Management of Spontaneous Isolated Mesenteric Artery Dissection : A Systematic Review
Acosta, S. LU
and Gonçalves, F. B.
(2021)
In Scandinavian Journal of Surgery
110(2).
p.130-138
- Abstract
Background and Aims: There are increasing reports on case series on spontaneous isolated mesenteric artery dissection, that is, dissections of the superior mesenteric artery and celiac artery, mainly due to improved diagnostic capacity of high-resolution computed tomography angiography performed around the clock. A few case–control studies are now available, while randomized controlled trials are awaited. Material and Methods: The present systematic review based on 97 original studies offers a comprehensive overview on risk factors, management, conservative therapy, morphological modeling of dissection, and prognosis. Results and Conclusions: Male gender, hypertension, and smoking are risk factors for isolated mesenteric artery... (More)
Background and Aims: There are increasing reports on case series on spontaneous isolated mesenteric artery dissection, that is, dissections of the superior mesenteric artery and celiac artery, mainly due to improved diagnostic capacity of high-resolution computed tomography angiography performed around the clock. A few case–control studies are now available, while randomized controlled trials are awaited. Material and Methods: The present systematic review based on 97 original studies offers a comprehensive overview on risk factors, management, conservative therapy, morphological modeling of dissection, and prognosis. Results and Conclusions: Male gender, hypertension, and smoking are risk factors for isolated mesenteric artery dissection, while the frequency of diabetes mellitus is reported to be low. Large aortomesenteric angle has also been considered to be a factor for superior mesenteric artery dissection. The overwhelming majority of patients can be conservatively treated without the need of endovascular or open operations. Conservative therapy consists of blood pressure lowering therapy, analgesics, and initial bowel rest, whereas there is no support for antithrombotic agents. Complete remodeling of the dissection after conservative therapy was found in 43% at mid-term follow-up. One absolute indication for surgery and endovascular stenting of the superior mesenteric artery is development of peritonitis due to bowel infarction, which occurs in 2.1% of superior mesenteric artery dissections and none in celiac artery dissections. The most documented end-organ infarction in celiac artery dissections is splenic infarctions, which occurs in 11.2%, and is a condition that should be treated conservatively. The frequency of ruptured pseudoaneurysm in the superior mesenteric artery and celiac artery dissection is very rare, 0.4%, and none of these patients were in shock at presentation. Endovascular therapy with covered stents should be considered in these patients.
(Less)
- author
- Acosta, S.
LU
and Gonçalves, F. B.
- organization
- publishing date
- 2021
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Arterial dissection, computed tomography, conservative therapy, mesenteric artery dissection, mesenteric ischemia, pseudoaneurysm
- in
- Scandinavian Journal of Surgery
- volume
- 110
- issue
- 2
- pages
- 130 - 138
- publisher
- Finnish Surgical Society
- external identifiers
-
- scopus:85102583212
- pmid:33724090
- ISSN
- 1457-4969
- DOI
- 10.1177/14574969211000546
- language
- English
- LU publication?
- yes
- id
- 975c14d0-bac1-41a9-8154-3bea962d08a6
- date added to LUP
- 2021-03-26 12:17:44
- date last changed
- 2024-06-29 09:42:30
@article{975c14d0-bac1-41a9-8154-3bea962d08a6,
abstract = {{<p>Background and Aims: There are increasing reports on case series on spontaneous isolated mesenteric artery dissection, that is, dissections of the superior mesenteric artery and celiac artery, mainly due to improved diagnostic capacity of high-resolution computed tomography angiography performed around the clock. A few case–control studies are now available, while randomized controlled trials are awaited. Material and Methods: The present systematic review based on 97 original studies offers a comprehensive overview on risk factors, management, conservative therapy, morphological modeling of dissection, and prognosis. Results and Conclusions: Male gender, hypertension, and smoking are risk factors for isolated mesenteric artery dissection, while the frequency of diabetes mellitus is reported to be low. Large aortomesenteric angle has also been considered to be a factor for superior mesenteric artery dissection. The overwhelming majority of patients can be conservatively treated without the need of endovascular or open operations. Conservative therapy consists of blood pressure lowering therapy, analgesics, and initial bowel rest, whereas there is no support for antithrombotic agents. Complete remodeling of the dissection after conservative therapy was found in 43% at mid-term follow-up. One absolute indication for surgery and endovascular stenting of the superior mesenteric artery is development of peritonitis due to bowel infarction, which occurs in 2.1% of superior mesenteric artery dissections and none in celiac artery dissections. The most documented end-organ infarction in celiac artery dissections is splenic infarctions, which occurs in 11.2%, and is a condition that should be treated conservatively. The frequency of ruptured pseudoaneurysm in the superior mesenteric artery and celiac artery dissection is very rare, 0.4%, and none of these patients were in shock at presentation. Endovascular therapy with covered stents should be considered in these patients.</p>}},
author = {{Acosta, S. and Gonçalves, F. B.}},
issn = {{1457-4969}},
keywords = {{Arterial dissection; computed tomography; conservative therapy; mesenteric artery dissection; mesenteric ischemia; pseudoaneurysm}},
language = {{eng}},
number = {{2}},
pages = {{130--138}},
publisher = {{Finnish Surgical Society}},
series = {{Scandinavian Journal of Surgery}},
title = {{Management of Spontaneous Isolated Mesenteric Artery Dissection : A Systematic Review}},
url = {{http://dx.doi.org/10.1177/14574969211000546}},
doi = {{10.1177/14574969211000546}},
volume = {{110}},
year = {{2021}},
}