Outcomes of Treatment Strategies for Isolated Spontaneous Superior Mesenteric Artery Dissection: A Systematic Review - A Systematic Review of Isolated SMA dissection

OBJECTIVES: Isolated spontaneous dissection of the superior mesenteric artery (SMA) without aortic dissection is being increasingly recognized. This study aimed to evaluate the latest clinical characteristics and optimal treatment. METHODS: We searched the Cochrane Library, MEDLINE, and Clinical Trial.gov databases through December 31, 2016, using the following words: "superior mesenteric artery" and "dissection." We retrieved articles presenting the treatment and outcomes of isolated SMA dissection published in English. We investigated the patient characteristics, treatments, follow-up, and prognoses. Additionally, we compared mortality rates and assessed the need for additional interventions between treatment strategies in symptomatic patients without accompanying proof of bowel ischaemia or aneurysm, which require immediate endovascular treatment or surgery. RESULTS: We identified 51 articles with 721 patients. The initial treatments in symptomatic patients without accompanying proof of bowel ischaemia or aneurysm were conservative treatment (82.1%), endovascular treatment (14.3%), catheter-directed infusion of medication (2.1%), and surgery (1.5%). Additional treatment was needed in 18.1% of patients receiving conservative treatment and 2.4% of patients receiving endovascular treatment (P = 0.0003). Mortality was not significantly different between each treatment strategy (P = 0.92). CONCLUSIONS: There was no significant difference in mortality of symptomatic SMA dissection patients without accompanying proof of bowel ischaemia or aneurysm between interventional treatment and conservative treatment. An additional treatment is needed in a minority of patients receiving conservative treatment, however, more frequently than in those receiving endovascular treatment.