Management Strategies for Isolated Mesenteric Artery Dissections
Summary
Spontaneous isolated dissection of a mesenteric artery—most commonly the superior mesenteric artery—arises when a tear in the arterial intima creates a false lumen that may compromise intestinal perfusion. Advances in cross-sectional imaging, particularly computed tomography angiography, have led to increased detection of both symptomatic and incidental dissections. Management strategies span a spectrum from strict medical observation to endovascular stenting and open surgery. In haemodynamically stable patients without signs of bowel ischaemia, initial conservative measures include blood pressure control, antiplatelet or anticoagulant therapy and serial imaging. Endovascular repair has emerged as a minimally invasive alternative when pain persists or radiological monitoring shows adverse morphological features, such as aneurysmal dilation or progressive stenosis of the true lumen. Open surgical reconstruction or bypass remains reserved for those who develop peritonitis, frank intestinal infarction or fail less invasive interventions. Worldwide, a tailored approach that balances clinical presentation, anatomical risk factors and resource availability underpins optimal outcomes and minimises the risk of long-term complications.
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Management Strategies for Isolated Mesenteric Artery Dissections publication trend
The graph below shows the total number of articles in management strategies for isolated mesenteric artery dissections across all publications each year (not limited to Nature Index journals).
Technical terms
Conservative management: Non-operative approach involving blood pressure control, antiplatelet or anticoagulant therapy and clinical and imaging surveillance.
Endovascular stenting: Minimally invasive placement of an intravascular stent to restore true-lumen patency and seal the false lumen.
False lumen: A secondary channel within the arterial wall created by dissection, which may compress the true lumen and impair blood flow.
Computed tomography angiography (CTA): Cross-sectional imaging technique that visualises arterial lumina and wall integrity, essential for diagnosing and monitoring dissections.
Arterial remodelling: Structural changes post-treatment characterised by true‐lumen enlargement and organised thrombosis of the false lumen.
References
- Comparative analysis of prevalence, evaluation, management, and rehabilitation outcome of spontaneous isolated visceral artery dissection: a systematic review and meta-analysis of 80 reports. International Journal of Surgery (2023).
- Long-term outcomes of conservative treatment and endovascular treatment in patients with symptomatic spontaneous isolated superior mesenteric artery dissection: a single-center experience. BMC Cardiovascular Disorders (2020).
- Comparison of Superior Mesenteric Artery Remodeling and Clinical Outcomes between Conservative or Endovascular Treatment in Spontaneous Isolated Superior Mesenteric Artery Dissection. Journal of Clinical Medicine (2022).
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