Departments of Rehabilitation and Treatment.
Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Sciences, Wangjing Hospital.
Int J Surg. 2023 Mar 1;109(3):469-480. doi: 10.1097/JS9.0000000000000301.
Because of relatively little data for management and evaluation surrounding spontaneous isolated visceral artery dissection (IVAD), existing studies have failed to provide comprehensive analysis for the management, evaluation, prevalence, as well as natural course of the disease. Therefore, we collected and analyzed current evidence on spontaneous IVAD with the aim of providing quantitative pooled data for the natural course and treatment standardization of the disease.
A systematic search of PubMed, Embase, the Cochrane Library, and Web of Science up to 1 June 2022, was conducted for relevant studies that investigating the natural course, treatment, classification, and outcomes of IVAD. The primary outcomes were to determine the difference in prevalence, risk factors, and characteristics between different spontaneous IVAD. Two reviewers assessed the trial quality and extracted the data independently. All statistical analyses were performed using the standard statistical procedures provided in Review Manager 5.2 and Stata 12.0.
A total of 80 reports with 1040 patients were identified. The pooled results indicated that in IVAD, isolated superior mesenteric artery dissection (ISMAD) was more prevalent, with a pooled prevalence of 60% (95% CI: 50-71%), followed by isolated celiac artery dissection (ICAD) (prevalence: 37%; 95% CI: 27-46%). IVAD was male predominated with a pooled proportion of 80% (95% CI: 72-89%). Similar results were found in ICAD (prevalence: 73%; 95% CI: 52-93%). More IVAD patients were diagnosed with symptoms than ICAD (64 vs. 59%). Regarding to the risk factors, this pooled analysis found smoking and hypertension were the top two conditions in both spontaneous IVAD and ICAD patients, with proportion of 43, 41, 44, and 32%, respectively. It was observed that ICAD appeared shorter dissection length (mean difference: -3.4 cm; 95% CI: -4.9 to -2.0; P <0.0001), higher prevalence of Sakamoto's classification Π (odds ratio: 5.31; 95% CI: 1.77-15.95; P= 0.003) and late progression (odds ratio: 2.84; 95% CI: 1.02-7.87; P= 0.05) than ISAMD.
Spontaneous IVAD was male predominant and ISMAD was most prevalent followed by ICAD. Smoking and hypertension were the top two conditions in both spontaneous IVAD and ICAD patients. The majority of patients diagnosed with IVAD received observation and conservative treatment and experienced a low proportion of reintervention or progression, especially for ICAD patients. In addition, ICAD and ISMAD had several differences in clinical features and dissection characteristics. Future studies with enough sample size and long follow-up are required to clear the management, long-term outcome, and risk factors of the IVAD prognosis.
由于自发性孤立内脏动脉夹层（IVAD）的管理和评估数据相对较少，现有的研究未能对该疾病的管理、评估、患病率以及自然病程进行全面分析。因此，我们收集并分析了目前关于自发性 IVAD 的证据，旨在为该疾病的自然病程和治疗标准化提供定量汇总数据。
系统检索了PubMed、Embase、Cochrane 图书馆和 Web of Science 截至 2022 年 6 月 1 日的相关研究，这些研究调查了 IVAD 的自然病程、治疗、分类和结局。主要结局是确定不同自发性 IVAD 之间的患病率、危险因素和特征的差异。两位评审员独立评估试验质量并提取数据。所有统计分析均使用 Review Manager 5.2 和 Stata 12.0 提供的标准统计程序进行。
共确定了 80 份报告，涉及 1040 名患者。汇总结果表明，在 IVAD 中，孤立性肠系膜上动脉夹层（ISMAD）更为常见，其患病率为 60%（95%CI：50-71%），其次是孤立性腹腔动脉夹层（ICAD）（患病率：37%；95%CI：27-46%）。IVAD 以男性为主，占 80%（95%CI：72-89%）。在 ICAD 中也发现了类似的结果（患病率：73%；95%CI：52-93%）。与 ICAD 相比，更多的 IVAD 患者出现症状（64% vs. 59%）。关于危险因素，这项汇总分析发现，吸烟和高血压是自发性 IVAD 和 ICAD 患者中排名前两位的情况，分别占 43%、41%、44%和 32%。观察到 ICAD 的夹层长度更短（平均差异：-3.4cm；95%CI：-4.9 至-2.0；P<0.0001），更常见 Sakamoto 分类Π（优势比：5.31；95%CI：1.77-15.95；P=0.003）和晚期进展（优势比：2.84；95%CI：1.02-7.87；P=0.05），而 ISAMD 则不然。
自发性 IVAD 以男性为主，ISMAD 最为常见，其次是 ICAD。吸烟和高血压是自发性 IVAD 和 ICAD 患者中排名前两位的情况。大多数被诊断为 IVAD 的患者接受了观察和保守治疗，并且再干预或进展的比例较低，尤其是 ICAD 患者。此外，ICAD 和 ISMAD 在临床特征和夹层特征方面存在一些差异。未来需要进行足够样本量和长期随访的研究，以明确 IVAD 预后的管理、长期结局和危险因素。
