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Systematic review and meta-analysis of current evidence in spontaneous isolated celiac and superior mesenteric artery dissection.
J Vasc Surg. 2018 10; 68(4):1228-1240.e9.JV

Abstract

OBJECTIVE

Spontaneous isolated celiac artery dissection (SICAD) and spontaneous isolated superior mesenteric artery dissection (SISMAD) represent the major types of spontaneous visceral artery dissection. However, no quantitative meta-analysis of SICAD and SISMAD is available. The aim of our study was to pool current evidence concerning basic profiles, treatment strategies, long-term adverse events, and morphologic changes of lesioned vessels in SICAD and SISMAD patients.

METHODS

We searched the MEDLINE, Embase, Scopus, and Cochrane Databases (January 1, 1946-September 21, 2017) for studies of SICAD and SISMAD. Related cohort studies or case series with sample size larger than 10 were included. Two reviewers independently extracted and summarized the data. A random-effects model was used to calculate pooled estimates.

RESULTS

In total, 43 studies were included. An estimated 8% (95% confidence interval [CI], 0.01-0.21) symptomatic SICAD and 12% (95% CI, 0.06-0.19) symptomatic SISMAD patients with initial conservative management required secondary intervention during follow-up, whereas none of the asymptomatic patients treated conservatively required secondary intervention. As for morphologic changes during follow-up, a higher proportion of SICAD patients (64%; 95% CI, 0.47-0.80) achieved complete remodeling compared with SISMAD patients (25%; 95% CI, 0.19-0.32), and an estimated 6% (95% CI, 0.00-0.16) of SICAD and 12% (95% CI, 0.05-0.20) of SISMAD patients had morphologic progression. Overall, the pooled estimate of long-term all-cause mortality was 0% (95% CI, 0.00-0.03) in SICAD and 1% (95% CI, 0.00-0.02) in SISMAD. When stratified by symptoms, symptomatic patients were associated with a significantly increased probability of accomplishing complete remodeling (odds ratio, 3.95; 95% CI, 1.31-11.85) compared with asymptomatic patients.

CONCLUSIONS

Initial conservative treatment is safe for asymptomatic SICAD or SISMAD patients. Symptomatic patients managed conservatively have relatively high occurrence of late secondary intervention, which may require closer surveillance, especially in SISMAD because of a lower rate of remodeling.

Authors+Show Affiliations

West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China; Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China.West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China; Institute of Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh, United Kingdom.Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China.Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China. Electronic address: docyuanding@gmail.com.Department of Biostatistics, School of Public Health, Yale University, New Haven, Conn; Department of Statistics, West China School of Public Health, Sichuan University, Chengdu, China.Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China.Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China.Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China.Department of Statistics, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.

Pub Type(s)

Journal Article
Meta-Analysis
Review

Language

eng

PubMed ID

30126785

Citation

Wang, Jiarong, et al. "Systematic Review and Meta-analysis of Current Evidence in Spontaneous Isolated Celiac and Superior Mesenteric Artery Dissection." Journal of Vascular Surgery, vol. 68, no. 4, 2018, pp. 1228-1240.e9.
Wang J, He Y, Zhao J, et al. Systematic review and meta-analysis of current evidence in spontaneous isolated celiac and superior mesenteric artery dissection. J Vasc Surg. 2018;68(4):1228-1240.e9.
Wang, J., He, Y., Zhao, J., Yuan, D., Xu, H., Ma, Y., Huang, B., Yang, Y., Bian, H., & Wang, Z. (2018). Systematic review and meta-analysis of current evidence in spontaneous isolated celiac and superior mesenteric artery dissection. Journal of Vascular Surgery, 68(4), 1228-e9. https://doi.org/10.1016/j.jvs.2018.05.014
Wang J, et al. Systematic Review and Meta-analysis of Current Evidence in Spontaneous Isolated Celiac and Superior Mesenteric Artery Dissection. J Vasc Surg. 2018;68(4):1228-1240.e9. PubMed PMID: 30126785.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Systematic review and meta-analysis of current evidence in spontaneous isolated celiac and superior mesenteric artery dissection. AU - Wang,Jiarong, AU - He,Yazhou, AU - Zhao,Jichun, AU - Yuan,Ding, AU - Xu,Hao, AU - Ma,Yukui, AU - Huang,Bin, AU - Yang,Yi, AU - Bian,He, AU - Wang,Ziqiang, Y1 - 2018/08/17/ PY - 2018/01/03/received PY - 2018/05/10/accepted PY - 2018/8/22/pubmed PY - 2018/12/12/medline PY - 2018/8/22/entrez KW - Long-term adverse effects KW - Remodeling KW - Spontaneous isolated celiac artery dissection KW - Spontaneous isolated superior mesenteric artery dissection SP - 1228 EP - 1240.e9 JF - Journal of vascular surgery JO - J. Vasc. Surg. VL - 68 IS - 4 N2 - OBJECTIVE: Spontaneous isolated celiac artery dissection (SICAD) and spontaneous isolated superior mesenteric artery dissection (SISMAD) represent the major types of spontaneous visceral artery dissection. However, no quantitative meta-analysis of SICAD and SISMAD is available. The aim of our study was to pool current evidence concerning basic profiles, treatment strategies, long-term adverse events, and morphologic changes of lesioned vessels in SICAD and SISMAD patients. METHODS: We searched the MEDLINE, Embase, Scopus, and Cochrane Databases (January 1, 1946-September 21, 2017) for studies of SICAD and SISMAD. Related cohort studies or case series with sample size larger than 10 were included. Two reviewers independently extracted and summarized the data. A random-effects model was used to calculate pooled estimates. RESULTS: In total, 43 studies were included. An estimated 8% (95% confidence interval [CI], 0.01-0.21) symptomatic SICAD and 12% (95% CI, 0.06-0.19) symptomatic SISMAD patients with initial conservative management required secondary intervention during follow-up, whereas none of the asymptomatic patients treated conservatively required secondary intervention. As for morphologic changes during follow-up, a higher proportion of SICAD patients (64%; 95% CI, 0.47-0.80) achieved complete remodeling compared with SISMAD patients (25%; 95% CI, 0.19-0.32), and an estimated 6% (95% CI, 0.00-0.16) of SICAD and 12% (95% CI, 0.05-0.20) of SISMAD patients had morphologic progression. Overall, the pooled estimate of long-term all-cause mortality was 0% (95% CI, 0.00-0.03) in SICAD and 1% (95% CI, 0.00-0.02) in SISMAD. When stratified by symptoms, symptomatic patients were associated with a significantly increased probability of accomplishing complete remodeling (odds ratio, 3.95; 95% CI, 1.31-11.85) compared with asymptomatic patients. CONCLUSIONS: Initial conservative treatment is safe for asymptomatic SICAD or SISMAD patients. Symptomatic patients managed conservatively have relatively high occurrence of late secondary intervention, which may require closer surveillance, especially in SISMAD because of a lower rate of remodeling. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/30126785/Systematic_review_and_meta_analysis_of_current_evidence_in_spontaneous_isolated_celiac_and_superior_mesenteric_artery_dissection_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(18)31078-4 DB - PRIME DP - Unbound Medicine ER -