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. 2022 Oct;47(10):3628-3637.
doi: 10.1007/s00261-022-03622-1. Epub 2022 Aug 1.

Correlation of Riolan's arch diameter to treatment choice in patients with isolated superior mesenteric artery dissection

Yang Peng #  1 , Ruixi Li #  1 , Guanglei Tang  1 , Ke Wang  1 , Mengya Sun  1 , Jian Guan  2
Affiliations

Correlation of Riolan's arch diameter to treatment choice in patients with isolated superior mesenteric artery dissection

Yang Peng et al. Abdom Radiol (NY). 2022 Oct.

Abstract

Objective: To investigate the diameter changes of Riolan's arch in patients with isolated superior mesenteric artery dissection (ISMAD) and to evaluate the implication for treatment selection.

Methods: Ninety-five patients with CT angiography (CTA) confirmed ISMAD were retrospectively included, and another 95 cases with no positive findings on abdominal CTA were included as controls. According to the treatment methods, the patients were subsequently divided into conservative treatment (n = 68) or invasive treatment (n = 27) subgroups. According to the initial CTA images, the prevalence of Riolan's arch as well as its diameter (DR) were determined in each subject, and compared between ISMAD and control cases, as well as between patients with different treatments. In patients with ISMAD, dissections were classified according to the Li classification.

Results: Riolan's arch prevalence and DR were significantly elevated in the ISMAD group compared with the control group (83.16% vs. 35.79%, P < 0.001; 2.63 ± 0.56 mm vs. 2.12 ± 0.39 mm, P < 0.001). Patients with invasive treatment had significantly higher baseline DR (2.93 ± 0.57 mm vs. 1.89 ± 1.14 mm, P < 0.001), and higher proportion of high-risk dissection (P < 0.001) than those administered conservative treatment. Binary logistic regression revealed DR (OR = 2.771, 95% CI 1.157-6.638, P = 0.022) and Li classification (OR = 0.107, 95% CI 0.019-0.586, P = 0.010) were independent risk factors for treatment selection. With cutoff of 2.635 mm, the area under the curve, sensitivity, and specificity were 0.805, 0.778 and 0.794, respectively.

Conclusion: Dilation of Riolan's arch is common in patients with ISMAD, and Riolan's arch diameter could be a convenient indicator of disease severity and inform subsequent treatment.

Keywords: Clinical decision-making; Collateral circulation; Computed tomography angiography; Dissection; Mesenteric artery; Superior.

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References

    1. Cho YP, Ko GY, Kim HK, Moon KM, Kwon TW. Conservative management of symptomatic spontaneous isolated dissection of the superior mesenteric artery. Br J Surg. 2009; 96(7):720-3. - DOI
    1. Bjorck M, Koelemay M, Acosta S, et al. Editor's Choice - Management of the Diseases of Mesenteric Arteries and Veins: Clinical Practice Guidelines of the European Society of Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2017; 53(4):460-510. - DOI
    1. Kim H, Labropoulos N. The role of aortomesenteric angle in occurrence of spontaneous isolated superior mesenteric artery dissection. Int Angiol. 2020; 39(2):125-30. - DOI
    1. Jia Z, Chen W, Su H, et al. Factors Associated with Failed Conservative Management in Symptomatic Isolated Mesenteric Artery Dissection. Eur J Vasc Endovasc Surg. 2019; 58(3):393-9. - DOI
    1. Kimura Y, Kato T, Inoko M. Outcomes of Treatment Strategies for Isolated Spontaneous Dissection of the Superior Mesenteric Artery: A Systematic Review. Ann Vasc Surg. 2018; 47:284-90. - DOI

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