Clinical ResearchManagement Strategy Based on Disease Stages for Patients with Symptomatic Isolated Mesenteric Artery Dissection
Introduction
Symptomatic isolated mesenteric artery dissection (IMAD) is an uncommon type of acute abdomen caused by vascular lesions.1 Recently, its identification has been increasing annually with the advancement of imaging technology.2
In clinical settings, the initial manifestation of symptomatic IMAD is usually acute abdominal pain, which can endanger lives when intestinal necrosis occurs. In addition, a few asymptomatic cases can be detected as incidental findings during examinations for other complaints. Currently, various treatment strategies have been reported,3 including conservative management and invasive therapy4 (endovascular interventions and surgical procedures). However, no recommendation can be given with regard to the optimal treatment.5
This study retrospectively analyzed the clinical data of symptomatic IMAD patients to propose a new management strategy based on IMAD clinical stages.
Section snippets
Study Population
This retrospective study was approved by all participating institutional review boards with a waiver of informed consent. From January 2011 to December 2018, 120 consecutive patients diagnosed with symptomatic IMAD from two institutions were included in the study. The clinical information pertaining to each patient was collected from their medical records, predominantly consisting of general epidemiological data, clinical manifestations, comorbidities, symptoms, imaging findings, and the
Patients
Overall, one hundred twenty patients diagnosed with symptomatic IMAD were collected from January 2011 to December 2018 in this study. These patients were categorized into a conservative management group (group A) and an invasive therapy group (group B). Of these 120 patients with symptomatic IMAD, 77 patients (69 men, 8 women; median age, 52.53 years; range, 39–73 years) were included in group A; these patients had undergone successful conservative management. The remaining 43 patients (34 men,
Discussions
Acute and chronic arterial ischemia of symptomatic IMAD has been mentioned in the European Society for Vascular Surgery (ESVS) guidelines.18 However, the clinical stages of symptomatic IMAD have not been clearly defined. In our study cohort, it was found that abdominal pain disappeared in most patients with conservative management after 7.57 days of admission, and the imaging morphology gradually became stable after discharge. During this period, if persistent symptoms did not improve,
Conclusions
Conservative treatment with antithrombotic agents should be a first-line regimen for symptomatic IMAD in the acute stage. Close clinical observation is necessary, and when there is a suspicion of bowel ischemia, endovascular intervention is a safe and feasible treatment in the subacute or chronic stage. When peritonitis is present, surgical treatment should be promptly performed regardless of the stage.
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Management of Spontaneous Isolated Mesenteric Artery Dissection: A Systematic Review
2021, Scandinavian Journal of Surgery
Y.J.X. and J.W.W. contributed equally to this work.
This research did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors.
The authors have no conflict of interest to declare.
Ethics approval was provided by the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology ethics committee.