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He Q, Yu F, Fu Y, Yang B, Huo R, Xian R, Liu S, Liang K, Tang G. Evaluation of isolated abdominal visceral artery dissection with multi-scale spiral computed tomography: a retrospective case series. J Cardiothorac Surg 2021; 16:61. [PMID: 33781323 PMCID: PMC8008608 DOI: 10.1186/s13019-021-01428-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 03/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background To evaluate the role of multi-slice spiral computed tomography (MSCT) angiography in the diagnosis of spontaneous isolated visceral artery dissection (SIVAD). Methods Twenty-seven patients with abdominal SIVAD were included in the study. The MSCT scans of the patients were subjected to various post-processing techniques to visualize the visceral artery wall. Clinical features including arterial dissection, thrombosis, dissection length, true/false lumen, and complications were recorded. Results Type I, IIa, and IIb SIVADs were observed in 11, 6, and 10 patients, respectively. Superior mesenteric artery (SMA) dissection was the most common (n = 16), followed by abdominal aortic dissection (n = 6), splenic artery dissection (n = 2), renal artery dissection (n = 2), and splenic artery dissection (n = 1). One patient with SMA dissection suffered small intestine ischemia, 1 with splenic artery dissection had splenic infarction, and 1 patient with left renal artery dissection experienced renal infarction. The false lumen was bigger than the true lumen in 20 patients, with 9 patients having thrombus. The true lumen was bigger than the false lumen in 7 patients. Conclusions MSCT angiography is a valuable technique in the diagnosis and treatment of patients with SIVAD. Patients with abdominal pain suspected due to SIVAD should be examined with MSCT angiography for early detection of SIVAD.
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Affiliation(s)
- Qizhou He
- Department of Radiology, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China.
| | - Fei Yu
- Department of Radiology, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Yajun Fu
- Department of Radiology, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Bin Yang
- Department of Radiology, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Ran Huo
- Department of Radiology, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Rong Xian
- Department of Radiology, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Shulan Liu
- Department of Radiology, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Kali Liang
- Department of Radiology, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Guangcai Tang
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou, 64600, Sichuan, China
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2
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Acosta S, Gonçalves FB. Management of Spontaneous Isolated Mesenteric Artery Dissection: A Systematic Review. Scand J Surg 2021; 110:130-138. [PMID: 33724090 PMCID: PMC8258720 DOI: 10.1177/14574969211000546] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background and Aims: There are increasing reports on case series on spontaneous isolated mesenteric artery dissection, that is, dissections of the superior mesenteric artery and celiac artery, mainly due to improved diagnostic capacity of high-resolution computed tomography angiography performed around the clock. A few case–control studies are now available, while randomized controlled trials are awaited. Material and Methods: The present systematic review based on 97 original studies offers a comprehensive overview on risk factors, management, conservative therapy, morphological modeling of dissection, and prognosis. Results and Conclusions: Male gender, hypertension, and smoking are risk factors for isolated mesenteric artery dissection, while the frequency of diabetes mellitus is reported to be low. Large aortomesenteric angle has also been considered to be a factor for superior mesenteric artery dissection. The overwhelming majority of patients can be conservatively treated without the need of endovascular or open operations. Conservative therapy consists of blood pressure lowering therapy, analgesics, and initial bowel rest, whereas there is no support for antithrombotic agents. Complete remodeling of the dissection after conservative therapy was found in 43% at mid-term follow-up. One absolute indication for surgery and endovascular stenting of the superior mesenteric artery is development of peritonitis due to bowel infarction, which occurs in 2.1% of superior mesenteric artery dissections and none in celiac artery dissections. The most documented end-organ infarction in celiac artery dissections is splenic infarctions, which occurs in 11.2%, and is a condition that should be treated conservatively. The frequency of ruptured pseudoaneurysm in the superior mesenteric artery and celiac artery dissection is very rare, 0.4%, and none of these patients were in shock at presentation. Endovascular therapy with covered stents should be considered in these patients.
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Affiliation(s)
- S Acosta
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Vascular Center, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
| | - F B Gonçalves
- Department of Angiology and Vascular Surgery, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central and NOVA Medical School, Lisboa, Portugal
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Zafar Y, Meidl L, Lonney M, Ullah W, Rashid MU. Coeliac trunk dissection causing splenic infarction: a comprehensive review. BMJ Case Rep 2019; 12:12/10/e231087. [PMID: 31615776 DOI: 10.1136/bcr-2019-231087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe the case of a 49-year-old man who presented with a 6-day history of epigastric abdominal pain radiating to his right shoulder which started suddenly after swinging a golf club. A CT angiography of the abdomen was performed which showed dissection of the coeliac trunk extending into the splenic artery and splenic infarct. Anticoagulation was initially started but discontinued due to a small retroperitoneal haemorrhage. The patient remained stable and was discharged on aspirin 325 mg for 1 month followed by aspirin 81 mg. We present this case as well as a review of previously reported cases of splenic infarct due to spontaneous coeliac trunk dissection with the treatments employed as well as the outcomes.
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Affiliation(s)
- Yousaf Zafar
- Internal Medicine, University of Missouri Kansas City, Kansas City, MO, USA
| | - Laura Meidl
- Internal Medicine, University of Missouri Kansas City, Kansas City, MO, USA
| | - Maddison Lonney
- Internal Medicine, University of Missouri Kansas City, Kansas City, MO, USA
| | - Waqas Ullah
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA
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Barnes S, Kushner B. Isolated Dissection of the Superior Mesenteric Artery. Clin Pract Cases Emerg Med 2018; 2:43-46. [PMID: 29849290 PMCID: PMC5965138 DOI: 10.5811/cpcem.2017.7.34224] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/28/2017] [Accepted: 07/11/2017] [Indexed: 11/24/2022] Open
Abstract
Isolated dissection of the superior mesenteric artery is a novel disease often presenting with vague signs and symptoms. Although the disease entity is rare, the potential for morbidity and mortality is high. This is a case report of a healthy 58-year-old male presenting with diffuse persistent abdominal pain. Diagnosed on computed tomography, this patient’s condition was managed conservatively with anticoagulants.
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Affiliation(s)
- Stacey Barnes
- St. Joseph's Regional Medical Center, Department of Emergency Medicine, Paterson, New Jersey
| | - Beth Kushner
- St. Joseph's Regional Medical Center, Department of Emergency Medicine, Paterson, New Jersey
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Tana M, Tana C, Schiavone C, Verdiani V, Palermo C, Alessandri M, Giamberardino MA, Montagnani A. Spontaneous dissection of the celiac artery in the young: a case report and systematic review of the literature. Hosp Pract (1995) 2017; 45:258-264. [PMID: 28891374 DOI: 10.1080/21548331.2017.1378059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 09/07/2017] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The spontaneous isolated celiac artery dissection (siCAD) represents a challenging cause of abdominal pain and complete information regarding incidence, etiology and risk factors in the young is still lacking. In this study, we report a case of siCAD occurred in a young woman and we systematically searched for information on siCADs in literature databases. METHODS PubMed/Embase and Cochrane were searched for, using the following terms: Isolated celiac trunk dissection, isolated celiac artery dissection, celiac artery dissection, celiac trunk dissection, spontaneous isolated visceral artery dissection, spontaneous isolated dissection of visceral arteries, isolated celiac artery dissection in the young, isolated celiac trunk dissection in the young. Patients were included if they were younger than 50 years, if they had a spontaneous etiology and a selective involvement of the celiac artery (with or without involvement of its branches). RESULTS 180 studies were found, and 18 remained after screening. Twenty-one patients (male = 19, female = 2) with siCADs were included. Mean age was 44.71 ± 3.61 years. Hypertension was the most prevalent comorbidity. All patients presented with abdominal pain, more often located in the epigastrium (n = 11). Almost all patients underwent CT to confirm the diagnosis. A conservative treatment was adopted in 13 patients while an invasive approach was adopted in 8 patients (endovascular approach in 7). DISCUSSION siCADs represent a rare but important cause of vascular dissection in the young. Uncomplicated cases can be safely treated with conservative strategies. The surgical or endovascular repair is indicated when dissections complicate or symptoms persist despite an adequate conservative treatment.
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Affiliation(s)
- Marco Tana
- a Internal Medicine Unit , Grosseto , Italy
| | - Claudio Tana
- b Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department , University-Hospital of Parma , Parma , Italy
| | - Cosima Schiavone
- c Department of Internistic Ultrasound , "G. d'Annunzio" University of Chieti , Chieti , Italy
| | | | | | | | - Maria Adele Giamberardino
- e Ce.S.I.-Met , "G. D'Annunzio" University of Chieti , Chieti , Italy
- f Geriatrics Clinic, Department of Medicine and Science of Aging , "G. D'Annunzio" University of Chieti , Chieti , Italy
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Otsuka H, Sato T, Aoki H, Nakagawa Y, Inokuchi S. Optimal management strategy for spontaneous isolated dissection of a visceral artery. Vascular 2017; 26:169-174. [DOI: 10.1177/1708538117722879] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives To describe our clinical experiences and recommend a management strategy for spontaneous isolated dissection of a visceral artery. Methods A retrospective study of patients from December 2005 to December 2015 was performed. Thirty-two patients had spontaneous isolated dissection of a visceral artery. Clinical features, computed tomography findings, the treatment method, and follow-up results were evaluated. Results There were 28 men and 4 women (mean age, 54 years). Dissection locations were the celiac artery in 10, superior mesenteric artery in 17, and celiac artery and superior mesenteric artery in 5 patients. Celiac artery stenosis existed with spontaneous isolated dissection of a visceral artery at a high rate. After diagnosis, the blood pressure of all patients was immediately controlled to a lower level. Three patients with arterial rupture and one patient with bowel infarction underwent operations for complications. Overall, the treatment of dissection involved drug therapy alone. The last follow-up computed tomography results of the true lumen residual ratio and the length of the dissected artery improved compared to the values on admission; the maximum diameter of the dissected artery did not enlarge. Eleven patients almost completely improved. No patients had any adverse event. Conclusions Most patients with spontaneous isolated dissection of a visceral artery can be first treated conservatively for dissection with strict blood pressure control and surveillance.
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Affiliation(s)
- Hiroyuki Otsuka
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Isehara City, Japan
| | - Toshiki Sato
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Isehara City, Japan
| | - Hiromichi Aoki
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Isehara City, Japan
| | - Yoshihide Nakagawa
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Isehara City, Japan
| | - Sadaki Inokuchi
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Isehara City, Japan
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7
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Le TB, Jeon YS, Hong KC, Cho SG, Park KM. Spontaneous dissections of multiple visceral arteries: an extremely rare case. Ann Surg Treat Res 2017; 92:225-229. [PMID: 28382296 PMCID: PMC5378564 DOI: 10.4174/astr.2017.92.4.225] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/22/2016] [Accepted: 09/12/2016] [Indexed: 11/30/2022] Open
Abstract
Spontaneous dissections of visceral arteries without aortic involvement are very rare. The etiologies of these entities are unclear and their clinical managements remain controversial. We report a case of spontaneous multiple dissections affecting 4 visceral arteries including the superior mesenteric artery, the celiac artery and the bilateral renal arteries. The patient was managed conservatively and endovascularly. The clinical manifestation markedly improved and laboratory tests returned to normal limits within 1 week. The regular follow-up suggested a good clinical and radiological outcome until 84 months.
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Affiliation(s)
- Trong Binh Le
- Endovascular Training Center, Inha University Hospital, Incheon, Korea
| | - Yong Sun Jeon
- Department of Radiology, Inha University School of Medicine, Incheon, Korea
| | - Kee Chun Hong
- Department of Vascular Surgery, Inha University School of Medicine, Incheon, Korea
| | - Soon Gu Cho
- Department of Radiology, Inha University School of Medicine, Incheon, Korea
| | - Keun-Myoung Park
- Department of Vascular Surgery, Inha University School of Medicine, Incheon, Korea
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8
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Hosaka A, Nemoto M, Miyata T. Outcomes of conservative management of spontaneous celiac artery dissection. J Vasc Surg 2017; 65:760-765.e1. [DOI: 10.1016/j.jvs.2016.09.058] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 09/23/2016] [Indexed: 10/20/2022]
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9
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Spontaneous Isolated Visceral Artery Dissection in a Middle Aged Male. Case Rep Emerg Med 2017; 2017:3704348. [PMID: 28116180 PMCID: PMC5237457 DOI: 10.1155/2017/3704348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 12/04/2016] [Indexed: 11/18/2022] Open
Abstract
Epigastric pain is a common complaint made by patients being evaluated in the emergency department. Spontaneous isolated visceral artery dissection is a rare cause with no reported prevalence. We present a case of a 37-year-old male evaluated in the emergency department for epigastric pain and subsequently diagnosed with a spontaneous isolated celiac artery dissection with involvement of the hepatic and splenic arteries. Recent case series suggest this disease may be managed medically in most cases. Surgical intervention may be considered for significant bleeding or signs of intestinal ischemia.
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10
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Su KYC, Stanhope ML, Kaufman BPW. Spontaneous hepatic artery dissection-a rare presentation of fibromuscular dysplasia. Oxf Med Case Reports 2016; 2016:omw083. [PMID: 28031848 PMCID: PMC5184840 DOI: 10.1093/omcr/omw083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/26/2016] [Accepted: 09/05/2016] [Indexed: 11/18/2022] Open
Abstract
Fibromuscular dysplasia (FMD) is a rare condition that causes structural compromise of the blood vessel presenting either as an incidental radiological finding, dissection or stenosis usually of the renal or craniocervical arteries. Seldom, patients present with spontaneous dissection in visceral arteries and there are few reports of hepatic involvement. This report outlines the case of a 43-year-old female who presented with severe right upper quadrant pain with a subsequent diagnosis of FMD manifesting as spontaneous hepatic artery dissection. The patient was treated with conservative antiplatelet therapy and regular radiographic follow-up, decided by the treating team as no clear guidelines exist for management of this particular presentation of FMD. Surgical management is not currently recommended to this patient due to the risk of further dissection, but may be considered if there is severe haemodynamic compromise or refractory pain.
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Affiliation(s)
- Kevin Y C Su
- General Medicine , Bundaberg Base Hospital , Bundaberg 4670 , Australia
| | - Melanie L Stanhope
- School of Medicine , University of Queensland , Herston 4006 , Australia
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Cavalcante RN, Motta-Leal-Filho JM, De Fina B, Galastri FL, Affonso BB, de Amorim JE, Wolosker N, Nasser F. Systematic Literature Review on Evaluation and Management of Isolated Spontaneous Celiac Trunk Dissection. Ann Vasc Surg 2016; 34:274-9. [DOI: 10.1016/j.avsg.2015.12.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 12/08/2015] [Accepted: 12/10/2015] [Indexed: 11/28/2022]
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12
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Lee SI, Kim JJ, Yang HJ, Lee K. Spontaneous dissection of celiac trunk with concurrent splenic artery dissection. Clin Exp Emerg Med 2015; 2:256-259. [PMID: 27752606 PMCID: PMC5052905 DOI: 10.15441/ceem.15.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 08/21/2015] [Accepted: 08/22/2015] [Indexed: 11/23/2022] Open
Abstract
Isolated spontaneous dissection of the celiac trunk is rarely diagnosed in acute abdominal pain. We present two cases of celiac trunk and splenic artery dissection with splenic infarction. Patients were successfully managed and stabilized by medical treatment. Isolated celiac trunk dissection can be fatal, therefore providers should be careful not to overlook this entity.
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Affiliation(s)
- Seo In Lee
- Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Jin Joo Kim
- Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Hyuk Jun Yang
- Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Keun Lee
- Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon, Korea
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