Management of Spontaneous Isolated Mesenteric Artery Dissection: A Systematic Review

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 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.

Celiac artery dissection in polycystic kidney disease

“…We made a diagnosis of spontaneous isolated celiac artery dissection (SICAD), and conservative medical therapy was conducted with blood pressure control by continuation of the administration of telmisartan and tolvaptan. Potential complications of celiac artery dissection such as ruptured pseudoaneurysm and splenic infarction were not detected in the present case 1 . CECT performed 4 days after the development of SICAD showed no progression of the disease.…”

“…Autosomal‐dominant polycystic kidney disease is associated with cardiovascular abnormalities such as intracranial aneurysms; however, complication of celiac artery dissection has been rarely reported. The risk factors for isolated mesenteric artery (superior mesenteric artery or celiac artery) dissection are male gender, hypertension, and smoking, though the present patient had been a non‐smoker 1 . ADPKD patients are reported to have a 5.49‐fold greater risk of aortic aneurysm and dissection than that in non‐ADPKD counterparts, 2 whereas the prevalence of celiac artery dissection in ADPKD patients remains unknown because of its rarity.…”

Isolated Superior Mesenteric Artery Dissection: An Unusual Etiology of Epigastric Pain

“…Although our patient was not hypertensive, he had some known risk factors for SMA dissection. Risk factors include male gender, hypertension, smoking, SMA-distal aorta angle, and Asian ethnicity [9,10]. CT angiography of the abdomen is the imaging of choice to diagnose SMA dissection.…”

Diagnosis of spontaneous isolated superior mesenteric artery dissection with ultrasound: A case report

“…Our patient had intermittent pain in the upper abdomen without any specific positive signs. Currently, conservative treatment, endovascular surgery, interventional radiology, and open surgery are therapeutic modalities for patients with SISMAD, but there are no clear recommendations for the treatment of SISMAD[ 15 , 16 , 19 , 20 ]. According to current guidelines, SISMAD treatment strategies are designed to control clinical symptoms and prevent complications such as intestinal necrosis.…”