Department of Interventional Vascular Surgery, Binzhou Medical University Hospital, Binzhou, PR China.
Key Laboratory of Metabolism and Molecular Medicine, The Ministry of Education, Department of Biochemistry and Molecular Biology, Fudan University Shanghai Medical College, Shanghai, PR China.
Vascular. 2021 Feb;29(1):45-53. doi: 10.1177/1708538120918415. Epub 2020 Jul 1.
The aim of this study was to evaluate the computed tomography follow-up outcomes and radiographic findings of symptomatic isolated mesenteric artery dissection (IMAD) after conservative management.
In this retrospective study, 130 consecutive patients with symptomatic IMAD from three institutions were enrolled from January 2011 to December 2019. The general epidemiological data, clinical manifestations, first-episode symptoms, imaging findings, and treatment strategy selection were analyzed from the medical records.
Among 130 patients diagnosed with symptomatic IMAD, positive remodeling of the SMA was achieved in 75.38% (98/130), and negative remodeling of the SMA was achieved in 24.62% (32/130). In the positive remodeling group, complete remodeling was achieved 39.23% (51/130) (type I 6 patients, type IIa 10 patients, type IIb 35 patients), in which type IIb was the most ( = 0.004). Moreover, of the 32 patients in whom negative remodeling of the SMA was achieved, significant differences were observed between the type IIa with respect to dissecting aneurysm formation ( = 0.04).Of the seven factors analyzed with a logistic regression model identified three factors significantly associated with negative remodeling: length of dissection (Waldχ 13.331; OR 6.945; 95% CI 2.762-10.498; = 0.014), true lumen residual diameter (TLRD) (Waldχ 9.626; OR 7.85; 95% CI 1.892-19.063; = 0.022), and branch involvement (Waldχ2 11.812; OR 7.247; 95% CI 1.245-14.830; = 0.011).
The prognosis of most symptomatic IMAD has a tendency to positive remodeling after conservative management, in which the initial type IIb classification is common. In contrast, risk factors for negative remodeling were type IIa, length of dissection, TLRD, and branch involvement. Patients with these morphological characteristics may not benefit from conservative management.
本研究旨在评估保守治疗后症状性孤立肠系膜动脉夹层（IMAD）的 CT 随访结果和影像学发现。
在这项回顾性研究中，我们从 2011 年 1 月至 2019 年 12 月从三所机构纳入了 130 例症状性 IMAD 连续患者。我们从病历中分析了一般人口统计学数据、临床表现、首发症状、影像学发现和治疗策略选择。
在诊断为症状性 IMAD 的 130 例患者中，75.38%（98/130）实现了 SMA 的正性重塑，24.62%（32/130）实现了 SMA 的负性重塑。在正性重塑组中，完全重塑的比例为 39.23%（51/130）（I 型 6 例，IIa 型 10 例，IIb 型 35 例），其中 IIb 型最常见（ = 0.004）。此外，在 SMA 负性重塑的 32 例患者中，IIa 型与夹层动脉瘤形成之间存在显著差异（ = 0.04）。在 logistic 回归模型分析的七个因素中，有三个因素与负性重塑显著相关：夹层长度（Waldχ 13.331；OR 6.945；95%CI 2.762-10.498； = 0.014）、真腔残余直径（TLRD）（Waldχ 9.626；OR 7.85；95%CI 1.892-19.063； = 0.022）和分支受累（Waldχ2 11.812；OR 7.247；95%CI 1.245-14.830； = 0.011）。
大多数症状性 IMAD 在保守治疗后有向正性重塑的趋势，其中初始 IIb 型分类较为常见。相反，负性重塑的危险因素是 IIa 型、夹层长度、TLRD 和分支受累。具有这些形态特征的患者可能无法从保守治疗中获益。
