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

被引:77
作者
Wang, Jiarong [1 ,2 ]
He, Yazhou [1 ,4 ]
Zhao, Jichun [2 ]
Yuan, Ding [2 ]
Xu, Hao [5 ,6 ]
Ma, Yukui [2 ]
Huang, Bin [2 ]
Yang, Yi [2 ]
Bian, He [7 ]
Wang, Ziqiang [3 ]
机构
[1] Sichuan Univ, West China Hosp, West China Sch Med, Chengdu, Sichuan, Peoples R China
[2] Sichuan Univ, West China Hosp, Dept Vasc Surg, 37 Guo Xue Alley, Chengdu 610041, Sichuan, Peoples R China
[3] Sichuan Univ, West China Hosp, Dept Gastrointestinal Surg, Chengdu, Sichuan, Peoples R China
[4] Univ Edinburgh, Western Gen Hosp, Inst Genet & Mol Med, Edinburgh, Midlothian, Scotland
[5] Yale Univ, Sch Publ Hlth, Dept Biostat, New Haven, CT USA
[6] Sichuan Univ, West China Sch Publ Hlth, Dept Stat, Chengdu, Sichuan, Peoples R China
[7] McMaster Univ, Populat Hlth Res Inst, Dept Stat, Hamilton, ON, Canada
关键词
Spontaneous isolated celiac artery dissection; Spontaneous isolated superior mesenteric artery dissection; Long-term adverse effects; Remodeling; ENDOVASCULAR STENT PLACEMENT; FOLLOW-UP; CONSERVATIVE THERAPY; MANAGEMENT STRATEGY; OUTCOMES; CLASSIFICATION;
D O I
10.1016/j.jvs.2018.05.014
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: Spontaneous isolated celiac artery dissection (SICAD) and spontaneous isolated superior mesenteric artery dissection (SISMAD) represent the major types of spontaneous visceral artery dissection. However, no quantitative meta-analysis of SICAD and SISMAD is available. The aim of our study was to pool current evidence concerning basic profiles, treatment strategies, long-term adverse events, and morphologic changes of lesioned vessels in SICAD and SISMAD patients. Methods: We searched the MEDLINE, Embase, Scopus, and Cochrane Databases (January 1, 1946-September 21, 2017) for studies of SICAD and SISMAD. Related cohort studies or case series with sample size larger than 10 were included. Two reviewers independently extracted and summarized the data. Arandom-effects model was used to calculate pooled estimates. Results: In total, 43 studies were included. An estimated 8% (95% confidence interval [CI], 0.01-0.21) symptomatic SICAD and 12% (95% CI, 0.06-0.19) symptomatic SISMAD patients with initial conservative management required secondary intervention during follow-up, whereas none of the asymptomatic patients treated conservatively required secondary intervention. As for morphologic changes during follow-up, a higher proportion of SICAD patients (64%; 95% CI, 0.47-0.80) achieved complete remodeling compared with SISMAD patients (25%; 95% CI, 0.19-0.32), and an estimated 6% (95% CI, 0.00-0.16) of SICAD and 12% (95% CI, 0.05-0.20) of SISMAD patients had morphologic progression. Overall, the pooled estimate of long-term all-cause mortality was 0% (95% CI, 0.00-0.03) in SICAD and 1% (95% CI, 0.00-0.02) in SISMAD. When stratified by symptoms, symptomatic patients were associated with a significantly increased probability of accomplishing complete remodeling (odds ratio, 3.95; 95% CI, 1.31-11.85) compared with asymptomatic patients. Conclusions: Initial conservative treatment is safe for asymptomatic SICAD or SISMAD patients. Symptomatic patients managed conservatively have relatively high occurrence of late secondary intervention, which may require closer surveillance, especially in SISMAD because of a lower rate of remodeling.
引用
收藏
页码:1228 / +
页数:22
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