Systematic review and meta-analysis of current evidence in endograft therapy for spontaneous isolated superior mesenteric artery dissection

The role of endovascular stent therapy (EST) in the treatment of spontaneous isolated superior mesenteric artery dissection (SISMAD) has gained momentum in recent years but remains controversial. We gathered research examining the advantages and disadvantages of EST for SISMAD patients. Primary outcomes involved both immediate and long-term results. Random or fixed effect models were used for effect size (ES) calculation with 95% confidence interval (CI) based on 50% heterogeneity threshold. Our analysis incorporated data from 21 studies including 611 SISMAD cases treated by EST. Our findings show a complication rate of approximately 1% following EST (95%CI 0.01-0.02, I-2 = 0%, P = 0.97), with a bare minimum mortality rate of < 1% (95%CI 0.00-0.01, I-2 = 0%, P > 0.05) and a reintervention rate of < 1% (95%CI 0.00-0.01, I-2 = 0%, P = 0.89). We also found technique success and symptom resolution approaching 94% and 99%, respectively, in the immediate postoperative phase. In the long run, we observed a recurrence of symptoms at 3% (95%CI 0.00-0.06, I-2 = 58.6%, P < 0.01), creation of new dissections at 1% (95%CI 0.00-0.02, I-2 = 0%, P = 0.73), aneurysm progression at 2% (95%CI 0.00-0.03, I-2 = 42.7%, P = 0.12), reintervention due to complications at 3% (95%CI 0.00-0.05, I-2 = 0%, P = 0.43) and stenotic stents at 12% (95%CI 0.04-0.23, I-2 = 77.5%, P < 0.01). Nevertheless, high levels of stent patency 98% (95% CI 0.97-1.00, I-2 = 0%, P = 0.51) and complete remodeling 88% (95% CI 0.82-0.94, I-2 = 65.5%, P < 0.05) were observed postoperatively. Overall, EST presents minimal complications and promising long-term outcomes for SISMAD, although the prevalence of stent stenosis requires further attention.