Tags

Type your tag names separated by a space and hit enter

Medical therapy and intervention do not improve uncomplicated isolated mesenteric artery dissection outcomes over observation alone.
J Vasc Surg 2017; 66(1):202-208JV

Abstract

OBJECTIVE

Isolated dissection of the mesenteric vessels is rare but increasingly recognized. This study aimed to evaluate patient characteristics, primary treatment, and subsequent outcomes of mesenteric dissection using multi-institutional data.

METHODS

All patients at participant hospitals between January 2003 and December 2015 with dissection of the celiac artery (or its branches) or dissection of the superior mesenteric artery (SMA) were included. Patients with an aortic dissection were excluded. Demographic, treatment, and follow-up data were collected. The primary outcomes included late vessel thrombosis (LVT) and aneurysmal degeneration (AD).

RESULTS

Twelve institutions identified 227 patients (220 with complete treatment records) with a mean age of 55 ± 12.5 years. Median time to last follow up was 15 months (interquartile range, 3.8-32). Most patients were men (82% vs 18% women) and symptomatic at presentation (162 vs 65 asymptomatic). Isolated SMA dissection was more common than celiac artery dissection (n = 158 and 81, respectively). Concomitant dissection of both arteries was rare (n = 12). The mean dissection length was significantly longer in symptomatic patients than in asymptomatic patients in both the celiac artery (27 vs 18 mm; P = .01) and the SMA (64 vs 40 mm; P < .001). Primary treatment was medical in 146 patients with oral anticoagulation or antiplatelet therapy (n = 76 and 70, respectively), whereas 56 patients were observed. LVT occurred in six patients, and 16 patients developed AD (3% and 8%, respectively). For symptomatic patients without evidence of ischemia (n = 134), there was no difference in occurrence of LVT with medical therapy compared with observation alone (9% vs 0%; P = .35). No asymptomatic patient (n = 64) had an episode of LVT at 5 years. AD rates did not differ among symptomatic patients without ischemia treated with medical therapy or observed (9% vs 5%; P = .95). Surgical or endovascular intervention was performed in 18 patients (3 ischemia, 13 pain, 1 AD, 1 asymptomatic). Excluding the patients treated for ischemia, there was no difference in LVT with surgical intervention vs medical management (one vs five; P = .57).

CONCLUSIONS

Asymptomatic patients with isolated mesenteric artery dissection may be observed and followed up with intermittent imaging. Symptomatic patients tend to have longer dissections than asymptomatic patients. Symptomatic isolated mesenteric artery dissection without evidence of ischemia does not require anticoagulation and may be treated with antiplatelet therapy or observation alone.

Authors+Show Affiliations

Division of Vascular Surgery, Department of Surgery, University of California, Davis, Sacramento, Calif. Electronic address: jloeffler@ucdavis.edu.Division of Vascular Surgery, Keio University School of Medicine, Tokyo, Japan.Division of Vascular Surgery, Keio University School of Medicine, Tokyo, Japan.Department of Vascular Surgery, Beaumont Hospital, Royal Oak, Mich.Department of Surgery, Virginia Commonwealth University, Richmond, Va.Beth Israel Deaconess Medical Center, Boston, Mass.Department of Surgery, Bernhoven Hospital, Uden, The Netherlands.Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands.Department of Cardiothoracic and Vascular Surgery, University of Texas Health Center, Houston, Tex.Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash.Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash.Department of Vascular and Thoracic Surgery, Hôpital Bichat, Paris, France.Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Colorado, Denver, Colo.Department of Vascular Surgery, University of California, Los Angeles, Calif.Division of Vascular and Endovascular Surgery, University of California, San Francisco, Calif.Division of Vascular Surgery, Department of Surgery, University of California, Davis, Sacramento, Calif.Department of Vascular Surgery, University of California, Los Angeles, Calif.

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study

Language

eng

PubMed ID

28506477

Citation

Loeffler, Jacob W., et al. "Medical Therapy and Intervention Do Not Improve Uncomplicated Isolated Mesenteric Artery Dissection Outcomes Over Observation Alone." Journal of Vascular Surgery, vol. 66, no. 1, 2017, pp. 202-208.
Loeffler JW, Obara H, Fujimura N, et al. Medical therapy and intervention do not improve uncomplicated isolated mesenteric artery dissection outcomes over observation alone. J Vasc Surg. 2017;66(1):202-208.
Loeffler, J. W., Obara, H., Fujimura, N., Bove, P., Newton, D. H., Zettervall, S. L., ... Lawrence, P. F. (2017). Medical therapy and intervention do not improve uncomplicated isolated mesenteric artery dissection outcomes over observation alone. Journal of Vascular Surgery, 66(1), pp. 202-208. doi:10.1016/j.jvs.2017.01.059.
Loeffler JW, et al. Medical Therapy and Intervention Do Not Improve Uncomplicated Isolated Mesenteric Artery Dissection Outcomes Over Observation Alone. J Vasc Surg. 2017;66(1):202-208. PubMed PMID: 28506477.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Medical therapy and intervention do not improve uncomplicated isolated mesenteric artery dissection outcomes over observation alone. AU - Loeffler,Jacob W, AU - Obara,Hideaki, AU - Fujimura,Naoki, AU - Bove,Paul, AU - Newton,Daniel H, AU - Zettervall,Sara L, AU - van Petersen,Andre S, AU - Geelkerken,Robert H, AU - Charlton-Ouw,Kristofer M, AU - Shalhub,Sherene, AU - Singh,Niten, AU - Roussel,Arnaud, AU - Glebova,Natalia O, AU - Harlander-Locke,Michael P, AU - Gasper,Warren J, AU - Humphries,Misty D, AU - Lawrence,Peter F, Y1 - 2017/05/12/ PY - 2016/11/28/received PY - 2017/01/31/accepted PY - 2017/5/17/pubmed PY - 2017/7/14/medline PY - 2017/5/17/entrez SP - 202 EP - 208 JF - Journal of vascular surgery JO - J. Vasc. Surg. VL - 66 IS - 1 N2 - OBJECTIVE: Isolated dissection of the mesenteric vessels is rare but increasingly recognized. This study aimed to evaluate patient characteristics, primary treatment, and subsequent outcomes of mesenteric dissection using multi-institutional data. METHODS: All patients at participant hospitals between January 2003 and December 2015 with dissection of the celiac artery (or its branches) or dissection of the superior mesenteric artery (SMA) were included. Patients with an aortic dissection were excluded. Demographic, treatment, and follow-up data were collected. The primary outcomes included late vessel thrombosis (LVT) and aneurysmal degeneration (AD). RESULTS: Twelve institutions identified 227 patients (220 with complete treatment records) with a mean age of 55 ± 12.5 years. Median time to last follow up was 15 months (interquartile range, 3.8-32). Most patients were men (82% vs 18% women) and symptomatic at presentation (162 vs 65 asymptomatic). Isolated SMA dissection was more common than celiac artery dissection (n = 158 and 81, respectively). Concomitant dissection of both arteries was rare (n = 12). The mean dissection length was significantly longer in symptomatic patients than in asymptomatic patients in both the celiac artery (27 vs 18 mm; P = .01) and the SMA (64 vs 40 mm; P < .001). Primary treatment was medical in 146 patients with oral anticoagulation or antiplatelet therapy (n = 76 and 70, respectively), whereas 56 patients were observed. LVT occurred in six patients, and 16 patients developed AD (3% and 8%, respectively). For symptomatic patients without evidence of ischemia (n = 134), there was no difference in occurrence of LVT with medical therapy compared with observation alone (9% vs 0%; P = .35). No asymptomatic patient (n = 64) had an episode of LVT at 5 years. AD rates did not differ among symptomatic patients without ischemia treated with medical therapy or observed (9% vs 5%; P = .95). Surgical or endovascular intervention was performed in 18 patients (3 ischemia, 13 pain, 1 AD, 1 asymptomatic). Excluding the patients treated for ischemia, there was no difference in LVT with surgical intervention vs medical management (one vs five; P = .57). CONCLUSIONS: Asymptomatic patients with isolated mesenteric artery dissection may be observed and followed up with intermittent imaging. Symptomatic patients tend to have longer dissections than asymptomatic patients. Symptomatic isolated mesenteric artery dissection without evidence of ischemia does not require anticoagulation and may be treated with antiplatelet therapy or observation alone. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/28506477/Medical_therapy_and_intervention_do_not_improve_uncomplicated_isolated_mesenteric_artery_dissection_outcomes_over_observation_alone_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(17)30370-1 DB - PRIME DP - Unbound Medicine ER -