Int J Surg. 2023 Mar 14. doi: 10.1097/JS9.0000000000000301. Online ahead of print.
BACKGROUND: Because of relatively little data for management and evaluation surrounding spontaneous isolated visceral artery dissection (IVAD), existing studies 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 aiming to provide quantitative pooled data for the natural course and treatment standardization of the disease.
METHODS: A systematic search of PubMed, Embase, Cochrane Library and Web of Science up to June 1, 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 of prevalence, risk factors and characteristics in different spontaneous IVAD. Two reviewers assessed 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.
RESULTS: 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 result was 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, our pooled analysis found smoking and hypertension were the top two conditions in both spontaneous IVAD and ICAD patients, with proportion of 43%, 41% and 44%, 32% respectively. It was observed that ICAD appeared shorter dissection length (MD -3.4 cm; 95% CI: -4.9, -2.0; P<0.0001), higher prevalence of Sakamoto’s classification Π (OR 5.31; 95% CI: 1.77 ‒ 15.95; P=0.003) and late progression (OR 2.84; 95% CI: 1.02 ‒ 7.87; P=0.05) than ISAMD.
CONCLUSIONS: 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 low proportion of re-intervention 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 IVAD prognosis.
PMID:36912770 | DOI:10.1097/JS9.0000000000000301