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Ye M, Zhou Q, Wu J, Zhang Z, Li B, Zheng T, Shao G. Conservative Versus Endovascular Treatment for Spontaneous Isolated Superior Mesenteric Artery Dissection: A Clinical and Imaging Follow-up Study. J Endovasc Ther 2024; 31:840-852. [PMID: 37026460 DOI: 10.1177/15266028231163733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
PURPOSE Spontaneous isolated superior mesenteric artery dissection (SISMAD) is a rare vascular disease, the treatment strategies for which remain debated. This retrospective study aimed to compare the outcomes of conservative and endovascular treatments in patients with SISMAD. MATERIALS AND METHODS Fifty-eight patients with SISMAD confirmed by computed tomography angiography admitted to our hospital between November 2017 and May 2021 and received confirmed conservative (n=43) or endovascular (n=15) treatment. The patient demographics, imaging analysis, and follow-up results were analyzed and compared. RESULTS The cohort included 54 males and 4 females with a mean age of 52 years. Abdominal pain was the major complaint (49/58, 84.5%), followed by chest pain (2/58, 3.4%). The mean follow-up was 9.1±7.9 months. The 2 main Sakamoto types were type III (27/58, 46.6%) and type IV (16/58, 27.6%). Most patients in both groups had angle 1 (aortomesenteric angle) and angle 2 (superior mesenteric artery [SMA] course) of over 80°. About 67.3% of patients had long length of dissection (>60 mm). The median distance between the SMA root and the dissection entry site was 1.5 cm, mostly (84.5% of the patients) in the curved segment of the SMA. Telephone follow-ups found that most patients survived pain-free, and none underwent intestinal resection. Only 4 patients, 2 in each group, had recurrent abdominal pain during follow-up and received stenting treatment to achieve complete vascular remodeling. Importantly, we found that the conservative and endovascular therapies achieved similar high remodeling rates (94% and 100%, respectively; p=0.335). The conservative group achieved satisfying vascular remodeling (partial, 35%; complete, 59%), making it as safe and effective a treatment as endovascular therapy. CONCLUSIONS Initial conservative management is safe and effective in patients with SISMAD. A high technical success rate and favorable short-term outcomes were associated with endovascular procedures as secondary interventions. It would be helpful to conduct large-scale, prospective, randomized controlled trials with long-term follow-up for SISMAD. CLINICAL IMPACT 1. This research provided more detail clinical information, such as evaluation of abdominal pain and measurements of SMA angles, which is all relevant to treatment. 2. What's more, the most surprising results of follow-up part shown that conservative treatment could reached the remodeling rate as high as endovascular treatment, which was relatively low in other studies. It helps us share our treatment experience with clinicians. 3. In addition, we get limited knowledge about this rare disease, it's encouraging us to do more researches based on the results we had.
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Affiliation(s)
- Mengmeng Ye
- Ningbo University of Medical School, Ningbo, China
| | - Qingyun Zhou
- Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Jiacheng Wu
- Ningbo University of Medical School, Ningbo, China
| | - Zheng Zhang
- Ningbo University of Medical School, Ningbo, China
| | - Bo Li
- Ningbo University of Medical School, Ningbo, China
| | - Tao Zheng
- Ningbo University of Medical School, Ningbo, China
| | - Guofeng Shao
- Ningbo University of Medical School, Ningbo, China
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Yang Y, Han T, Lin C, Luan J, Yang J, Mao L, Fu W, Guo D, Zhu T. Comparison of clinical outcomes between medical or/and endovascular therapy in spontaneous isolated superior mesenteric artery dissection patients without bowel ischemia. Asian J Surg 2024:S1015-9584(24)01785-8. [PMID: 39209631 DOI: 10.1016/j.asjsur.2024.08.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 07/25/2024] [Accepted: 08/06/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVE This study aims to assess the clinical results of endovascular intervention for spontaneous isolated superior mesenteric artery dissection (SISMAD) and its impact on superior mesenteric artery (SMA) remodeling in comparison to solely medical management. METHODS All patients with SISMAD between January 2015 and August 2023 were included. The primary endpoints were the absence of major adverse events (MAEs), including dissection-related mortality, recurrence of mesenteric ischemia symptoms, and the necessity for intervention. The secondary endpoints were stenosis or occlusion of the SMA and morphologic remodeling of the dissections. RESULTS A total of 217 SISMAD patients were included. In this study, 127 (58.5 %) patients received medical management alone (conservative group), and 90 (41.5 %) underwent endovascular therapy (EVT group). In the EVT group, the technical success rate was 94.4 % (85/90). During follow-up, 13 (6.0 %) patients experienced MAEs, and 1 patient in the conservative group death related to SISMAD. The patients in EVT group showed more complete remodeling than those in the conservative group (76 (84.4 %) vs 66 (52.0 %), P < .0001). Survival analysis showed that the estimated MAEs-free survival rates were97.8 %, 95.6 %, and 95.6 % in EVT group and 98.4 %, 94.5 %, 92.9 % in conservative group at one, two, and three years, respectively. No significant difference was observed in both groups. CONCLUSION The findings indicate that both endovascular treatment and medical management alone yield comparable rates of MAE-free survival among patients with SISMAD. Additionally, endovascular therapy exhibits a higher rate of complete remodeling and greater freedom from stenosis or occlusion of the SMA.
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Affiliation(s)
- Yimin Yang
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tonglei Han
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Changpo Lin
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jingyang Luan
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jizhou Yang
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Le Mao
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Daqiao Guo
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Ting Zhu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
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Wang J, Luan F, Bai Z, Liu Z. Systematic review and meta-analysis of current evidence in endograft therapy for spontaneous isolated superior mesenteric artery dissection. Updates Surg 2024; 76:1169-1181. [PMID: 38546969 DOI: 10.1007/s13304-024-01821-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 03/04/2024] [Indexed: 08/24/2024]
Abstract
The role of endovascular stent therapy (EST) in the treatment of spontaneous isolated superior mesenteric artery dissection (SISMAD) has gained momentum in recent years but remains controversial. We gathered research examining the advantages and disadvantages of EST for SISMAD patients. Primary outcomes involved both immediate and long-term results. Random or fixed effect models were used for effect size (ES) calculation with 95% confidence interval (CI) based on 50% heterogeneity threshold. Our analysis incorporated data from 21 studies including 611 SISMAD cases treated by EST. Our findings show a complication rate of approximately 1% following EST (95%CI 0.01-0.02, I2 = 0%, P = 0.97), with a bare minimum mortality rate of < 1% (95%CI 0.00-0.01, I2 = 0%, P > 0.05) and a reintervention rate of < 1% (95%CI 0.00-0.01, I2 = 0%, P = 0.89). We also found technique success and symptom resolution approaching 94% and 99%, respectively, in the immediate postoperative phase. In the long run, we observed a recurrence of symptoms at 3% (95%CI 0.00-0.06, I2 = 58.6%, P < 0.01), creation of new dissections at 1% (95%CI 0.00-0.02, I2 = 0%, P = 0.73), aneurysm progression at 2% (95%CI 0.00-0.03, I2 = 42.7%, P = 0.12), reintervention due to complications at 3% (95%CI 0.00-0.05, I2 = 0%, P = 0.43) and stenotic stents at 12% (95%CI 0.04-0.23, I2 = 77.5%, P < 0.01). Nevertheless, high levels of stent patency 98% (95% CI 0.97-1.00, I2 = 0%, P = 0.51) and complete remodeling 88% (95% CI 0.82-0.94, I2 = 65.5%, P < 0.05) were observed postoperatively. Overall, EST presents minimal complications and promising long-term outcomes for SISMAD, although the prevalence of stent stenosis requires further attention.
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Affiliation(s)
- Jian Wang
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang, University's Medical School, Hangzhou, 310051, Zhejiang, China
| | - Fengming Luan
- Department of General Surgery, The Second Affiliated Hospital of Zhejiang, University's Medical School, Hangzhou, 310051, Zhejiang, China
| | - Zhixuan Bai
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Zhejiang, University's Medical School, Hangzhou, 310051, Zhejiang, China
| | - Zhengjie Liu
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang, University's Medical School, Hangzhou, 310051, Zhejiang, China.
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Zhang B, Shen Y, Jin L, Wang J. Systematic review and meta-analysis of current evidences in endograft therapy vs. medical treatment for Spontaneous Isolated Superior Mesenteric Artery Dissection. Langenbecks Arch Surg 2024; 409:215. [PMID: 39008150 DOI: 10.1007/s00423-024-03406-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 07/04/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVE Endovascular stent therapy (EST) for spontaneous isolated superior mesenteric artery dissection (SISMAD) is gaining popularity, yet the treatment strategy - BMT or EST - remains debatable. METHODS A meta-analysis examined all randomized trials and observational studies exploring the relative merits and potential risks of EST vs. BMT in treating SISMAD patients. Key outcomes included early and long-term adverse effects, with odds ratios (ORs) and 95% confidence intervals (CI) calculated. A random- or fixed-effects model was selected according to a 50% heterogeneity threshold. RESULTS 9 observational studies involving a total of 672 SISMAD patients (303 EST), met our selection criteria. We discovered no noteworthy distinctions between the EST group and the BMT group in terms of early symptoms' alleviation, reinterventions, or all-cause mortality. However, patients receiving EST management will be hospitalized longer than those receiving BMT (EST: 13.2 ± 5.1 months vs. BMT: 7.0 ± 2.2 months, P < 0.01). In the long run, EST was found to significantly contribute to a higher rate of complete remodeling (OR: 4.53, CI: 3.01 ~ 6.81, P < 0.01; heterogeneity, I2 = 50%) and a lower incidence of aneurysm formation (OR: 0.19, CI: 0.06 ~ 0.6, P < 0.01; heterogeneity, I2 = 0%) than BMT. However, there are no significant differences between ESTand BMTin terms of all-cause mortality, recurrent syndrome, reintervention, and SMA stenosis or occlusion. CONCLUSION EST can effectively prevent the formation of aneurysmal dissection and improve SISMAD remodeling. Both EST and BMT are similar in reducing long-term mortality, recurrent symptoms, severe SMA stenosis or occlusion, and the need for reintervention in patients with SISMAD.
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Affiliation(s)
- Baoyou Zhang
- Department of Cardiac and Thoracic Vascular Surgery, The First People's Hospital of Jiashan County, The Second Affiliated Hospital of Zhejiang University, Jiashan Branch, Jiaxing, Zhejiang, 310051, China
| | - Yuexin Shen
- Department of Cardiac and Thoracic Vascular Surgery, The First People's Hospital of Jiashan County, The Second Affiliated Hospital of Zhejiang University, Jiashan Branch, Jiaxing, Zhejiang, 310051, China
| | - Ling Jin
- Department of Cardiac and Thoracic Vascular Surgery, The First People's Hospital of Jiashan County, The Second Affiliated Hospital of Zhejiang University, Jiashan Branch, Jiaxing, Zhejiang, 310051, China
| | - Jian Wang
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang, University's Medical School, Hangzhou, Zhejiang, 310051, China.
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Mei J, Yan H, Zhao X, Yuan Y, Su H, Xue T, Jia Z. In-stent Restenosis After Stenting for Superior Mesenteric Artery Dissection Is Associated With Stent Landing Zone: From Clinical Prediction to Hemodynamic Mechanisms. J Endovasc Ther 2024:15266028241241494. [PMID: 38561992 DOI: 10.1177/15266028241241494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To identify risk factors for in-stent restenosis (ISR) in patients undergoing stent placement for superior mesenteric artery dissection (SMAD) and to determine the hemodynamic mechanism underlying ISR. METHODS For this retrospective study, patients with SMAD who had ISR after stent placement were included in the ISR group, and age- and sex-matched patients with SMAD who did not experience ISR after stent placement were included in the control group. Clinical, imaging, and hemodynamic data were assessed. Multivariable regression was used to identify independent ISR risk factors. Structural and fluid dynamics simulations were applied to determine the hemodynamic mechanism underlying the occurrence of ISR. RESULTS The study population included 26 patients with ISR and 26 control patients. Multivariate analysis demonstrated that stent-to-vascular (S/V) ratio (odds ratio [OR], 1.14; 95% confidence interval [CI]: 1.00-1.29; p=0.045), stent proximal position >10 mm away from the SMA root (OR, 108.67; 95% CI: 3.09-3816.42; p=0.010), and high oscillatory shear index (OSI) area (OR, 1.25; 95% CI: 1.02-1.52; p=0.029) were predictors of ISR. In structural and fluid dynamics simulations, a stent proximal position near the abdominal aorta (AA) or entering into the AA reduced the contact area between the proximal struts of the stent and the vascular wall, and alleviated the distal lumen overdilation. CONCLUSION The S/V ratio, stent proximal position away from the SMA root (>10 mm), and high OSI area are independent risk factors for ISR in patients with SMAD undergoing stent placement. Deploying the proximal end of the stent near the AA or entering into the AA appears to improve the hemodynamic environment in the SMA lumen and ultimately reduce the risk of ISR. CLINICAL IMPACT In-stent restenosis is an uncommon but potentially catastrophic complication after stent placement for the management of superior mesenteric artery dissection. This study identified risk factors for in-stent restenosis and demonstrated that, as long as the stent can fully cover the dissection range, deploying the proximal end of the stent near the abdominal aorta or less entering into the abdominal aorta may reduce the risk of in-stent restenosis in this patient population.
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Affiliation(s)
- Junhao Mei
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou Second People's Hospital, Nanjing Medical University, Changzhou, China
| | - Hui Yan
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Xi Zhao
- Central Research Institute, United Imaging Healthcare, Shanghai, China
| | - Yuan Yuan
- Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Haobo Su
- Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Tongqing Xue
- Department of Interventional Radiology, Huaian Hospital of Huai'an City, Huai'an, China
| | - Zhongzhi Jia
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou Second People's Hospital, Nanjing Medical University, Changzhou, China
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Guo W, Chen L, Li X, Zhu L, Zhang H, Wu B, Lu Q, Xia S, Ding Z, Zhang L. A comparative study on the transbrachial and transfemoral approaches for the treatment of superior mesenteric artery lesions. J Vasc Access 2024:11297298231225679. [PMID: 38436293 DOI: 10.1177/11297298231225679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Superior Mesenteric Artery (SMA) lesions present a significant challenge in endovascular surgery. Both the transbrachial (TBA) and the transfemoral (TFA) approaches have been employed for the treatment of these lesions, but the comparative effectiveness of these methods remains unclear. MATERIALS AND METHODS A retrospective analysis was conducted on patients who underwent TBA and TFA at a tertiary center between June 2020 and February 2023. Key parameters including technical success, procedural details, and complication rates were examined. RESULTS In a study of 99 patients, 66 underwent Transfemoral Approach (TFA) and 33 underwent Transbrachial Approach (TBA). No significant age or gender differences were noted between groups. TFA procedures were longer (90.0 vs 63.5 min, p = 0.002) and had higher fluoroscopy times (59.0 vs 43.0 min, p = 0.02) and selective SMA times (366.0 vs 245.0 min, p = 0.038) compared to TBA, especially with a smaller aortomesenteric angle (<90°). Technical success rates were high in both groups (TFA 97%, TBA 93.9%, p = 0.60). Complication rates were similar between groups, with no significant predictors for access site complications identified. CONCLUSION Both the TBA and the TFA are effective for the treatment of SMA lesions, with TBA potentially offering advantages in terms of efficiency and patient recovery, particularly in cases with certain anatomy. No significant differences in complication rates were found between the two groups. Further research, including prospective randomized trials, is needed to confirm these findings.
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Affiliation(s)
- Wenying Guo
- Department of Vascular Surgery, Shanghai Changhai Hospital, Navy Medical University (Second Military Medical University), Shanghai, People's Republic of China
| | - Li Chen
- Division of Vascular Surgery, Department of General Surgery, Tai'an City Central Hospital, Taian, Shandong, China
| | - Xiaoye Li
- Department of Vascular Surgery, Shanghai Changhai Hospital, Navy Medical University (Second Military Medical University), Shanghai, People's Republic of China
| | - Longtu Zhu
- Department of Vascular Surgery, Shanghai Changhai Hospital, Navy Medical University (Second Military Medical University), Shanghai, People's Republic of China
| | - Hao Zhang
- Department of Vascular Surgery, Shanghai Changhai Hospital, Navy Medical University (Second Military Medical University), Shanghai, People's Republic of China
| | - Biao Wu
- Department of Vascular Surgery, Shanghai Changhai Hospital, Navy Medical University (Second Military Medical University), Shanghai, People's Republic of China
| | - Qingsheng Lu
- Department of Vascular Surgery, Shanghai Changhai Hospital, Navy Medical University (Second Military Medical University), Shanghai, People's Republic of China
| | - Shibo Xia
- Department of Vascular Surgery, Shanghai Changhai Hospital, Navy Medical University (Second Military Medical University), Shanghai, People's Republic of China
| | - Zhichen Ding
- Department of Vascular Surgery, Shanghai Changhai Hospital, Navy Medical University (Second Military Medical University), Shanghai, People's Republic of China
| | - Lei Zhang
- Department of Vascular Surgery, Shanghai Changhai Hospital, Navy Medical University (Second Military Medical University), Shanghai, People's Republic of China
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Shang T, Zhou HJ, Wang YS, Qiu C, Chen TC, Sun J, Lu T, Wu Z, Zhang H, Li Z, Li DL. Mid-term Results of the Treatment of Isolated Dissection of the Celiac Artery: A Comparative Analysis of Endovascular Versus Conservative Therapy. J Endovasc Ther 2024; 31:80-88. [PMID: 35852451 DOI: 10.1177/15266028221112254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Endovascular treatment (EVT) is an alternative method used to treat isolated dissection of the celiac artery (IDCA). However, only a few mid-term results have been reported. This study aimed to analyze and compare the outcomes of endovascular and non-operative therapies for IDCA. METHODS Data from a cohort of consecutive IDCA patients enrolled in the study hospital between April 2012 and September 2020 were retrospectively reviewed. Demographic information, imaging features, treatment modalities, and follow-up results of celiac artery remodeling and adverse events were collected and analyzed. RESULTS A total of 87 patients were enrolled in the study. Stents were deployed in 68 patients, and non-operative treatment (blood pressure control and pain management) was continued in the remaining 19 patients who did not receive stenting; among these 19 patients, EVT failed in 6. The mean follow-up period was 37.3 (range, 10-85 months) and 44.0 (range, 9-80 months) months in the EVT and non-operative groups, respectively. During follow-up, the overall complete remodeling (absence of residual dissection with no false lumen or no intramural thrombus) rate was significantly higher in the EVT group than in the non-operative group (87.3% vs 7.1%, p<0.001). The incomplete remodeling (improved true lumen with malabsorption or partial thrombosis of the false lumen) rate was not significantly different between the EVT and non-operative groups (6.3% vs 14.3%; p=0.2984). Meanwhile, the adverse event-free survival rates were 89.0%, 67.0%, and 67.0% at 1, 3, and 5 years, respectively, in the EVT group compared with 39.7% and 29.8% at 1 and 3 years in the non-operative group (p<0.0001). CONCLUSIONS EVT for IDCA may be considered an effective management option with a favorable clinical success rate, an encouraging complete remodeling rate, and a satisfactory adverse event-free survival rate. However, further evaluation with a long-term follow-up is required. CLINICAL IMPACT Endovascular intervention for isolated dissection of the celiac artery has attracted inadequate attention. In this retrospective study with comparative analysis of endovascular versus conservative therapy for isolated dissection of the celiac artery patients, a better complete remodeling rate and a higher adverse event-free survival rate were observed in the endovascular treatment (EVT) group during follow-up, indicating that EVT could be an effective management option for isolated dissection of the celiac artery.
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Affiliation(s)
- Tao Shang
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hua-Ji Zhou
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Vascular Surgery, Ping Hu People's Hospital, Jiaxing, China
| | - Yi-Shu Wang
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chenyang Qiu
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tian-Chi Chen
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jie Sun
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo No.2 Hospital), Ningbo, China
| | - Tian Lu
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ziheng Wu
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongkun Zhang
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhenjiang Li
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dong-Lin Li
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Ben Abdallah I, Huguet A, Nuzzo A, Mirault T, Roussel A, El Batti S, Ronot M, Castier Y, Corcos O. Acute Isolated Mesenteric Artery Dissection: Four Year Experience From a French Intestinal Stroke Centre. Eur J Vasc Endovasc Surg 2022; 64:656-664. [PMID: 36075544 DOI: 10.1016/j.ejvs.2022.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 08/17/2022] [Accepted: 08/28/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE This study aimed to report outcomes of patients with symptomatic acute isolated mesenteric artery dissection (IMAD) treated within a French intestinal stroke centre (ISC). METHODS All patients with symptomatic IMAD referred to the ISC from January 2016 to January 2020 were included prospectively. Patients with aortic dissection and asymptomatic IMAD were not included. The standardised medical protocol included anticoagulation and antiplatelet therapy, gastrointestinal resting, and oral antibiotics. Operations were considered for acute mesenteric ischaemia (AMI). RESULTS Among the 453 patients admitted to an ISC during the study period, 34 (median age, 53 years [41 - 67]; 82% men) with acute symptomatic IMAD were included. According to the classification of Yun et al., IMADs were reported as follows: type I (n = 7, 20%), type IIa (n = 6, 18%), type IIb (n = 15, 44%), and type III (i.e., complete superior mesenteric artery [SMA] occlusion; n = 6, 18%). Overall, nine (26%) patients had AMI (type I/II, n = 3; type III, n = 6). On initial computerised tomography angiogram, nine (26%) patients had an associated visceral arterial dissection or pseudoaneurysm. All patients with types I/II (n = 28, 82%) followed a favourable clinical course with conservative therapy, with no need for any operation. All patients with type III (n = 6, 18%) underwent urgent laparotomy with SMA revascularisation (open, n = 4; stenting, n = 1) and or bowel resection (early, n = 3; late, n = 1). Rates of intestinal resection and short bowel syndrome were 12% and 8.8%, respectively. After a median follow up of 26 months [18 - 42], recurrence of symptoms occurred in four (12%) patients and aneurysmal change in 14 (41%), with no re-intervention. CONCLUSION Although IMAD was associated with a high frequency of AMI, a standardised protocol produced a low rate of intestinal resection. Conservative therapy seems appropriate in types I/II patients, whereas urgent SMA revascularisation should aim to avoid intestinal resection or death in type III patients.
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Affiliation(s)
- Iannis Ben Abdallah
- Université Paris Cité and Assistance Publique-Hôpitaux de Paris (APHP), Paris, France; Department of Vascular and Thoracic Surgery, Hôpital Bichat, APHP, Paris, France; SURVI (Structure d'URgences Vasculaires Intestinales, i.e., Intestinal Stroke Centre), Hôpitaux Beaujon/Bichat, APHP; Inserm, UMR_S 1140, Fondation Carpentier, Paris, France.
| | - Audrey Huguet
- SURVI (Structure d'URgences Vasculaires Intestinales, i.e., Intestinal Stroke Centre), Hôpitaux Beaujon/Bichat, APHP
| | - Alexandre Nuzzo
- Université Paris Cité and Assistance Publique-Hôpitaux de Paris (APHP), Paris, France; SURVI (Structure d'URgences Vasculaires Intestinales, i.e., Intestinal Stroke Centre), Hôpitaux Beaujon/Bichat, APHP
| | - Tristan Mirault
- Université Paris Cité and Assistance Publique-Hôpitaux de Paris (APHP), Paris, France; National Reference Centre for Rare Vascular Diseases, FAVA-MULTI, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - Arnaud Roussel
- Department of Vascular and Thoracic Surgery, Hôpital Bichat, APHP, Paris, France; SURVI (Structure d'URgences Vasculaires Intestinales, i.e., Intestinal Stroke Centre), Hôpitaux Beaujon/Bichat, APHP
| | - Salma El Batti
- Université Paris Cité and Assistance Publique-Hôpitaux de Paris (APHP), Paris, France; Inserm, UMR_S 1140, Fondation Carpentier, Paris, France; Department of Vascular Surgery, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - Maxime Ronot
- Université Paris Cité and Assistance Publique-Hôpitaux de Paris (APHP), Paris, France; SURVI (Structure d'URgences Vasculaires Intestinales, i.e., Intestinal Stroke Centre), Hôpitaux Beaujon/Bichat, APHP; Department of Radiology, Hôpital Beaujon, APHP, Clichy, France
| | - Yves Castier
- Université Paris Cité and Assistance Publique-Hôpitaux de Paris (APHP), Paris, France; Department of Vascular and Thoracic Surgery, Hôpital Bichat, APHP, Paris, France; SURVI (Structure d'URgences Vasculaires Intestinales, i.e., Intestinal Stroke Centre), Hôpitaux Beaujon/Bichat, APHP
| | - Olivier Corcos
- Université Paris Cité and Assistance Publique-Hôpitaux de Paris (APHP), Paris, France; SURVI (Structure d'URgences Vasculaires Intestinales, i.e., Intestinal Stroke Centre), Hôpitaux Beaujon/Bichat, APHP
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Qiu C, Wu Z, He Y, Tian L, Zhu Q, Shang T, Zhang H, Li D. Endovascular therapy versus medical treatment for spontaneous isolated dissection of the superior mesenteric artery. Cochrane Database Syst Rev 2022; 9:CD014703. [PMID: 36074662 PMCID: PMC9455746 DOI: 10.1002/14651858.cd014703.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) occurs when a tear in the inner layer of the superior mesenteric artery (SMA) allows blood to flow between the layers of the SMA, forcing the layers apart, and creating two lumens. Abdominal pain is the most prevalent clinical manifestation. Other people may have no symptoms or experience nausea, vomiting, diarrhea, or blood in their stools. For people with SIDSMA who are not suspected of intestinal necrosis or intra-abdominal bleeding, medical treatment and endovascular therapy are the main treatment options. There is no consensus on the optimum first-line management strategy. OBJECTIVES To evaluate the benefits and harms of endovascular therapy versus medical treatment for spontaneous isolated dissection of the superior mesenteric artery (SIDSMA). SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 3 August 2021. SELECTION CRITERIA We planned to include all randomized controlled trials (RCTs) which compared endovascular therapy and medical treatments for SIDSMA. We planned to exclude studies where participants were treated with open surgery. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were endovascular intervention rate and recurrent abdominal pain. Our secondary outcomes were open surgery rate, remodeling rate of SMA, new aneurysm formation of SMA, SMA occlusion, new dissection of SMA, death, symptom relief rate and complications of endovascular therapy. We planned to use GRADE to assess certainty of evidence for each outcome. MAIN RESULTS We did not identify any RCTs to include in any analysis. AUTHORS' CONCLUSIONS We were not able to include any RCTs that compared endovascular therapy versus medical treatment in people with SIDSMA. High-quality RCTs that evaluate the benefits and harms of these interventions are needed to help determine the optimal strategy for managing SIDSMA.
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Affiliation(s)
- Chenyang Qiu
- Department of Vascular Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Ziheng Wu
- Department of Vascular Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yangyan He
- Department of Vascular Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Lu Tian
- Department of Vascular Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Qianqian Zhu
- Department of Vascular Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Tao Shang
- Department of Vascular Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Hongkun Zhang
- Department of Vascular Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Donglin Li
- Department of Vascular Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Yu H, Jia Z. Superior mesenteric artery remodeling in patients with superior mesenteric artery dissections takes time to occur. J Vasc Surg 2021; 74:682. [PMID: 34303483 DOI: 10.1016/j.jvs.2021.01.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/27/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Haiyang Yu
- Department of Interventional Radiology, Changzhou No. 2 People's Hospital, Changzhou, China
| | - Zhongzhi Jia
- Department of Interventional Radiology, Changzhou No. 2 People's Hospital, Changzhou, China
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