51
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Morzycki A, Casey P, Lee M. Self-limiting Spontaneous Isolated Celiac Artery Dissection: A Case Report. EJVES Short Rep 2015. [DOI: 10.1016/j.ejvssr.2015.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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52
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Patel KS, Benshar O, Vrabie R, Patel A, Adler M, Hines G. A major pain in the … Back and epigastrium: an unusual case of spontaneous celiac artery dissection. J Community Hosp Intern Med Perspect 2014; 4:23840. [PMID: 25432642 PMCID: PMC4246143 DOI: 10.3402/jchimp.v4.23840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Revised: 08/13/2014] [Accepted: 09/11/2014] [Indexed: 11/14/2022] Open
Abstract
A 60-year-old woman with mitral valve prolapse, chronic low back pain, and a 30-pack year smoking history presented for a second admission of poorly controlled mid-back pain 10 days after her first admission. She had concomitant epigastric pain, sharp/burning in quality, radiating to the right side and to the mid-back, not associated with food nor improving with pain medications. She denied nausea, vomiting, diarrhea, constipation, dark stools, or blood per rectum. Our purpose was to determine the cause of the patient's epigastric pain. Physical examination revealed epigastric and mid-back tenderness on palpation. Labs were normal except for a hemoglobin drop from 14 to 12.1 g/dL over 2 days. Abdominal ultrasound and subsequent esophagogastroduodenoscopy were normal. Contrast-enhanced abdominal computed tomographic (CT) scan revealed the development of a spontaneous celiac artery dissection as the cause of the epigastric pain. The patient was observed without stenting and subsequent CT angiography 4 days later did not reveal worsening of the dissection. She was discharged on aspirin and clopidogrel with outpatient follow-up. Thus far, less than 100 cases of isolated spontaneous celiac artery dissections have been reported. The advent of CT scans and magnetic resonance imaging has increasingly enabled its detection. Risk factors may include hypertension, arteriosclerosis, smoking, and cystic medial necrosis. There is a 5:1 male to female ratio with an average presenting age of 55. Management of dissections may include surgical repair, endovascular stenting, and selective embolization. Limited dissections can be managed conservatively with anti-platelet and/or anticoagulation agents and strict blood pressure control, as done in our patient.
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Affiliation(s)
- Kumkum Sarkar Patel
- Department of Internal Medicine, Winthrop-University Hospital, Mineola, NY, USA;
| | - Orel Benshar
- School of Medicine, St. George's University, Great Neck, NY, USA
| | - Raluca Vrabie
- Division of Gastroenterology, Winthrop-University Hospital, Mineola, NY, USA
| | - Anik Patel
- Division of Gastroenterology, Winthrop-University Hospital, Mineola, NY, USA
| | - Marc Adler
- Department of Internal Medicine, Winthrop-University Hospital, Mineola, NY, USA
| | - George Hines
- Department of Vascular Surgery, Winthrop-University Hospital, Mineola, NY, USA
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53
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Perini P, Baque J, Chau Y, Sedat J, Batt M. Percutaneous embolization of symptomatic dissecting aneurysms of the celiac artery. Acta Radiol 2014; 55:1076-81. [PMID: 24226294 DOI: 10.1177/0284185113511079] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Isolated spontaneous dissection of visceral arteries, not associated with aortic dissection, is a rare condition. To date, there is no consensus on the optimal treatment strategy. PURPOSE To investigate the feasibility, efficacy, and safety of percutaneous embolization for the treatment of isolated and symptomatic dissecting aneurysm of the celiac artery. MATERIAL AND METHODS From March 2010 to October 2011, four patients were diagnosed at our institution with symptomatic dissecting aneurysm of the celiac trunk. All patients had acute abdominal pain, two had intra-abdominal hemorrhage and bleeding shock. Three patients underwent elective "trapping" embolization of the celiac trunk with Amplatzer vascular plugs in the hepatic and splenic artery and celiac trunk, and coils in left gastric artery. One patient had a splenic artery rupture and underwent selective embolization of this vessel with platinum-fiber coils. RESULTS Angiography and postoperative CT scan confirmed artery occlusion after embolization in all cases. Revascularization of celiac trunk branches was obtained via collaterals. No procedure-related adverse events occurred during follow-up (median, 4.5 months; range, 3-24 months) and vessel occlusion was maintained. CONCLUSION Isolated and symptomatic dissecting aneurysm of the celiac trunk can be successfully managed by embolization techniques with good short- to mid-term results.
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Affiliation(s)
- Paolo Perini
- Division of Vascular Surgery, Graduate School of Medicine, University of Nice-Sophia-Antipolis, France
| | - Jean Baque
- Division of Vascular Radiology, Graduate School of Medicine, University of Nice-Sophia-Antipolis, France
| | - Yves Chau
- Division of Vascular Radiology, Graduate School of Medicine, University of Nice-Sophia-Antipolis, France
| | - Jacques Sedat
- Division of Vascular Radiology, Graduate School of Medicine, University of Nice-Sophia-Antipolis, France
| | - Michel Batt
- Division of Vascular Surgery, Graduate School of Medicine, University of Nice-Sophia-Antipolis, France
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54
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Clinical usefulness with the combination of color Doppler and contrast-enhanced harmonic EUS for the assessment of visceral vascular diseases. J Clin Gastroenterol 2014; 48:845-50. [PMID: 24231932 DOI: 10.1097/mcg.0000000000000032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
GOALS To evaluate the clinical usefulness of the color Doppler and contrast-enhanced harmonic endoscopic ultrasonography (CEH-EUS) in diagnosing visceral vascular diseases and in assessing morphologic and hemodynamic characteristics required for optimized patient management. BACKGROUND Mesenteric arteries are easily accessible with EUS because of its proximities to the gastrointestinal tract. STUDY EUS was performed in 12 patients with clinically suspected visceral vascular disease, as determined by computed tomography (CT) scan between February 2012 and March 2013. Conventional B-mode, color Doppler, and CEH-EUS was performed to evaluate vascular status of the celiac artery and superior mesenteric artery (SMA). RESULTS CT scan imaging suggested arterial dissection in 9 patients; arterial stenosis or occlusion in 2 patients, and periarterial soft tissue cuffing in 1 patient. EUS accurately identified all the visceral vascular lesions of 11 patients and 1 patient with suspected SMA dissection on CT imaging was proven to be normal by EUS. EUS also identified one undefined dissection not detected on abdominal CT. EUS examination revealed vascular intimal flap in 5 patients and blood flow within the true lumen and thrombi within the false lumen in 8 patients. In addition, the stenotic area could be calculated using color Doppler EUS. Two patients underwent surgical thrombectomy and angioplasty because of total occlusion of SMA on color Doppler and CEH-EUS. CONCLUSIONS The combination of color Doppler and CEH-EUS may be a promising diagnostic modality to assess the splanchnic artery without exposure to radiation. Moreover, EUS is a useful tool to determine the appropriate treatment options for patients with isolated mesenteric artery dissection.
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55
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Isolated spontaneous dissection of a visceral artery: a rare cause of epigastric pain. Emerg Radiol 2014; 22:215-20. [DOI: 10.1007/s10140-014-1255-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 07/09/2014] [Indexed: 10/25/2022]
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56
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Dissecting Aneurysm of the Hepatic Artery Caused by an Isolated Spontaneous Celiac Trunk Dissection. Ann Vasc Surg 2014; 28:1316.e7-13. [DOI: 10.1016/j.avsg.2013.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 09/14/2013] [Accepted: 11/03/2013] [Indexed: 11/21/2022]
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57
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Rehman AU, Almanfi A, Nadella S, Sohail U. Isolated spontaneous celiac artery dissection in a 47-year-old man with von Willebrand disease. Tex Heart Inst J 2014; 41:344-5. [PMID: 24955061 DOI: 10.14503/thij-13-3404] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Isolated spontaneous dissection of the celiac artery is rare, and its occurrence without aortic dissection is even rarer. The typical symptom of this dissection is acute-onset abdominal pain. Complications of the condition include aneurysm formation, rupture, and abdominal-organ ischemia or infarction, especially in the liver or spleen. We report the case of a 47-year-old man with von Willebrand disease who had an isolated spontaneous dissection of the celiac artery. We used computed tomography and computed tomographic angiography in the diagnosis and characterization of the dissection. To our knowledge, this is the first report of celiac artery dissection in a patient with von Willebrand disease.
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Affiliation(s)
- Aziz Ur Rehman
- Department of Internal Medicine, St. Luke's Hospital, Chesterfield, Missouri 63017
| | - Abdelkader Almanfi
- Department of Internal Medicine, St. Luke's Hospital, Chesterfield, Missouri 63017
| | - Srikanth Nadella
- Department of Internal Medicine, St. Luke's Hospital, Chesterfield, Missouri 63017
| | - Umair Sohail
- Department of Internal Medicine, St. Luke's Hospital, Chesterfield, Missouri 63017
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58
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Untereiner X, Kretz B, Camin-Kretz A, Tibuleac A, Gu WM, Faller B, Matysiak L. Dissecting Aneurysm of the Celiac Trunk: A Case Report. Ann Vasc Surg 2014; 28:1037.e1-4. [DOI: 10.1016/j.avsg.2013.08.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 07/19/2013] [Accepted: 08/12/2013] [Indexed: 10/25/2022]
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59
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Options for treatment of spontaneous mesenteric artery dissection. J Vasc Surg 2014; 59:1433-9.e1-2. [DOI: 10.1016/j.jvs.2014.01.040] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 01/10/2014] [Accepted: 01/19/2014] [Indexed: 01/17/2023]
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60
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Melo ELA, Siqueira RA, Paula FTMD. Spontaneous dissection of the celiac trunk: report of three cases and review of the literature. J Vasc Bras 2014. [DOI: 10.1590/jvb.2014.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Spontaneous dissection of the celiac trunk is quite an uncommon medical condition, with few case reports in the medical literature. Sudden epigastric abdominal pain is the most common complaint reported by patients, but due to the rarity of this disease in clinical practice and the nonspecific nature of its symptoms, a high degree of clinical suspicion is needed to establish diagnosis. However, improvements in imaging techniques are facilitating diagnosis of this clinical entity, increasing its detection rate. The ideal treatment has not yet been fully established in the literature and the available therapeutic strategies are conservative medical treatment, surgical revascularization or endovascular intervention. In this article we report on three cases of spontaneous dissection of the celiac trunk and conduct a review of the literature on this disease
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61
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Brown C, Cooper J, Denison A, Jansen J. Coeliac axis dissection secondary to blunt abdominal trauma: A case report and review of the literature. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.injury.2013.12.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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62
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Abstract
Dissection of the visceral arteries happens infrequently, with the superior mesenteric artery being the most commonly affected. Isolated dissection of the celiac trunk is rare, and only a few cases have been reported in the medical literature. We report the case of a 51-year-old male who presented with abdominal pain and was subsequently diagnosed with a celiac trunk dissection with secondary pancreatitis and pancreatic infarction. The patient's symptoms improved with conservative medical management. We review the current literature involving celiac trunk dissection and its management, and provide discussion regarding this unrecognized complication of pancreatitis.
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63
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Rama Krishnan R, Murali K, Madan R, Francis G. CT imaging findings and endovascular management of isolated spontaneous dissecting aneurysm of celiac artery. Indian J Radiol Imaging 2013; 23:234-7. [PMID: 24347853 PMCID: PMC3843331 DOI: 10.4103/0971-3026.120275] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Isolated spontaneous dissecting aneurysm of celiac artery without concomitant involvement of aorta is a rare entity and only a few cases are reported in the literature. More cases are being detected recently with greater advancements in CT technology. Clinicians and emergency physicians should be aware of this condition and should include it in the differential diagnosis of patients who present with refractory postprandial epigastric pain, particularly in middle-aged men. We present a case of a 45-year-old male with isolated spontaneous dissecting celiac artery aneurysm, with special emphasis on CT findings and the role of endovascular management.
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Affiliation(s)
| | - K Murali
- Department of Radiology, MIOT Hospitals, Chennai, India
| | - R Madan
- Department of Radiology, MIOT Hospitals, Chennai, India
| | - G Francis
- Department of Radiology, MIOT Hospitals, Chennai, India
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64
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Neychev V, Krol E, Dietzek A. Unusual presentation and treatment of spontaneous celiac artery dissection. J Vasc Surg 2013; 58:491-5. [DOI: 10.1016/j.jvs.2012.10.136] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 10/08/2012] [Accepted: 10/16/2012] [Indexed: 11/29/2022]
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65
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Spontaneous dissection of the celiac artery: a case report and literature review. Am J Emerg Med 2013; 31:1000.e3-5. [DOI: 10.1016/j.ajem.2013.02.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 02/02/2013] [Indexed: 11/18/2022] Open
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66
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Kang UR, Kim YH, Lee YH. Endovascular stent graft for treatment of complicated spontaneous dissection of celiac artery: report of two cases. Korean J Radiol 2013; 14:460-4. [PMID: 23690714 PMCID: PMC3655301 DOI: 10.3348/kjr.2013.14.3.460] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 06/18/2012] [Indexed: 11/15/2022] Open
Abstract
We report 2 cases of complicated spontaneous dissection of the celiac artery, which were successfully treated by a stent graft. The first patient was a 47-year-old man who presented with acute abdominal pain. CT scan showed ruptured saccular aneurysm with surrounding retroperitoneal hematoma. The second patient was a 57-year-old man with progressive dissecting aneurysm. Endovascular stent graft was placed in the celiac trunk to control bleeding, and to prevent rupture in each patient. Follow-up CT scans showed complete obliteration of a dissecting aneurysm.
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Affiliation(s)
- Ung Rae Kang
- Department of Diagnostic Radiology, Catholic University of Daegu School of Medicine, Daegu 705-718, Korea
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67
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Sequential Multiple Visceral Arteries Dissections Without Aortic Involvement. Ann Vasc Surg 2013; 27:497.e9-13. [DOI: 10.1016/j.avsg.2012.05.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 03/01/2012] [Accepted: 05/06/2012] [Indexed: 11/19/2022]
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68
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Galastri FL, Nasser F, Affonso BB, Amorim JED, Travassos FB. Dissecção espontânea do tronco celíaco: qual a melhor abordagem terapêutica? J Vasc Bras 2013. [DOI: 10.1590/s1677-54492013000100014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A dissecção espontânea das artérias viscerais é um evento relativamente raro. Dor abdominal súbita no epigástrio é o sintoma mais frequentemente manifestado pelos pacientes. O avanço das técnicas de exames de imagem possibilitou o diagnóstico deste evento com maior facilidade, aumentando a incidência das dissecções das artérias viscerais. O tratamento clínico conservador, a revascularização cirúrgica, e a terapia endovascular são as três possíveis opções terapêuticas. Neste artigo, relatamos os casos de dois pacientes com dissecção espontânea do tronco celíaco conduzidos de formas diversas, de acordo com a apresentação clínica e exames de imagem, além de realizar uma revisão bibliográfica sobre esta doença.
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Affiliation(s)
| | - Felipe Nasser
- Universidade de São Paulo; Hospital Israelita Albert Einstein, Brasil
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69
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Isolated celiac and superior mesenteric artery dissection identified with MDCT: imaging findings and clinical course. J Comput Assist Tomogr 2012; 36:539-45. [PMID: 22992604 DOI: 10.1097/rct.0b013e318265129e] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Isolated celiac or superior mesenteric artery (SMA) dissection is a rare entity in the absence of aortic dissection. Our objective was to detail imaging and clinical course of celiac and or SMA dissections. METHODS We conducted a retrospective search from 2004 to 2010 using "celiac and/or SMA dissection" keywords. Analysis of medical record and imaging at diagnosis and follow-up was performed. Dissections for any reason without aortic dissection were included. RESULTS Twenty-four celiac and 18 SMA dissections were detected in 38 patients. One third of the dissections diagnosed with interactive multiplanar reconstruction/maximum intensity projection (MIP)/3-dimensional (3D) rendering were missed on standard imaging planes. No patients had bowel ischemia or died. Eighty-four percent of the patients were observed, 2 patients received anticoagulation, 2 patients received surgical repair, and 3 patients received stenting. Twenty-three of 25 cases treated with observation exhibited no change or improvement/resolution (2/25) with 20.9-month mean follow-up. CONCLUSION Most isolated celiac and SMA dissections were asymptomatic/incidental, supporting observation and surveillance with intervention reserved for vascular compromise. Interactive multiplanar reconstruction/maximum intensity projection/3D rendering can increase diagnostic sensitivity.
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70
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Celiac artery dissection seen with ruptured pancreaticoduodenal arcade aneurysms in two cases of celiac artery stenosis from compression by median arcuate ligament. J Vasc Surg 2012; 56:1114-8. [PMID: 22795523 DOI: 10.1016/j.jvs.2012.04.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 04/17/2012] [Accepted: 04/20/2012] [Indexed: 11/21/2022]
Abstract
We report two cases of ruptured pancreaticoduodenal arcade aneurysms that were successfully treated by embolotherapy. In these cases, contrast-enhanced computed tomography, sagittal reformed images, and angiography revealed celiac artery stenoses due to compression by the median arcuate ligament. Computed tomography also showed acute localized dissection in the distal celiac axis, suggesting that aneurysmal rupture had occurred immediately after development of the dissection. When unruptured pancreaticoduodenal arcade aneurysms are identified in the context of celiac artery dissection, the possibility of rupture may be high and requires strict observation and consideration of embolotherapy.
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71
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Lee CH, Jang LC. A Dissecting Aneurysm of the Common and Proper Hepatic Artery with Dissection of the Celiac Axis and the Superior Mesenteric Artery. Vasc Specialist Int 2012. [DOI: 10.5758/kjves.2012.28.2.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Chung Heon Lee
- Department of Surgery, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Lee Chan Jang
- Department of Surgery, Chungbuk National University College of Medicine, Cheongju, Korea
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72
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Zhang T, Zhang X, Zhang X, Jiang J, Zhou B. Endovascular treatment of isolated spontaneous celiac artery dissection. Vascular 2012; 20:118-20. [PMID: 22472366 DOI: 10.1258/vasc.2011.cr0302] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This report presents the case of a patient with isolated spontaneous celiac artery dissection. The patient developed acute abdominal pain that was induced by eating. Computed tomography and selective angiography revealed an intimal flap that separated the true and false lumens located 3 cm from the origin of the celiac artery. We treated the patient with a stent that was deployed endovascularly into the celiac artery to seal the entry site. Postoperative angiography revealed that the graft was patent and the follow-up period was uneventful. The etiology, clinical features, diagnostic modalities and treatment options of isolated spontaneous celiac artery dissection are reported.
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Affiliation(s)
- Tao Zhang
- Department of Vascular Surgery, Peking University People's Hospital, No. 11 Xizhimen South Street, West District, Beijing 100044, China
| | - Xiaoming Zhang
- Department of Vascular Surgery, Peking University People's Hospital, No. 11 Xizhimen South Street, West District, Beijing 100044, China
| | - Xuemin Zhang
- Department of Vascular Surgery, Peking University People's Hospital, No. 11 Xizhimen South Street, West District, Beijing 100044, China
| | - Jingjun Jiang
- Department of Vascular Surgery, Peking University People's Hospital, No. 11 Xizhimen South Street, West District, Beijing 100044, China
| | - Bingying Zhou
- Biological and Biomedical Sciences Program, University of North Carolina, Chapel Hill, NC 27599, USA
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73
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Sarkar J, Plackett TP, Kellicut DC, Edwards KD. A case report of coeliac artery dissection following a motor vehicle collision. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.injury.2011.10.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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74
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Batt M, Baque J. Successful percutaneous embolization of a symptomatic celiac artery dissection with aneurysmal dilation with detachable vascular plugs. J Vasc Surg 2011; 54:1812-5. [DOI: 10.1016/j.jvs.2011.05.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 04/04/2011] [Accepted: 05/07/2011] [Indexed: 11/16/2022]
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75
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Symptomatic spontaneous celiac artery dissection treated by conservative management: serial imaging findings. ACTA ACUST UNITED AC 2011; 36:79-82. [PMID: 20981421 DOI: 10.1007/s00261-010-9657-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the correlation of clinical characteristics with serial imaging findings of symptomatic spontaneous celiac artery dissection treated by conservative management. METHODS Eight consecutive, hemodynamically stable patients with symptomatic spontaneous celiac artery dissection without associated aortic dissection that received non-operative treatments were included in this study. Their clinical characteristics, treatment methods, serial imaging findings and outcomes were analyzed retrospectively. RESULTS Acute left flank pain related to splenic infarction was the most common clinical manifestation. Initial contrast-enhanced dynamic computed tomography scan showed celiac artery dissection with partial thrombosis in all eight patients and involvement of branch vessels in 7. Full anticoagulation was carried out immediately after the diagnosis in seven patients. All patients, except one with endovascular stent placement, were asymptomatic after successful conservative management and follow-up computed tomography scan showed preservation of distal perfusion with ongoing regression of false lumen in five patients. After a mean follow-up of 16 months, there was no mortality or morbidity related to the dissection. CONCLUSIONS Serial imaging findings showed that conservative management of celiac artery dissection can be performed successfully in selective patients with stable hemodynamics.
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76
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Crowhurst TD, Ho P. Hepatic Artery Dissection in a 65-Year-Old Woman With Acute Pancreatitis. Ann Vasc Surg 2011; 25:386.e17-21. [DOI: 10.1016/j.avsg.2010.09.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 09/25/2010] [Indexed: 10/18/2022]
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77
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Silvestre JMDS, Sardinha WE, Piazzalunga M, Fernandes B, Motta F, Silvestre GDS. Dissecção isolada do tronco celíaco: relato de caso. J Vasc Bras 2010. [DOI: 10.1590/s1677-54492010000300010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A dissecção espontânea isolada do tronco celíaco sem a dissecção concomitante da aorta é uma condição rara, pouco descrita na literatura. O objetivo do presente trabalho é descrever um caso dessa entidade clínica em um paciente masculino, 74 anos, assintomático, cujo diagnóstico foi feito por ultrassonografia e confirmado com angiotomografia computadorizada. O paciente tem sido acompanhado com sucesso mediante observação clínica por um período de 25 meses.
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78
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Zeina AR, Nachtigal A, Troitsa A, Admon G, Avshovich N. Isolated spontaneous dissection of the celiac trunk in a patient with bicuspid aortic valve. Vasc Health Risk Manag 2010; 6:383-6. [PMID: 20539840 PMCID: PMC2882890 DOI: 10.2147/vhrm.s9912] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Indexed: 11/23/2022] Open
Abstract
Isolated spontaneous dissection of celiac trunk is a rare entity. The spontaneous dissection of the visceral artery occurs without aortic dissection. The most consistent presenting symptom is acute onset abdominal pain. Complications consist of ischemia, aneurysm formation, and rupture. We report an exceptional case of an isolated spontaneous dissection of the celiac trunk which occurred in a 49 year old male with a previously undiagnosed bicuspid aortic valve (BAV). We also describe the classical appearance in different imaging modalities with a particular emphasis on multidetector computed tomography, and discuss the clinical manifestation and its relationship to BAV.
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Affiliation(s)
- Abdel-Rauf Zeina
- Department of Radiology, Hillel Yaffe Medical Center, Hadera, Israel.
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79
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Abstract
Spontaneous visceral artery dissection is an uncommon event with an unpredictable natural history with superior mesenteric artery being the most common affected artery. It is most often asymptomatic and usually diagnosed at autopsy. Pre-disposing factors are not specific but have been suggested to be pre-existing vascular disease, hypertension and pregnancy. Spontaneous resolution, definitive occlusion of the artery, and formation of an aneurysm with associated complications are some other possible outcomes. Isolated dissection of the celiac artery (CA) is rare and there are only a few cases reported in the literature. We present a case of a 65 year old male with spontaneous celiac artery dissection and provide a review of the current literature about imaging findings and management of this entity.
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Affiliation(s)
- Sandeep Vaidya
- University of Washington Medical Center, Department of Interventional Radiology, Seattle, WA, USA
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80
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Wang JL, Hsieh MJ, Lee CH, Chen CC, Hsieh IC. Celiac artery dissection presenting with abdominal and chest pain. Am J Emerg Med 2010; 28:111.e3-5. [PMID: 20006218 DOI: 10.1016/j.ajem.2009.02.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Accepted: 02/12/2009] [Indexed: 10/20/2022] Open
Affiliation(s)
- Jian-Liung Wang
- Second Section of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
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81
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Imaging findings and management of isolated dissection of the visceral arteries. Jpn J Radiol 2009; 27:430-7. [DOI: 10.1007/s11604-009-0366-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2009] [Accepted: 08/16/2009] [Indexed: 10/19/2022]
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82
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Mousa AY, Coyle BW, Affuso J, Haser PB, Vogel TR, Graham AM. Nonoperative Management of Isolated Celiac and Superior Mesenteric Artery Dissection: Case Report and Review of the Literature. Vascular 2009; 17:359-64. [DOI: 10.2310/6670.2009.00053] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Isolated dissection of the origin of both celiac and superior mesenteric arteries is a rare vascular pathology with limited management guidelines. The presentation is generally nonspecific, most often manifesting with epigastric pain radiating to the back. A high diagnostic index of suspicion and stepwise management are essential for a successful outcome. This case report details the clinical course of a 57-year-male who presented with a 2-week history of epigastric discomfort with back pain and was found to have focal celiac artery dissection with aneurysmal dilation of 1.2 cm. His vital signs were stable, and the physical examination was unremarkable. At this time, he was placed on antiplatelet medication and was scheduled for endovascular repair of his celiac aneurysm with a covered stent graft. Two weeks later, recurrent abdominal pain prompted a repeat computed tomographic scan that revealed sequential superior mesenteric artery (SMA) dissection. The patient was admitted and anticoagulated. A complete workup ruled out underlying collagen vascular and autoimmune pathology. He remained stable, with significant symptomatic improvement. After 6 months, anticoagulation was discontinued and antiplatelet therapy was instituted for long-term management. Subsequent operative or endovascular intervention was not required. The patient was continuing to do well on his 18-month clinical follow-up. There are 71 cases of SMA and 12 cases of celiac artery dissection in the literature. This report outlines this rare presentation of isolated, proximal sequential celiac artery and SMA dissection. This case illustrates that conservative management may be warranted in uncomplicated, isolated visceral arterial dissection.
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Affiliation(s)
- Albeir Y. Mousa
- *Division of Vascular Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Brian W. Coyle
- *Division of Vascular Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - John Affuso
- *Division of Vascular Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Paul B. Haser
- *Division of Vascular Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Todd R. Vogel
- *Division of Vascular Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Alan M. Graham
- *Division of Vascular Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ
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83
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Basile A, Tsetis D, Montineri A, Coppolino F, Patti MT, Fatuzzo F. Self-expanding Stent Placement as a Bridge for Safe Hepatic Chemoembolization in a Patient with Isolated Spontaneous Dissection of the Celiac Artery. J Vasc Interv Radiol 2009; 20:425-6. [DOI: 10.1016/j.jvir.2008.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2008] [Revised: 11/18/2008] [Accepted: 11/20/2008] [Indexed: 11/26/2022] Open
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84
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Nordanstig J, Gerdes H, Kocys E. Spontaneous Isolated Dissection of the Celiac Trunk with Rupture of the Proximal Splenic Artery: A Case Report. Eur J Vasc Endovasc Surg 2009; 37:194-7. [DOI: 10.1016/j.ejvs.2008.10.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Accepted: 10/15/2008] [Indexed: 10/21/2022]
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85
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Abstract
The long-standing discussion concerning the mere existence of single vessel abdominal artery disease can be closed: chronic gastrointestinal ischaemia (CGI) due to single vessel abdominal artery stenosis exists, can be treated successfully and in a safe manner. The most common causes of single vessel CGI are the coeliac artery compression syndrome (CACS) in younger patients, and atherosclerotic disease in elderly patients. The clinical symptoms of single vessel CGI patients are postprandial and exercise-related pain, weight loss, and an abdominal bruit. The current diagnostic approach in patients suspected of single vessel CGI is gastrointestinal tonometry combined with radiological visualisation of the abdominal arteries to define possible arterial stenosis. Especially in single vessel abdominal artery stenosis, gastrointestinal tonometry plays a pivotal role in establishing the diagnosis CGI. First-choice treatment of single vessel CGI remains surgical revascularisation, especially in CACS. In elderly or selected patients endovascular stent placement therapy is an acceptable option.
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Affiliation(s)
- Désirée van Noord
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Centre's, Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands
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86
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Taourel P, Thuret R, Hoquet MD, Doyon FC, Merigeaud S, Delabrousse E. Computed tomography in the nontraumatic renal causes of acute flank pain. Semin Ultrasound CT MR 2009; 29:341-52. [PMID: 18853840 DOI: 10.1053/j.sult.2008.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Renal colic pain due to obstructing stone is the main renal cause of acute flank pain. However, other causes may be responsible for the same clinical findings, including acute pyelonephritis, acute vascular conditions, and hemorrhage. The purpose of this review is to describe the differential diagnosis, the computed tomographic findings and pitfalls, and the role and impact of computed tomography in the diagnosis and management of the renal causes of acute flank pain.
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Affiliation(s)
- Patrice Taourel
- Imaging Department, Hospital Lapeyronie, Montpellier, France.
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87
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Isolated spontaneous dissection of the splanchnic arteries. J Vasc Surg 2008; 48:329-33. [PMID: 18502087 DOI: 10.1016/j.jvs.2008.03.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Revised: 02/29/2008] [Accepted: 03/04/2008] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Isolated dissection of a splanchnic artery, including the celiac artery, superior mesenteric artery (SMA), and inferior mesenteric artery, and their branches, is a relatively rare condition. This study was conducted to define the characteristics of patients with splanchnic artery dissection and the clinical course of isolated splanchnic artery dissection. METHODS The records of 19 patients were reviewed to survey demographic data, the location of dissection, symptoms, diagnostic modalities, treatment, and long-term outcome. RESULTS The locations of dissection were the superior mesenteric artery (SMA) in 11 patients, celiac artery in 3, both celiac artery and SMA in 2, and common hepatic artery, celiac artery to splenic artery, and celiac artery to proper hepatic artery in 1 each. In all but one with systemic sclerosis and Sjögren syndrome, the underlying cause of dissection was unclear. There were 12 asymptomatic and seven symptomatic patients. All cases were diagnosed by computed tomography. Surgical treatment was performed in one patient with a large aneurysm of the common hepatic artery, and the remaining 18 patients were followed-up conservatively. The mean follow-up duration was 20.9 +/- 25.4 months (range, 2-116 months). No expansion or progression of the false lumen was observed in these patients. CONCLUSION Patients with spontaneous dissection of the splanchnic arteries are often asymptomatic, and in this series, none developed significant end organ ischemia. Most patients with this rare condition can be managed expectantly with clinical follow-up including computed tomography imaging to assess aneurysm formation.
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