Accurate diagnosis and treatment of isolated mesenteric artery dissections

Objectives The aim of this study was to evaluate the clinical features and management strategy for patients with symptomatic spontaneous isolated celiac artery dissection (SICAD). Methods In this retrospective study, consecutive patients with symptomatic SICAD from two institutions were included. The demographics, clinical manifestations, comorbidities, imaging findings and treatment strategy selection were obtained from the medical records. The general epidemiological data, treatment regimens and clinical and follow-up outcomes were analysed. Results Patients were divided into the conservative treatment group (group A, n = 26) and endovascular treatment group (group B, n = 11). Of these 37 patients, extent of dissection in both groups included only celiac trunk (61.54%% vs. 18.18%, p = 0.03), common hepatic artery (CHA) and splenic artery (SA) (3.85%% vs. 54.55%, p = 0.001), CHA (7.69% vs. 18.18%, p = 0.57), SA (23.08% vs. 9.09, p = 0.65) and left gastric artery (LGA) (3.85% vs. 54.55%, p = 0.99). Of note, the extension of the lesion in group A was shorter than that in group B. In addition, there were significantly more type IIb in group A than in group B (42.31% vs. 9.09%, p = 0.06) and the mean length of dissection in group A was 42.3 ± 54.71 mm which was significantly shorter than that in the group B 58.45 ± 3.71 mm ( p =0.04). During a median follow-up of 11.5 months, the 1, 3, 6 and 12 month follow-ups were completed in 100% (37/37), 100% (37/37), 94.59% (35/37) and 91.19% (34/37) of patients, respectively. The cumulative rate of persistent disease stability in patients with endovascular treatment group was higher than in that conservative treatment group at the 3, 6, 9 and 12 months (50% vs. 16.67%, p = 0.001; 80% vs. 37.5%, p =0.03; 100% vs. 62.5%, p = 0.012;100% vs. 91.67%, p = 0.02 respectively). Conclusion Most symptomatic SICAD have a tendency to persistent disease stability after conservative treatment. Risk factors for failed conservative treatment were length of dissection and branch involvement. Furthermore, endovascular treatment was associated with a high technical success and persistent disease stability rate, which might be reserved for patients with failed conservative treatment.

“…Clinicians should have a strong understanding of the relevant anatomy, as well as clinical presentations of SICAD will aid in making this rare diagnosis. 18…”

Section: Discussionmentioning

confidence: 99%

Clinical features and management strategy of symptomatic spontaneous isolated celiac artery dissection

Gao

Xie²,

Shang

et al. 2021

“…Occasionally, it manifests itself with atypical clinical symptoms or is completely non-symptomatic, making it easy to overlook and misdiagnose in a significant proportion of patients. Therefore, raising awareness of SICAD in participants is critical to avoid misdiagnosis 1 . Abdominal pain was the most prevalent symptom, occurring in 83.54% of symptomatic cases, particularly epigastric discomfort.…”

Section: Discussionmentioning

confidence: 99%

“…It is characterized by the lesions in the celiac artery (CA) that do not involve the aorta, resulting in an unpredictable natural history. 1 Tanaka Y, et al documented only 72 cases of SICAD between 1964 and 2011. 2 SICAD and spontaneous isolated superior mesenteric artery dissection (SISMAD) have recently been linked in a significant number of studies since both vascular diseases have similar symptoms and outcomes.…”

Section: Introductionmentioning

confidence: 99%

Current status of spontaneous isolated celiac artery dissection

Han

et al. 2022

Self Cite

Background This study aimed to evaluate the current status of spontaneous isolated celiac artery dissection (SICAD). Methods The English-language literature published in various databases before December 2020 was reviewed. All case reports and series were included. If multiple reports came from the same hospital and covered the same period, only the most recent report was considered. The clinical characteristics, imaging features, and treatment outcome were analyzed. Results The study enrolled 88 English language publications between January 1959 and December 2020, including 70 case reports, two case series, and 16 clinical studies. Overall, 316 cases of SICAD were reported in the studies, including 268 men and 44 women (unavailable for 4, men: women ratio: 6:1, p < 0.05). The median age was 50.5 years (range: 6–72) in men and 53.9 years (range: 41–67) in women. Most patients (83.54%, 264/316) complained about stomach pain, primarily in the epigastric region (38.61%, 122/316). The misdiagnosis rate in this study was 3.16% (10/316). The most commonly used imaging modality was computed tomography angiography (CTA), with 97.47% (308/316) cases reporting its use in diagnosis and/or management. The rate of symptom improvement with Conservative Management, with or without antithrombotic agents, was 92.45% (98/106) and 96.58% (141/146), respectively. The rate of symptom improvement after surgical recanalization was 100% (13/13). Moreover, endovascular management resulted in a 100% (50/50) symptom improvement rate. Conclusion Conservative management is the first-line treatment for SICAD. The surgical or endovascular intervention had a high technical success rate, suggesting that it should be reserved for patients who have failed conservative treatment.

“…In these patients, endovascular management was used as the first-line for 19 patients (Group A).Of these patients, stent placement was performed in 10 patients including two cases of covered stents; stenting combined with coiling was performed in 6 patients(Figure 2); coils embolotherapy was performed in 2 patients; and endovascular thrombolysis was performed in 1 patient. 10 Thirty-two patients with endovascular management as second-line treatment (Group B), stent implantation was performed in 19 patients (Figure 3); stenting combined with coiling was performed in 7 patients; coils embolotherapy was performed in 4 patients (Figure 4); and endovascular thrombolysis was performed in 2 patients.…”

Section: Methodsmentioning

confidence: 99%

Mid-term outcomes of symptomatic isolated superior mesenteric artery dissection with endovascular management

Shang

et al. 2020

Self Cite

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.