MISC 16. Conservative Management for Symptomatic Spontaneous Isolated Dissection of Superior Mesenteric Artery With or Without Antithrombotic Therapy: A Meta-analysis

Abstract

Conservative treatment is feasible in most patients with spontaneous isolated dissection of superior mesenteric artery (SIDSMA). However, the role of antithrombotic therapy (AT) is not well defined in either symptomatic or asymptomatic patients. This meta-analysis aimed to compare the resolution rate with or without AT. A systematic search of electronic databases including PubMed, Embase, Cochrane Library, and Web of Science up to August 2018 was performed. Meta-analyses were conducted to determine primary resolution rate, long-term aneurysmal change, and any event after conservative treatment. We included data from 35 articles involving 842 patients with SIDSMA. No significant differences were observed in resolution rates (random-effects model; relative risk, 0.96; 95% confidence interval [CI], 0.87-1.05). The pooled resolution rate was 91% (CI, 85-95) with AT and 95% (CI, 88-100) without AT (P = .21). The pooled aneurysmal change rate was 3% with AT and 11% without AT, with no statistical differences (relative risk, 0.44; CI, 0.12-1.64; P = .22). Patients with symptomatic SIDSMA can be effectively managed either with or without antithrombotics. There is no significant difference in the pooled outcomes between the two groups. We suggest deferring antithrombotics for SIDSMA until further evidences support the use of them.