Options for treatment of spontaneous mesenteric artery dissection

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, wit...

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Bibliographic Details
Published in:Journal of vascular surgery 2014-05, Vol.59 (5), p.1433-1439.e2
Main Author: Garrett, H. Edward, MD
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Algorithms
Aneurysm, Dissecting - diagnosis
Aneurysm, Dissecting - drug therapy
Aneurysm, Dissecting - surgery
Aneurysm, Dissecting - therapy
Cardiovascular Agents - adverse effects
Cardiovascular Agents - therapeutic use
Critical Pathways
Endovascular Procedures - adverse effects
Female
Humans
Male
Mesenteric Arteries - diagnostic imaging
Mesenteric Arteries - drug effects
Mesenteric Arteries - surgery
Middle Aged
Patient Selection
Surgery
Tomography, X-Ray Computed
Treatment Outcome
Vascular Surgical Procedures - adverse effects
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Summary: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.
ISSN:0741-5214
1097-6809
DOI:10.1016/j.jvs.2014.01.040