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Review
. 2019 May;49(5):400-418.
doi: 10.4070/kcj.2018.0429.

Diagnosis and Management of Isolated Superior Mesenteric Artery Dissection: A Systematic Review and Meta-Analysis

Waqas Ullah  1 , Maryam Mukhtar  2 , Hafez Mohammad Abdullah  3 , Mamoon Ur Rashid  4 , Asrar Ahmad  5 , Abu Hurairah  6 , Usman Sarwar  5 , Vincent M Figueredo  7
Affiliations
Review

Diagnosis and Management of Isolated Superior Mesenteric Artery Dissection: A Systematic Review and Meta-Analysis

Waqas Ullah et al. Korean Circ J. 2019 May.

Abstract

The objective of this study was to analyze the three different management modalities for isolated superior mesenteric artery (SMA) dissection. We did a comprehensive literature search and found 703 articles on the initial search, out of which 111 articles consisting of 145 patients were selected for analysis. The mean age was 55.7 years (standard deviation,9.7;33-85) and 80.6% were male. These patients were managed conservatively (41.3%), endovascularly (28.1%) or surgically (30%). The median follow-up was 10 months (interquartile range [IQR], 4-18 months), 12 months (IQR, 6-19 months) and 14 months (IQR, 6-20 months) respectively. Contrast-enhanced computed tomography (CT) was the most commonly used diagnostic tool in the conservative group (43.8%), while conventional CT scan was the most widely used in endovascular (58.1%) and surgical group (50%). 17% percent of the conservative group had SMA angiography for diagnosis, while this was less than 3% in the other groups. Of these patients, 96.7%, 97.4%, and 100.0% recovered successfully in the conservative, endovascular, and surgical groups respectively. There was no significant difference in the mortality between the three groups (Pearson χ²=0.482). This suggests a conservative and endovascular approach could be used in most patients, which can reduce costs and surgery-related morbidity and mortality. Surgical management should be reserved for cases having infarction or widespread bowel ischemia and in cases where other treatment modalities fail.

Keywords: Arterial dissection; Arteriography Endovascular repair; CT angiography; Spontaneous dissection.

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Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Figure 1
Figure 1. Type I: Patent false lumen; Type II: False lumen without re-entry; Type III: thrombosed false lumen with an ulcer-like projection; Type IV: completely thrombosed false lumen with no ulcer like projection.
Figure 2
Figure 2. Prisma flow sheet showing the search strategy on isolated SMA dissection.
SMA = superior mesenteric artery.
Figure 3
Figure 3. Flow sheet for diagnostic testing for SMA dissection based on symptomatology.
CT = computed tomography; SMA = superior mesenteric artery.
Figure 4
Figure 4. A flow diagram for management approach of isolated SMA dissection.
CT = computed tomography; SMA = superior mesenteric artery.
See this image and copyright information in PMC

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