Mid-term Outcomes of Asymptomatic and Symptomatic Isolated Mesenteric Artery Dissections.

BACKGROUND: Isolated spontaneous mesenteric artery dissections present with a broad spectrum of symptoms and are increasingly detected due to the widespread use of computed tomography. Treatment options are debated, from observation and medical management to endovascular procedures and open surgery. METHODS: A retrospective review was performed on patients with isolated superior mesenteric artery (SMA) or celiac artery (CA) dissections at a single institution from January 2017 to August 2025. Patients with concomitant aortic dissection were excluded. Data collected included clinical characteristics, imaging findings classified by Zerbib classification, treatment approaches, and outcomes. Patients were categorized based on presentation (asymptomatic vs symptomatic). RESULTS: A total of 39 patients were identified, with a median age of 58 years (IQR 52-71). The majority were male (87%) and Asian (62%). SMA was involved in 72% of cases, and 67% were symptomatic. Management strategies included observation (15%), medical therapy (54%), endovascular procedures (2.6%), and surgery (28%). Symptomatic patients tended to be younger (56 vs. 71 years, P = .020) and had higher white blood cell counts (12 vs. 7.6, P = .016). Intramural hematoma was more common among symptomatic patients (58% vs. 15%, P = .017). All patients who underwent surgery were symptomatic (42% vs. 0%, P = .007), and 23% presented with acute mesenteric ischemia. Among symptomatic patients, 58% did not require operative intervention, supporting non-operative management in appropriately selected patients without evidence of acute mesenteric ischemia, rupture, or hemodynamic instability. Only one patient had an underlying connective tissue disorder, and one had rheumatoid arthritis with vasculitis. Three-year survival rates were comparable between groups (asymptomatic 92.3±7.4%, symptomatic 92.2±8.4%, P = .696). Symptom resolution occurred in all cases. Treatment failure requiring secondary intervention was observed in 15% of symptomatic patients. Zerbib Types V and VI were associated with the need for operative intervention. CONCLUSIONS: Mid-term outcomes are generally favorable for both asymptomatic and symptomatic isolated mesenteric dissections. Asymptomatic cases can be managed safely with observation or medical therapy. Factors such as symptoms, Zerbib classification (V-VI), and the presence of intramural hematoma are strongly associated with the likelihood of requiring surgical intervention. Personalized management based on clinical presentation and imaging severity is essential for optimal outcomes.