Options for treatment of spontaneous mesenteric artery dissection.

Abstract

Mesenteric artery dissection was once thought to be rare but has been identified more frequently with increasing use of computerized tomographic angiographic imaging. Multiple reports advocate a wide range of treatment including medical therapy, endovascular, and surgical intervention, with no clear guidelines for the application of each treatment. A systematic review of the literature was analyzed and used to create a treatment algorithm that was applied to nine patients in our institution. Although medical therapy is adequate for most patients with mesenteric artery dissection, 14% failed medical therapy, sometimes with severe consequences. Asymptomatic status on presentation predicted successful medical therapy for superior mesenteric artery dissection (P = .0037). Intensive surveillance is indicated during medical therapy, and invasive intervention may be necessary.