Options for treatment of spontaneous mesenteric artery dissection

Abstract

Objective: Mesenteric artery dissection was once thought to be rare but has been identified more frequently with increasing use of computerized tomographic angiographic imaging. Multiple reports advocate a wide range of treatment including medical therapy, endovascular, and surgical intervention, with no clear guidelines for the application of each treatment.

Methods: A systematic review of the literature was analyzed and used to create a treatment algorithm that was applied to nine patients in our institution.

Results: Although medical therapy is adequate for most patients with mesenteric artery dissection, 14% failed medical therapy, sometimes with severe consequences. Asymptomatic status on presentation predicted successful medical therapy for superior mesenteric artery dissection (P = .0037).

Conclusions: Intensive surveillance is indicated during medical therapy, and invasive intervention may be necessary.