Management Strategy Based on Disease Stages for Patients with Symptomatic Isolated Mesenteric Artery Dissection

An optimal treatment regimen is sought for symptomatic isolated mesenteric artery dissection (IMAD) on the basis of its clinical staging.

From January 2011 to December 2018, 120 patients with symptomatic IMAD from two institutions were collected retrospectively. We reviewed the clinical features, risk factors, computed tomography (CT) images, treatment modalities, and follow-up results to propose a new management strategy based on the clinical stages of the disease.

A total of 120 patients were collected in this study; 77 patients (69 men, 8 women; median age, 52.53 years; range, 39-73 years) who had undergone successful conservative management with antithrombotic agents were included in group A. The remaining 43 patients (34 men, 9 women; median age, 52.63 years; range, 26-66 years) who underwent invasive therapy were included in group B. Significant differences were observed between the two groups with respect to dissection length (50.72 ± 27.72 mm vs. 62 ± 24.3 mm; P = 0.02), true lumen residual diameter (3.31 ± 1.05 mm vs. 2.83 ± 2.05 mm; P = 0.01), and branch involvement (8 and 19, respectively; P < 0.001). Success was achieved in 76.24% (77/101) of patients treated by conservative management with antithrombotic agents in the acute stage; 43 patients underwent invasive interventional therapy in different stages of symptomatic IMAD. In group A, 6 patients had recurrent abdominal pain, three of whom underwent invasive intervention, and the remaining patients improved after conservative treatment. Positive remodeling was observed in 80.33% (49/61) of patients treated with conservative management alone versus 19.67% (12/61) of patients who experienced negative remodeling. Endovascular intervention in group B, CT angiography, or mesenteric angiography yielded complete remodeling in 23 (76.67%, 23/30) patients and evidence of stent restenosis in 7 (23.33%, 7/30) patients. Among the surgical patients, 7 patients showed improvement in the luminal diameter. However, 3 patients with short bowel syndrome require long-term parenteral nutrition.

Conservative management with antithrombotic agents should be a first-line regimen for symptomatic IMAD in the acute stage. If symptoms persist, endovascular intervention is a safe and feasible treatment in the subacute or chronic stage. When peritonitis is present, surgical treatment should be promptly performed, regardless of the disease stage.