Long-term Outcomes of Endovascular Versus Medical Treatment for Isolated Superior Mesenteric Artery Dissection: A 10-Year Retrospective Study.

Purpose: 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.

Materials and methods: 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.

Results: 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%.

Conclusion: 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 of evidence: Level 3, non-randomized controlled cohort/follow-up study.