title: The evidence for nonoperative management of visceral artery dissections: a single-center experience.
abstract: BACKGROUND
  Spontaneous isolated visceral artery dissection is an uncommon condition encountered by clinicians. Presentation may vary from asymptomatic to acute intestinal ischemia, although a clear natural history has yet to be elucidated. No consensus exists on how best to manage these patients in the absence of true intestinal ischemia; however, much of the literature suggests that intervention is required. We present our institution's experience with 10 patients, both symptomatic and asymptomatic, all but 1 of whom was managed medically.
  
  
  METHODS
  From September 2009 to August 2013, 10 patients presented to our institution with celiac or mesenteric artery dissection. We retrospectively reviewed these patients' clinical presentation, treatment, and follow-up.
  
  
  RESULTS
  The mean age of the patients was 61.5 ± 10.3 (standard deviation [SD]) years (range, 41-77 years), and the mean follow-up period was 14.7 ± 11.6 (SD) months (range, 1-31 months). Four (40%) patients had abdominal pain and no ischemic changes of the bowel. There were 1 type I, 6 type II, 2 type III, and 1 type IV dissections according to Sakamoto classification. Treatments included observation without anticoagulation treatment in 8 patients (80%), anticoagulation treatment in 1 patient (10%), and endovascular stenting in 1 patient (10%) with unremitting abdominal pain. Anticoagulation was used in the 1 symptomatic patient with radiographic evidence of associated thrombus. The disease stabilized in all patients during follow-up.
  
  
  CONCLUSIONS
  Most authors tend to advocate an endovascular or even operative repair for these processes. In our experience, most of these patients have a self-limited course of symptoms or their dissections are found incidentally. We believe that the results of conservative management in our cohort of patients support the conservative approach over the once recommended operative repair.
authors.affiliation: Department of Vascular Surgery, Mount Sinai St. Luke's Hospital and Mount Sinai Roosevelt Hospital, New York, NY.
authors.forename: Sean
authors.initials: S
authors.lastname: Alcantara
authors.affiliation: Department of Vascular Surgery, Mount Sinai St. Luke's Hospital and Mount Sinai Roosevelt Hospital, New York, NY.
authors.forename: Chun Kevin
authors.initials: CK
authors.lastname: Yang
authors.affiliation: Department of Vascular Surgery, Mount Sinai St. Luke's Hospital and Mount Sinai Roosevelt Hospital, New York, NY.
authors.forename: Jordan
authors.initials: J
authors.lastname: Sasson
authors.affiliation: Department of Vascular Surgery, Mount Sinai St. Luke's Hospital and Mount Sinai Roosevelt Hospital, New York, NY.
authors.forename: Selena
authors.initials: S
authors.lastname: Goss
authors.affiliation: Department of Vascular Surgery, Mount Sinai St. Luke's Hospital and Mount Sinai Roosevelt Hospital, New York, NY.
authors.forename: Alan
authors.initials: A
authors.lastname: Benvenisty
authors.affiliation: Department of Vascular Surgery, Mount Sinai St. Luke's Hospital and Mount Sinai Roosevelt Hospital, New York, NY.
authors.forename: George
authors.initials: G
authors.lastname: Todd
authors.affiliation: Department of Vascular Surgery, Mount Sinai St. Luke's Hospital and Mount Sinai Roosevelt Hospital, New York, NY. Electronic address: JLantis@chpnet.org.
authors.forename: John
authors.initials: J
authors.lastname: Lantis
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D000925:Anticoagulants / Q000627:therapeutic use*; D001158:Arteries; D057510:Endovascular Procedures / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014781:Viscera / Q000098:blood supply*; D057832:Watchful Waiting
chemical_list: D000925:Anticoagulants