Endovascular Stent-Graft Repair of Spontaneous Isolated Dissection of the Superior Mesenteric Artery

Wen, Didi; Wang, Zhankui; Yu, Jing; Zhang, Wenlong; Yang, Xiaobin; He, Hua; Zhang, Xuexin; Ying, Lin; An, Rui; Zheng, Ming‐Hua; Xu, Jian

doi:10.1007/s00270-018-1889-0

Cited by 24 publications

(23 citation statements)

References 20 publications

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“…We read with great interest the recent article by Wen et al [1]. The authors reported 12 consecutive patients who received endovascular treatment with a covered stent and declared that endovascular treatment should be performed in patients with a spontaneous dissection of the superior mesenteric artery (SMA) patients who are symptomatic, without aneurysms rupture or bowel necrosis.…”

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confidence: 78%

Regarding “Endovascular Stent-Graft Repair of Spontaneous Isolated Dissection of the Superior Mesenteric Artery”

Jia

2018

Cardiovasc Intervent Radiol

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confidence: 78%

Regarding “Endovascular Stent-Graft Repair of Spontaneous Isolated Dissection of the Superior Mesenteric Artery”

Jia

2018

Cardiovasc Intervent Radiol

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“…6 Covered stents can be used to seal the entry point and dissecting aneurysm; bare stents cannot be used for this purpose. 14,15 However, covered stents are not usually recommended for patients with IMAD because these stents can cause the obliteration of multiple side branches of the mesenteric artery, which may worsen intestinal ischaemia or even lead to intestinal necrosis. 7,16 This obliteration of the side branches does not occur with the use of bare stents alone or stent assisted coiling, and so these techniques are widely used in the management of IMAD.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of Patients with Isolated Mesenteric Artery Dissection Aneurysm: Bare Stents Alone Versus Stent Assisted Coiling

Jia

Chen

et al. 2019

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS Endovascular stenting has been used successfully in the management of symptomatic isolated mesenteric artery dissection (IMAD) aneurysms. However, no study has compared the use of bare stents alone versus stent assisted coiling in IMAD aneurysms. The results of this study indicate that bare stents alone and stent assisted coiling have high technical success rates and demonstrate good mid-term patency in patients with IMAD aneurysms. Bare stents alone may serve as an alternative to stent assisted coiling for the management of IMAD aneurysms. Objective: The aim was to evaluate the outcomes of endovascular treatment with bare stents alone versus stent assisted coiling in isolated mesenteric artery dissection (IMAD) aneurysms. Methods: Patients with an IMAD aneurysm who underwent endovascular stenting between February 2010 and February 2017 at one of three institutions were included in this study. Data regarding technical success, procedure time, symptom resolution, complications, changes in IMAD aneurysm, and stent patency were recorded. Results: A total of 38 patients (35 men) were included, 27 treated with bare stents alone and 11 treated with stent assisted coiling. Technical success was achieved in 100% of patients treated with bare stents and in 81.8% of those treated with stent assisted coiling (p ¼ 0.078). The mean procedure times were 62.6 AE 5.3 min for treatment with bare stents and 116.4 AE 8.4 min for stent assisted coiling (p < 0.001). A total of 23 patients had persistent symptoms before stenting; all symptoms were resolved within 3.0 AE 0.7 days. No procedure related major complications occurred. Over 30.2 AE 18.1 months of follow up, complete resolution of the IMAD aneurysm was achieved in all patients; good stent patency and in stent re-stenosis were achieved in 65.8% and 34.2% patients, respectively. There were no occlusions of the stented arteries. Conclusions: Bare stents alone and stent assisted coiling have high technical success rates and demonstrate good intermediate patency in patients with an IMAD aneurysm. Bare stents alone may serve as an alternative to stent assisted coiling for the management of IMAD aneurysm

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“…(6,24,28) Long-term complications included stent stenosis, stent occlusion, stent thrombosis. (6,7,24) Endothelial injury, neointimal hyperplasia, and chronic inflammation could be the causes. (29,30) However, the incidence was relatively low and only 2.1% of the endovascularly treated patients had a secondary intervention.…”

Section: Discussionmentioning

confidence: 99%

Long-term Outcomes of Conservative Treatment and Endovascular Treatment in Patients with Symptomatic Spontaneous Isolated Superior Mesenteric Artery Dissection: A Single-center Experience

Qiu

Wang

et al. 2019

Preprint

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Background: Spontaneous isolated superior mesenteric artery dissection (SISMAD) is a rare vascular disorder and the treatment strategies remain controversial. This study aimed to compare outcomes of conservative and endovascular treatments in symptomatic patients with SISMAD. Methods: Forty-two consecutive SISMAD patients between October 2009 and May 2018 in a single center were enrolled in the study. Based on their symptoms, 15 had conservative treatment and 27 had endovascular treatment. The baseline characteristics, treatments, and follow-up results of the conservative group and endovascular group were analyzed. Results: The rate of symptom relief was 93.3% in the conservative group and 96.3% in the endovascular group, respectively. The procedure-related complications in the endovascular group included one case of pseudoaneurysm formation in the left brachial artery. During the follow-up period (median 28.5 months), a higher proportion of patients in the conservative group had symptom recurrence (42.9% in the conservative group versus 4.8% in the endovascular group, p < 0.001). Four patients in the conservative group and one patient in the endovascular group had additional endovascular intervention during follow-up. Compared with the conservative group, patients in the endovascular group had statistically significantly longer symptom-free survival ( p = 0.014) and a higher rate of superior mesenteric artery (SMA) remodeling ( p < 0.001). Conclusions: For symptomatic SISMAD, endovascularly treated patients had a lower rate of symptom recurrence and a higher rate of SMA remodeling in the long term. Endovascular treatment should be considered as the first-line treatment of SISMAD.

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Endovascular Stent-Graft Repair of Spontaneous Isolated Dissection of the Superior Mesenteric Artery

Abstract: For symptomatic spontaneous isolated dissection of SMA in patients without aneurysms rupture and bowel necrosis, endovascular treatment with covered stents may be a safe and effective treatment option with a good short-term outcome.

Cited by 24 publications

References 20 publications

Regarding “Endovascular Stent-Graft Repair of Spontaneous Isolated Dissection of the Superior Mesenteric Artery”

Regarding “Endovascular Stent-Graft Repair of Spontaneous Isolated Dissection of the Superior Mesenteric Artery”

Endovascular Treatment of Patients with Isolated Mesenteric Artery Dissection Aneurysm: Bare Stents Alone Versus Stent Assisted Coiling

Long-term Outcomes of Conservative Treatment and Endovascular Treatment in Patients with Symptomatic Spontaneous Isolated Superior Mesenteric Artery Dissection: A Single-center Experience

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