Skip to main content

Advertisement

SpringerLink
Log in

Systematic review and meta-analysis of current evidence in endograft therapy for spontaneous isolated superior mesenteric artery dissection

  • Review Article
  • Published:
Updates in Surgery Aims and scope Submit manuscript

Abstract

The role of endovascular stent therapy (EST) in the treatment of spontaneous isolated superior mesenteric artery dissection (SISMAD) has gained momentum in recent years but remains controversial. We gathered research examining the advantages and disadvantages of EST for SISMAD patients. Primary outcomes involved both immediate and long-term results. Random or fixed effect models were used for effect size (ES) calculation with 95% confidence interval (CI) based on 50% heterogeneity threshold. Our analysis incorporated data from 21 studies including 611 SISMAD cases treated by EST. Our findings show a complication rate of approximately 1% following EST (95%CI 0.01–0.02, I2 = 0%, P = 0.97), with a bare minimum mortality rate of < 1% (95%CI 0.00–0.01, I2 = 0%, P > 0.05) and a reintervention rate of < 1% (95%CI 0.00–0.01, I2 = 0%, P = 0.89). We also found technique success and symptom resolution approaching 94% and 99%, respectively, in the immediate postoperative phase. In the long run, we observed a recurrence of symptoms at 3% (95%CI 0.00–0.06, I2 = 58.6%, P < 0.01), creation of new dissections at 1% (95%CI 0.00–0.02, I2 = 0%, P = 0.73), aneurysm progression at 2% (95%CI 0.00–0.03, I2 = 42.7%, P = 0.12), reintervention due to complications at 3% (95%CI 0.00–0.05, I2 = 0%, P = 0.43) and stenotic stents at 12% (95%CI 0.04–0.23, I2 = 77.5%, P < 0.01). Nevertheless, high levels of stent patency 98% (95% CI 0.97–1.00, I2 = 0%, P = 0.51) and complete remodeling 88% (95% CI 0.82–0.94, I2 = 65.5%, P < 0.05) were observed postoperatively. Overall, EST presents minimal complications and promising long-term outcomes for SISMAD, although the prevalence of stent stenosis requires further attention.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Bjorck M, Koelemay M, Acosta S et al (2017) Editor’s choiced 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 53:460–510

    Article  CAS  PubMed  Google Scholar 

  2. Luan JY, Guan X, Li X et al (2016) Isolated superior mesenteric artery dissection in China. J Vasc Surg 63:530–536

    Article  PubMed  Google Scholar 

  3. Heo SH, Kim YW, Woo SY et al (2017) Treatment strategy based on the natural course for patients with spontaneous isolated superior mesenteric artery dissection. J Vasc Surg 65:1142–1151

    Article  PubMed  Google Scholar 

  4. Kimura Y, Kato T, Inoko M (2018) Outcomes of treatment strategies for isolated spontaneous dissection of the superior mesenteric artery: a systematic review. Ann Vasc Surg 47:284–290

    Article  PubMed  Google Scholar 

  5. Garrett HE Jr (2014) Options for treatment of spontaneous mesenteric artery dissection. J Vasc Surg 59:1433–1439

    Article  PubMed  Google Scholar 

  6. Ben Abdallah I, Huguet A, Nuzzo A et al (2022) Acute isolated mesenteric artery dissection: four year experience from a french intestinal stroke centre. Eur J Vasc Endovasc Surg 64:656–664

    Article  PubMed  Google Scholar 

  7. Morgan CE, Mansukhani NA, Eskandari MK, Rodriguez HE (2018) Ten-year review of isolated spontaneous mesenteric arterial dissections. J Vasc Surg 67:1134–1142

    Article  PubMed  Google Scholar 

  8. Min SI, Yoon KC, Min SK et al (2011) Current strategy for the treatment of symptomatic spontaneous isolated dissection of superior mesenteric artery. J Vasc Surg 54:461–466

    Article  PubMed  Google Scholar 

  9. Wen D, Wang Z, Yu J et al (2018) Endovascular stent-graft repair of spontaneous isolated dissection of the superior mesenteric artery. Cardiovasc Intervent Radiol 41:692–698

    Article  PubMed  Google Scholar 

  10. Jia Z, Su H, Chen W et al (2019) Endovascular treatment of patients with isolated mesenteric artery dissection aneurysm: bare stents alone versus stent assisted coiling. Eur J Vasc Endovasc Surg 57:400–406

    Article  PubMed  Google Scholar 

  11. Gobble RM, Brill ER, Rockman CB et al (2009) Endovascular treatment of spontaneous dissections of the superior mesenteric artery. J Vasc Surg 50:1326–1332

    Article  PubMed  Google Scholar 

  12. Luan JY, Li X (2014) CT classification and endovascular management of isolated dissection of the superior mesenteric artery with anatomical variations. Eur J Vasc Endovasc Surg 47:209

    Article  CAS  PubMed  Google Scholar 

  13. Cavalcante RN, Motta-Leal-Filho JM, De Fina B et al (2016) Systematic literature review on evaluation and management of isolated spontaneous celiac trunk dissection. Ann Vasc Surg 34:274–279

    Article  PubMed  Google Scholar 

  14. Kimura Y, Kato T, Nagao K et al (2017) Outcomes and radiographic findings of isolated spontaneous superior mesenteric artery dissection. Eur J Vasc Endovasc Surg 53:276–281

    Article  CAS  PubMed  Google Scholar 

  15. Moher D, Liberati A, Tetzlaff J et al (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8:336–341

    Article  PubMed  Google Scholar 

  16. Munn Z, Barker TH, Moola S et al (2020) Methodological quality of case series studies: an introduction to the JBI critical appraisal tool. JBI Evid Synth 18:2127–2133

    PubMed  Google Scholar 

  17. Ioannidis JP (2008) Interpretation of tests of heterogeneity and bias in meta-analysis. J Eval Clin Pract 14:951–957

    Article  PubMed  Google Scholar 

  18. Higgins JP, Thompson SG, Deeks JJ et al (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  PubMed  PubMed Central  Google Scholar 

  19. Pang P, Jiang Z, Huang M et al (2013) Value of endovascular stent placement for symptomatic spontaneous isolated superior mesenteric artery dissection. Eur J Radiol 82:490–496

    Article  PubMed  Google Scholar 

  20. Lv PH, Zhang XC, Wang LF et al (2014) Management of isolated superior mesenteric artery dissection. World J Gastroenterol 20:17179–17184

    Article  PubMed  PubMed Central  Google Scholar 

  21. Li N, Lu QS, Zhou J et al (2014) Endovascular stent placement for treatment of spontaneous isolated dissection of the superior mesenteric artery. Ann Vasc Surg 28:445–451

    Article  PubMed  Google Scholar 

  22. Li DL, He YY, Alkalei AM et al (2014) Management strategy for spontaneous isolated dissection of the superior mesenteric artery based on morphologic classification. J Vasc Surg 59:165–172

    Article  CAS  PubMed  Google Scholar 

  23. Kim J, Yoon CJ, Seong N et al (2017) Spontaneous dissection of superior mesenteric artery: long-term outcome of stent placement. J Vasc Interv Radiol 28:1722–1726

    Article  PubMed  Google Scholar 

  24. Qiu C, He Y, Li D et al (2019) Mid-term results of endovascular treatment for spontaneous isolated dissection of the superior mesenteric artery. Eur J Vasc Endovasc Surg 58:88–95

    Article  PubMed  Google Scholar 

  25. Hang C, Chen W, Su H et al (2019) Distal edge stenosis after stent placement for isolated superior mesenteric artery dissection: mechanisms and risk factor analysis. Cardiovasc Intervent Radiol 42:1095–1101

    Article  PubMed  Google Scholar 

  26. Ou J, Hu H, Wu Z et al (2019) A modified endovascular technique for treating spontaneous isolated superior mesenteric artery dissection and the early to medium-term outcomes. Heliyon 5:e01354

    Article  PubMed  PubMed Central  Google Scholar 

  27. Fu YF, Cao C, Shi YB (2020) Endovascular bare stenting for isolated superior mesenteric artery dissection. Vasc Endovascular Surg 54:12–16

    Article  PubMed  Google Scholar 

  28. Yan W, Huang R, Shi Q et al (2019) Multidetector computed tomography in the diagnosis of spontaneous isolated superior mesenteric artery dissection: changes in diameter on nonenhanced scan and stent treatment follow-up. J Int Med Res 47:6139–6148

    Article  PubMed  PubMed Central  Google Scholar 

  29. Xu Y, Li X, Shang D et al (2021) Mid-term outcomes of symptomatic isolated superior mesenteric artery dissection with endovascular management. Vascular 29:301–310

    Article  CAS  PubMed  Google Scholar 

  30. Shi Y, Ni G, Zhao B et al (2020) Management of symptomatic spontaneous isolated superior mesenteric artery dissection: a single centre experience with mid term follow up. Eur J Vasc Endovasc Surg 60:863–871

    Article  PubMed  Google Scholar 

  31. Xu L, Shao J, Zhang D et al (2020) Long-term outcomes of conservative treatment and endovascular treatment in patients with symptomatic spontaneous isolated superior mesenteric artery dissection: a single-center experience. BMC Cardiovasc Disord 29(20):256

    Article  Google Scholar 

  32. Gao P, Li G, Chen J et al (2021) The impact of endovascular treatment on clinical outcomes of stable symptomatic patients with spontaneous superior mesenteric artery dissection. J Vasc Surg 73:1269–1276

    Article  PubMed  Google Scholar 

  33. Sun J, Wang L, Que Y et al (2022) Management of patients with uncomplicated symptomatic isolated mesenteric artery dissection: a multicentre experience. Eur J Vasc Endovasc Surg 64:507–514

    Article  PubMed  Google Scholar 

  34. Yu SH, Hii IH, Wu IH (2022) Comparison of superior mesenteric artery remodeling and clinical outcomes between conservative or endovascular treatment in spontaneous isolated superior mesenteric artery dissection. J Clin Med 11:465

    Article  PubMed  PubMed Central  Google Scholar 

  35. Qi X, Tang B, Zhang H et al (2023) Midterm results of the conservative, bare stent, and bare stent-assisted coiling treatments for symptomatic isolated superior mesenteric artery dissection. Ann Vasc Surg 96:232–240

    Article  PubMed  Google Scholar 

  36. Ye M, Zhou Q, Wu J, Zhang Z, Li B, Zheng T, Shao G (2023) Conservative versus endovascular treatment for spontaneous isolated superior mesenteric artery dissection: a clinical and imaging follow-up study. J Endovasc Ther. https://doi.org/10.1177/15266028231163733

    Article  PubMed  Google Scholar 

  37. Ji J, Xie Y, Bai Z et al (2023) Placement of bare self-expanding metal stent for isolated superior mesenteric artery dissection. Ann Vasc Surg 96:223–231

    Article  PubMed  Google Scholar 

  38. Lian LS, Wu ZY, Zhang Z et al (2023) Five-year results of spontaneous isolated superior mesenteric artery dissection from two teaching hospitals in China. Ann Vasc Surg 92:42–48

    Article  PubMed  Google Scholar 

  39. Sakamoto I, Ogawa Y, Sueyoshi E et al (2007) Imaging appearances and management of isolated spontaneous dissection of the superior mesenteric artery. Eur J Radiol 64(1):103e10

    Article  Google Scholar 

  40. Wang J, He Y, Zhao J et al (2018) Systematic review and meta-analysis of current evidence in spontaneous isolated celiac and superior mesenteric artery dissection. J Vasc Surg 68(4):1228–1240

    Article  PubMed  Google Scholar 

  41. Zhu Y, Peng Y, Xu M et al (2018) Treatment strategies and outcomes of symptomatic spontaneous isolated superior mesenteric artery dissection: a systematic review and meta-analysis. J Endovasc Ther 25:640–648

    Article  PubMed  Google Scholar 

  42. Karaolanis G, Antonopoulos C, Tsilimigras DI et al (2019) Spontaneous isolated superior mesenteric artery dissection: systematic review and meta-analysis. Vascular 27:324–337

    Article  PubMed  Google Scholar 

  43. Ahmad F, Turner SA, Torrie P et al (2008) Iatrogenic femoral artery pseudoaneurysms–a review of current methods of diagnosis and treatment. Clin Radiol 63:1310–1316

    Article  CAS  PubMed  Google Scholar 

  44. Koreny M, Riedmuller E, Mikfardjam M et al (2004) Arterial puncture closing devices compared with standard manual compression after cardiac catheterization: systematic review and meta-analysis. JAMA 291:350–357

    Article  CAS  PubMed  Google Scholar 

  45. Park YJ, Park KB, Kim DI et al (2011) Natural history of spontaneous isolated superior mesenteric artery dissection derived from follow-up after conservative treatment. J Vasc Surg 54:1727–1733

    Article  PubMed  Google Scholar 

  46. Tomita K, Obara H, Sekimoto Y et al (2016) Evolution of computed tomographic characteristics of spontaneous isolated superior mesenteric artery dissection during conservative management. Circ J 80:1452–1459

    Article  PubMed  Google Scholar 

Download references

Funding

The study was supported by a special fund for research expense of Zhejiang University (Code: 226-2022-00093 and School code: K20220023).

Author information

Authors and Affiliations

  1. Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang, University’s Medical School, Hangzhou, 310051, Zhejiang, China

    Jian Wang & Zhengjie Liu

  2. Department of General Surgery, The Second Affiliated Hospital of Zhejiang, University’s Medical School, Hangzhou, 310051, Zhejiang, China

    Fengming Luan

  3. Department of Cardiovascular Surgery, The Second Affiliated Hospital of Zhejiang, University’s Medical School, Hangzhou, 310051, Zhejiang, China

    Zhixuan Bai

Authors
  1. Jian Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fengming Luan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhixuan Bai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zhengjie Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zhengjie Liu.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest.

Research involving human participants and/or animals

This article does not involve any studies with animals. The present study is a systematic review of medical data, which was in accordance with the ethical standards of our institution and the ethical principles by the Helsinki Declaration.

Informed consent

Formal consent was not required for this type of study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 22 KB)

13304_2024_1821_MOESM2_ESM.tif

Supplementary file2 Supplementary Fig.1 Sensitivity analysis of syndrome relief during the perioperative period (TIF 8571 KB)

Supplementary file3 Supplementary Fig.2 Sensitivity analysis of dissection remodeling in the long run (TIF 8432 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, J., Luan, F., Bai, Z. et al. Systematic review and meta-analysis of current evidence in endograft therapy for spontaneous isolated superior mesenteric artery dissection. Updates Surg (2024). https://doi.org/10.1007/s13304-024-01821-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s13304-024-01821-7

Keywords

Search

Navigation