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Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Mid-term outcomes of symptomatic isolated superior mesenteric artery dissection with endovascular management
Yingjiang Xu1,2, Xuexin Li3, Dan Shang4
1Department of Interventional Vascular Surgery, Binzhou Medical University Hospital, Binzhou, PR China.
Insights
Endovascular management for symptomatic isolated superior mesenteric artery dissection (ISMAD) shows high technical success and symptom control. Early intervention is recommended for persistent pain or disease progression.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Gastroenterology
Background:
- Symptomatic isolated superior mesenteric artery dissection (ISMAD) is a rare condition requiring effective treatment.
- Endovascular management offers a minimally invasive approach for vascular pathologies.
Purpose of the Study:
- To evaluate the clinical outcomes, safety, and efficacy of endovascular management for symptomatic ISMAD.
- To compare endovascular treatment as a first-line versus second-line therapy.
Main Methods:
- Retrospective analysis of 51 consecutive patients with symptomatic ISMAD undergoing endovascular management.
- Patients were divided into Group A (first-line therapy) and Group B (second-line therapy).
- Data collected included demographics, clinical presentation, treatment details, imaging, and follow-up outcomes.
Main Results:
- High technical success rate of 90.2% (46/51) for endovascular procedures.
- Significant differences observed in symptom duration, intestinal ischemia rates, and dissection length between groups.
- Positive outcomes (SMA events) achieved in 81.25% of patients during a median 36.51-month follow-up.
Conclusions:
- Endovascular management is technically successful and effective in controlling symptoms of symptomatic ISMAD.
- Early consideration of endovascular intervention is advised for persistent pain or signs of disease progression after conservative treatment.
Objectives:
The clinical outcomes, safety, and efficacy of endovascular management are explored for symptomatic isolated superior mesenteric artery dissection (ISMAD).
Methods:
In this retrospective study, 51 consecutive patients with symptomatic ISMAD received endovascular management from three institutions between January 2011 and December 2019.These patients were categorized into group A (endovascular treatment was used as the first-line therapy) and group B(endovascular treatment was used as the second-line therapy). The general epidemiological data, clinical manifestations, first-episode symptoms, treatment process, imaging findings, follow-up outcomes were analyzed from the medical records.
Results:
A total of 51 patients with endovascular management were collected in this study. Significant differences were observed between the two groups with respect to the course (150 h vs. 57 h; p < 0.001), intestinal ischemia (26.32% vs. 6,25%; p = 0.04) and dissection length (45.26 ± 13.78 mm vs. 63.37 ± 12.73 mm; p < 0.001). Technical success rate was 90.2% (46/51). There was significant difference in the MOD (42.27 ± 23.41 min vs. 76.63 ± 28.62 min p < 0.001), MPSRT (4.67 ± 2.65 h vs. 7.32 ± 2.49 h, p = 0.02), LOS (9.52 ± 3.72 days vs. 11.86 ± 4.13 days; p = 0.01) between the two groups. The bleeding complication rate was 7.84% (one patient in group A and three patients in group B). A total of 48 (94.12%, 48/51) patients were followed up for a median of 36.51 months (range, 4-87 months). Positive events of the SMA were achieved in 81.25% (39/48), and negative events of the SMA were achieved in 18.75% (8/48) based on the follow-up contrast-enhanced CT scan.
Conclusions:
Endovascular management of symptomatic ISMAD has a high technical success rate and efficient at controlling symptoms. Furthermore, as more positive events occur, endovascular management should be encouraged early when pain persists after conservative management or there are signs of disease progression.
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