Medical therapy and intervention do not improve uncomplicated isolated mesenteric artery dissection outcomes over observation alone

Jacob W. Loeffler, Hideaki Obara, Naoki Fujimura, Paul Bove, Daniel H. Newton, Sara L. Zettervall, Andre S. van Petersen, Robert H. Geelkerken, Kristofer M. Charlton-Ouw, Sherene Shalhub, Niten Singh, Arnaud Roussel, Natalia O. Glebova, Michael P. Harlander-Locke, Warren J. Gasper, Misty D. Humphries, Peter F. Lawrence

Research output: Contribution to journalArticle

6 Citations (Scopus)

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.

Original languageEnglish
JournalJournal of Vascular Surgery
DOIs
Publication statusAccepted/In press - 2016 Nov 28

Fingerprint

Mesenteric Arteries
Dissection
Observation
Therapeutics
Celiac Artery
Thrombosis
Ischemia
Superior Mesenteric Artery

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Medical therapy and intervention do not improve uncomplicated isolated mesenteric artery dissection outcomes over observation alone. / Loeffler, Jacob W.; Obara, Hideaki; Fujimura, Naoki; Bove, Paul; Newton, Daniel H.; Zettervall, Sara L.; van Petersen, Andre S.; Geelkerken, Robert H.; Charlton-Ouw, Kristofer M.; Shalhub, Sherene; Singh, Niten; Roussel, Arnaud; Glebova, Natalia O.; Harlander-Locke, Michael P.; Gasper, Warren J.; Humphries, Misty D.; Lawrence, Peter F.

In: Journal of Vascular Surgery, 28.11.2016.

Research output: Contribution to journalArticle

Loeffler, JW, Obara, H, Fujimura, N, Bove, P, Newton, DH, Zettervall, SL, van Petersen, AS, Geelkerken, RH, Charlton-Ouw, KM, Shalhub, S, Singh, N, Roussel, A, Glebova, NO, Harlander-Locke, MP, Gasper, WJ, Humphries, MD & Lawrence, PF 2016, 'Medical therapy and intervention do not improve uncomplicated isolated mesenteric artery dissection outcomes over observation alone', Journal of Vascular Surgery. https://doi.org/10.1016/j.jvs.2017.01.059
Loeffler, Jacob W. ; Obara, Hideaki ; Fujimura, Naoki ; Bove, Paul ; Newton, Daniel H. ; Zettervall, Sara L. ; van Petersen, Andre S. ; Geelkerken, Robert H. ; Charlton-Ouw, Kristofer M. ; Shalhub, Sherene ; Singh, Niten ; Roussel, Arnaud ; Glebova, Natalia O. ; Harlander-Locke, Michael P. ; Gasper, Warren J. ; Humphries, Misty D. ; Lawrence, Peter F. / Medical therapy and intervention do not improve uncomplicated isolated mesenteric artery dissection outcomes over observation alone. In: Journal of Vascular Surgery. 2016.
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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.",
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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.

PY - 2016/11/28

Y1 - 2016/11/28

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.

AB - 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.

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