Cardiovascular Center (C.-N.H., H.-L.K.) and Department of Nuclear Medicine (Y.-H.W.), National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan; Graduate Institute of Medical Sciences, College of Medicine, Taipei
| | - Lung-Chun Lin
- From the Departments of Internal Medicine (M.-S.L., L.-C.L., H.-Y.L., Y.-H.L., H.-L.K.) and Neurology (C.-C.C.), National Taiwan University Hospital, Taipei, Taiwan; Division of Cardiovascular Surgery, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan (C.-H.L.); Cardiovascular Center (C.-N.H., H.-L.K.) and Department of Nuclear Medicine (Y.-H.W.), National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan; Graduate Institute of Medical Sciences, College of Medicine, Taipei
| | - Hung-Yuan Li
- From the Departments of Internal Medicine (M.-S.L., L.-C.L., H.-Y.L., Y.-H.L., H.-L.K.) and Neurology (C.-C.C.), National Taiwan University Hospital, Taipei, Taiwan; Division of Cardiovascular Surgery, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan (C.-H.L.); Cardiovascular Center (C.-N.H., H.-L.K.) and Department of Nuclear Medicine (Y.-H.W.), National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan; Graduate Institute of Medical Sciences, College of Medicine, Taipei
| | - Cheng-Hsin Lin
- From the Departments of Internal Medicine (M.-S.L., L.-C.L., H.-Y.L., Y.-H.L., H.-L.K.) and Neurology (C.-C.C.), National Taiwan University Hospital, Taipei, Taiwan; Division of Cardiovascular Surgery, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan (C.-H.L.); Cardiovascular Center (C.-N.H., H.-L.K.) and Department of Nuclear Medicine (Y.-H.W.), National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan; Graduate Institute of Medical Sciences, College of Medicine, Taipei
| | - Chi-Chao Chao
- From the Departments of Internal Medicine (M.-S.L., L.-C.L., H.-Y.L., Y.-H.L., H.-L.K.) and Neurology (C.-C.C.), National Taiwan University Hospital, Taipei, Taiwan; Division of Cardiovascular Surgery, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan (C.-H.L.); Cardiovascular Center (C.-N.H., H.-L.K.) and Department of Nuclear Medicine (Y.-H.W.), National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan; Graduate Institute of Medical Sciences, College of Medicine, Taipei
| | - Chih-Neng Hsu
- From the Departments of Internal Medicine (M.-S.L., L.-C.L., H.-Y.L., Y.-H.L., H.-L.K.) and Neurology (C.-C.C.), National Taiwan University Hospital, Taipei, Taiwan; Division of Cardiovascular Surgery, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan (C.-H.L.); Cardiovascular Center (C.-N.H., H.-L.K.) and Department of Nuclear Medicine (Y.-H.W.), National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan; Graduate Institute of Medical Sciences, College of Medicine, Taipei
| | - Yen-Hung Lin
- From the Departments of Internal Medicine (M.-S.L., L.-C.L., H.-Y.L., Y.-H.L., H.-L.K.) and Neurology (C.-C.C.), National Taiwan University Hospital, Taipei, Taiwan; Division of Cardiovascular Surgery, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan (C.-H.L.); Cardiovascular Center (C.-N.H., H.-L.K.) and Department of Nuclear Medicine (Y.-H.W.), National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan; Graduate Institute of Medical Sciences, College of Medicine, Taipei
| | - Shih-Chung Chen
- From the Departments of Internal Medicine (M.-S.L., L.-C.L., H.-Y.L., Y.-H.L., H.-L.K.) and Neurology (C.-C.C.), National Taiwan University Hospital, Taipei, Taiwan; Division of Cardiovascular Surgery, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan (C.-H.L.); Cardiovascular Center (C.-N.H., H.-L.K.) and Department of Nuclear Medicine (Y.-H.W.), National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan; Graduate Institute of Medical Sciences, College of Medicine, Taipei
| | - Yen-Wen Wu
- From the Departments of Internal Medicine (M.-S.L., L.-C.L., H.-Y.L., Y.-H.L., H.-L.K.) and Neurology (C.-C.C.), National Taiwan University Hospital, Taipei, Taiwan; Division of Cardiovascular Surgery, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan (C.-H.L.); Cardiovascular Center (C.-N.H., H.-L.K.) and Department of Nuclear Medicine (Y.-H.W.), National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan; Graduate Institute of Medical Sciences, College of Medicine, Taipei
| | - Hsien-Li Kao
- From the Departments of Internal Medicine (M.-S.L., L.-C.L., H.-Y.L., Y.-H.L., H.-L.K.) and Neurology (C.-C.C.), National Taiwan University Hospital, Taipei, Taiwan; Division of Cardiovascular Surgery, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan (C.-H.L.); Cardiovascular Center (C.-N.H., H.-L.K.) and Department of Nuclear Medicine (Y.-H.W.), National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan; Graduate Institute of Medical Sciences, College of Medicine, Taipei
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