Wang Bing, Pan Jun, Xu Yiting, Qiu Xuxian, Ding Zhenwei, Li Donlin, Zhang Hongkun, Qiu Chenyang, Wu Ziheng
Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79# Qingchun Rd, Hangzhou, 310003, China.
Department of Vascular Nursing, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Cardiovasc Intervent Radiol. 2025 May;48(5):593-602. doi: 10.1007/s00270-025-03985-0. Epub 2025 Feb 26.
Isolated superior mesenteric artery dissection (IMAD) is increasing in prevalence. Both endovascular and medical treatments are frequently used, but based on studies with relatively small sample sizes and limited follow-up. This article aims to compare the long-term outcomes of medical treatment versus endovascular treatment for isolated superior mesenteric artery dissection.
Patients who were treated for IMAD at our institution between June 2009 and March 2019 were retrospectively investigated. The primary outcomes were freedom from adverse events and the complete remodeling rate. Propensity score matching (PSM) was used to align baseline data, ensuring comparability between the two groups.
The study cohort comprises 226 patients with IMAD. The mean follow-up duration was 74.9 ± 28.3 months. One hundred and ninety-one patients (84.5%) received endovascular treatment, and 35 (15.5%) were treated medically. The freedom from adverse event rate was 91.8% in the endovascular group and 79.6% in the medical group at 60 months (p < 0.05) and 87.6% and 74.6%, at 120 months (p < 0.05). The complete remodeling rate was 69.3% in the endovascular group and 29.0% in the medical group (p < 0.01) at 60 months and 70.8% and 37.8%, respectively, at 120 months (p < 0.01). After propensity score matching, the freedom from adverse event rate was 91.9% versus 85.6% (p < 0.05) at 60 months and 87.8% versus 78.6% (p < 0.05) at 120 months. The complete remodeling rate was 69.8% versus 43.0% (p < 0.01) at 60 months and 71.2% in the endovascular group versus 43.0%.
The freedom from adverse event and complete remodeling rates were higher in patients with IMAD who received endovascular treatment than in those who were treated medically during long-term follow-up.
Level 3, non-randomized controlled cohort/follow-up study.
孤立性肠系膜上动脉夹层（IMAD）的患病率正在上升。血管内治疗和药物治疗都经常被使用，但基于样本量相对较小且随访有限的研究。本文旨在比较孤立性肠系膜上动脉夹层的药物治疗与血管内治疗的长期疗效。
对2009年6月至2019年3月在我院接受IMAD治疗的患者进行回顾性研究。主要结局指标为无不良事件发生和完全重塑率。采用倾向评分匹配（PSM）来调整基线数据，确保两组之间具有可比性。
研究队列包括226例IMAD患者。平均随访时间为74.9±28.3个月。191例（84.5%）患者接受了血管内治疗，35例（15.5%）接受了药物治疗。血管内治疗组60个月时无不良事件发生率为91.8%，药物治疗组为79.6%（p<0.05）；120个月时分别为87.6%和74.6%（p<0.05）。血管内治疗组60个月时完全重塑率为69.3%，药物治疗组为29.0%（p<0.01）；120个月时分别为70.8%和37.8%（p<0.01）。倾向评分匹配后，60个月时无不良事件发生率分别为91.9%和85.6%（p<0.05），120个月时分别为87.8%和78.6%（p<0.05）。血管内治疗组60个月时完全重塑率为69.8%，药物治疗组为43.0%（p<0.01）；120个月时血管内治疗组为71.2%，药物治疗组为43.0%。
在长期随访中，接受血管内治疗的IMAD患者的无不良事件发生率和完全重塑率高于接受药物治疗的患者。
3级，非随机对照队列/随访研究。
