Factors Associated with Failed Conservative Management in Symptomatic Isolated Mesenteric Artery Dissection

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Gastroenterology

Background:

• Symptomatic isolated mesenteric artery dissection (IMAD) is a rare condition.
• Conservative management is often the initial treatment approach for IMAD.
• Identifying factors predicting conservative management failure is crucial for optimizing patient outcomes.

Purpose of the Study:

• To evaluate factors associated with the failure of conservative management in patients with symptomatic isolated mesenteric artery dissection.
• To identify predictors of treatment failure in this patient cohort.

Main Methods:

• Retrospective study of 123 patients with symptomatic isolated mesenteric artery dissection treated with conservative therapy.
• Conservative management failure defined by persistent/aggravated symptoms, aneurysmal dilation, or new dissecting aneurysm.
• Univariable and multivariable analyses to identify risk factors for failure.

Main Results:

• Conservative management succeeded in 72.4% of patients, with symptom resolution within 3.8 days.
• Failure occurred in 27.6% of patients, all successfully treated with endovascular stenting.
• Type II IMADs (Sakamoto classification) and ≥90% luminal stenosis were significant predictors of failure (OR 33.76 and 40.70, respectively).

Conclusions:

• Conservative management is a successful initial treatment for the majority of symptomatic isolated mesenteric artery dissection patients.
• Type II IMADs and high-grade luminal stenosis (≥90%) are significant risk factors for conservative treatment failure.
• These findings aid in selecting appropriate treatment strategies for IMAD.