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

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Gastroenterology

Background:

• Spontaneous isolated superior mesenteric artery dissection (SISMAD) is a rare vascular condition with an incidence of 0.06%.
• Understanding the optimal management strategies for SISMAD is crucial for patient outcomes.

Purpose of the Study:

• To conduct a meta-analysis identifying outcomes associated with various treatment options for SISMAD.
• To compare conservative, endovascular, and open repair strategies in both asymptomatic and symptomatic SISMAD patients.

Main Methods:

• A systematic literature search was performed across PubMed, EMBASE, and Cochrane Library.
• Endpoints included outcomes of conservative treatment, symptom resolution rates by treatment modality, conversion rates from conservative to interventional treatment, lesion characteristics, and arterial remodeling.

Main Results:

• The meta-analysis included 30 studies with 729 patients; 83.4% were symptomatic.
• Conservative management yielded a high symptom resolution rate (92.8%) with a low pooled rate of bowel ischemia (3.75%).
• Conversion to endovascular or open repair was required in 12.3% and 4.4% of cases, respectively, with high resolution rates for both (88.8% endovascular, 100% open).

Conclusions:

• Conservative treatment is effective for the majority of symptomatic SISMAD patients, often leading to an uncomplicated course.
• A small percentage of patients may require conversion to endovascular or open repair, indicating the generally benign nature of SISMAD.