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Zhu F, Zhang L, Shang D. The management of spontaneous isolated celiac artery dissection: A case report and literature review. Vascular 2023:17085381231197931. [PMID: 37604155 DOI: 10.1177/17085381231197931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
OBJECTIVES Spontaneous isolated celiac artery dissection (SICAD) without associated aortic dissection is a rare disease. Complications are ischemia, aneurysm formation, and rupture. Different treatment options have been reported for managing SICAD, including conservative management, endovascular intervention, and open surgery. Despite the increased recognition of this disease, there are no consensus guidelines on management of this condition. To improve the knowledge and treatment of this disease, a case of SICAD was reported. METHODS AND RESULTS We describe the case of a 57-year-old woman with SICAD whose symptoms improved after endovascular treatment when conservative treatment failed and systematically analyze the management strategy for patients with SICAD. CONCLUSIONS SICAD is a rare disease and has no universally agreed upon guidelines for treatment. Most patients can be first treated conservatively for dissection with strict blood pressure control, antithrombotic therapy, and intensive surveillance. For SICAD patients with aneurysms located in the celiac trunk, stent grafts can be used in such patients without affecting the branch blood supply.
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Affiliation(s)
- Feng Zhu
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liqiang Zhang
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dan Shang
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Zhou F, Zheng Z, Pan Y. General features, management strategies, and outcomes of symptomatic spontaneous isolated celiac artery dissection. Front Surg 2022; 9:972276. [PMID: 36338634 PMCID: PMC9635887 DOI: 10.3389/fsurg.2022.972276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives Spontaneous isolated celiac artery dissection (SICAD) is a rare condition that has not been fully investigated and reported, and very little is known regarding its prognosis and management. Here, we aimed to provide more evidence on the management strategy and outcome for symptomatic SICAD based on the experience of a single center. Methods From January 2018 to December 2021, a total of consecutive 51 patients with symptomatic SICAD were retrospectively included in this study. These patients had been selectively treated with conservative treatment (n = 31) or endovascular treatment (n = 20). Baseline data, imaging findings, treatment strategy, outcomes, and follow-up data have been described and analyzed. Results The mean age of the patients was 53.2 ± 9.6 years, 44 (86.3%) were male, and 36 (70.6%) had hypertension. The median length of stay was 10.0 days. The complete remission rate was 92.2% on discharge. The median follow-up time was 21.0 months. A secondary intervention was required for two patients during follow-up in the conservative group, wherein one underwent a stent placement three months after discharge because of progression of symptoms and extension of dissection, and the other required intervention one month after discharge because of symptomatic progression. No secondary intervention was required in the endovascular group. Occasional and mild relapse of symptoms occurred in two patients in both the conservative and endovascular groups, with no secondary intervention. The length of dissection (25.5 ± 11.8 mm vs. 19.1 ± 7.4 mm, P = 0.022) and complete remodeling rate (85.7% vs. 15.4%, P < 0.001) in the endovascular group were greater than that in the conservative group. Conclusion Patients with symptomatic SICAD who were selectively treated with conservative treatment or endovascular treatment had satisfactory early and medium-term outcomes. Endovascular treatment showed significant advantages in the complete remodeling of the celiac artery and presented with a lower rate of secondary intervention. Moreover, it was found to be a safe and effective remedy for failed conservative treatment.
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Effectiveness of the Conservative Therapy for Symptomatic Isolated Celiac Artery Dissection. Cardiovasc Intervent Radiol 2017; 40:994-1002. [DOI: 10.1007/s00270-017-1680-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 04/28/2017] [Indexed: 11/25/2022]
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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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Esteban-Zubero E, Flamarique-Pascual A. Disección aneurismática del tronco celíaco, una entidad infrecuente. IATREIA 2017. [DOI: 10.17533/udea.iatreia.v30n2a08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Xia T, Zhou JY, Mou YP, Xu XW, Zhou YC, Huang CJ, Zhang RC, Lu C, Chen RG, Xu YY. Laparoscopic ligation of celiac trunk and splenic artery aneurysms with function preservation. MINIM INVASIV THER 2016; 26:56-59. [PMID: 27598531 DOI: 10.1080/13645706.2016.1223696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Celiac trunk aneurysms (CTAs) are rare and usually asymptomatic. Although most of these aneurysms can be treated with percutaneous embolization, some uncommon locations of the aneurysm may make this approach impossible. We report a patient with a celiac trunk aneurysm (CTA) and a proximal splenic artery aneurysm (SAA). Due to the size and location of these two aneurysms, after multidisciplinary discussion, endovascular management was considered inappropriate and they were treated by laparoscopic ligation of the two aneurysms and revascularization. This procedure offers good postoperative recovery with good preservation of the visceral function. Some collateral vessels in the viscera were obvious on postoperative day 7.
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Affiliation(s)
- Tao Xia
- a Department of Surgery , Zhejiang University School of Medicine , Hangzhou , Zhejiang Province , China
| | - Jia-Yu Zhou
- a Department of Surgery , Zhejiang University School of Medicine , Hangzhou , Zhejiang Province , China
| | - Yi-Ping Mou
- b Department of Gastrointestinal-Pancreatic Surgery , Zhejiang Provincial Peoples' Hospital , Hangzhou , Zhejiang Province , China
| | - Xiao-Wu Xu
- b Department of Gastrointestinal-Pancreatic Surgery , Zhejiang Provincial Peoples' Hospital , Hangzhou , Zhejiang Province , China
| | - Yu-Cheng Zhou
- b Department of Gastrointestinal-Pancreatic Surgery , Zhejiang Provincial Peoples' Hospital , Hangzhou , Zhejiang Province , China
| | - Chao-Jie Huang
- b Department of Gastrointestinal-Pancreatic Surgery , Zhejiang Provincial Peoples' Hospital , Hangzhou , Zhejiang Province , China
| | - Ren-Chao Zhang
- b Department of Gastrointestinal-Pancreatic Surgery , Zhejiang Provincial Peoples' Hospital , Hangzhou , Zhejiang Province , China
| | - Chao Lu
- a Department of Surgery , Zhejiang University School of Medicine , Hangzhou , Zhejiang Province , China
| | - Rong-Gao Chen
- a Department of Surgery , Zhejiang University School of Medicine , Hangzhou , Zhejiang Province , China
| | - Yun-Yun Xu
- b Department of Gastrointestinal-Pancreatic Surgery , Zhejiang Provincial Peoples' Hospital , Hangzhou , Zhejiang Province , China
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Lim JY, Choi YH, Lee SH. Unusual presentation and treatment of isolated spontaneous gastric artery dissection. Clin Exp Emerg Med 2016; 3:112-115. [PMID: 27752628 PMCID: PMC5051608 DOI: 10.15441/ceem.15.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 04/16/2016] [Accepted: 04/19/2016] [Indexed: 11/23/2022] Open
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Corey MR, Ergul EA, Cambria RP, English SJ, Patel VI, Lancaster RT, Kwolek CJ, Conrad MF. The natural history of splanchnic artery aneurysms and outcomes after operative intervention. J Vasc Surg 2016; 63:949-57. [DOI: 10.1016/j.jvs.2015.10.066] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/15/2015] [Indexed: 10/22/2022]
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Sun J, Li DL, Wu ZH, He YY, Zhu QQ, Zhang HK. Morphologic findings and management strategy of spontaneous isolated dissection of the celiac artery. J Vasc Surg 2016; 64:389-394. [PMID: 26926933 DOI: 10.1016/j.jvs.2015.12.050] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 12/20/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We report the morphologic findings and treatment of spontaneous isolated dissection of the celiac artery (SIDCA). METHODS Twenty-three patients with SIDCA presenting between January 2009 and December 2014 were enrolled in this retrospective study. The demographic data, clinical features, morphologic findings, treatment modalities, and follow-up results of these patients were reviewed. We proposed a morphologic classification for SIDCA similar to that of spontaneous isolated dissection of the superior mesenteric artery. RESULTS Initially, 11 patients were treated endovascularly, and 12 were treated medically. Four patients treated medically had an aggravation of the dissection and needed endovascular salvage. All patients recovered successfully. None of the patients developed abdominal pain, required reintervention, or died. In the medically treated group, the false lumen was completely thrombosed and absorbed in 4 patients, partially thrombosed in 2, and patent in 2. All stents were patent with the false lumen completely thrombosed and absorbed in the endovascular group. CONCLUSIONS SIDCA can be treated medically in stable patients but requires intensive follow-up. Endovascular therapy can be applied in high-risk patients with recurrent symptoms, visceral malperfusion, or aneurysm. Open surgery should be considered if endovascular repair is not suitable or has failed. The short-term results of endovascular management are encouraging but further evaluation with long-term follow-up is necessary.
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Affiliation(s)
- Jie Sun
- Department of Vascular Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Dong-Lin Li
- Department of Vascular Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
| | - Zi-Heng Wu
- Department of Vascular Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yang-Yan He
- Department of Vascular Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qian-Qian Zhu
- Department of Vascular Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hong-Kun Zhang
- Department of Vascular Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Regus S, Lang W. Rupture Risk and Etiology of Visceral Artery Aneurysms and Pseudoaneurysms. Vasc Endovascular Surg 2016; 50:10-5. [DOI: 10.1177/1538574415627868] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background: The aim of this study was to analyze differences in rupture risk and etiology of visceral artery aneurysms (VAAs) and visceral artery pseudoaneurysms (VAPAs) in a single-center experience. Materials and Methods: We retrospectively reviewed all patients with a VAA or VAPA after treatment by open surgical or endovascular repair (ER) in our institution. Patient history, treatment details, and outcome were recorded and analyzed. Results: From January 1996 to April 2014, 29 (12 women) patients with 33 aneurysms (26 VAAs and 7 VAPAs) were treated in elective and urgent settings by open repair or ER. Etiology was quite different, most common was atherosclerosis (61.5%) in VAA and chronic pancreatitis (85.7%) in VAPA. Rupture rate was 19.2% in VAA and 42.9% in VAPA, whereas mean size of ruptured VAA was 4.4 cm and of ruptured VAPA was 2 cm. Open repair (suture, ligation, and aneurysmectomy with or without arterial reconstruction) and ER (coil embolization in the packing technique) were performed in half of all cases. After follow-up (72-month VAA and 82-month VAPA), aneurysm-free survival was reported to be 95% in VAA and 100% in VAPA. Conclusion: Chronic pancreatitis seems to be a prominent risk factor for the development of VAPA in this single-center experience. Modern endovascular techniques with promising short- and long-term results could broaden indications to treat asymptomatic VAA and VAPA.
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Affiliation(s)
- Susanne Regus
- Vascular Surgery, Department of Vascular Surgery, University Hospital, Erlangen, Germany
| | - Werner Lang
- Vascular Surgery, Department of Vascular Surgery, University Hospital, Erlangen, Germany
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Endovascular Treatment of a Dissected Celiac Trunk Aneurysm Complicated with Consequent Pseudoaneurysm: Primary Treatment and Treatment Relapse after 5 Years. Case Rep Vasc Med 2015; 2015:291953. [PMID: 26124975 PMCID: PMC4466360 DOI: 10.1155/2015/291953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 05/18/2015] [Indexed: 11/17/2022] Open
Abstract
We report on an asymptomatic 56-year-old male with incidental diagnosis of celiac trunk aneurysm, diagnosed during an ultrasound scan performed to control polycystic kidney disease. The CT scan revealed a 3.8 cm saccular aneurysm of the celiac artery dissected in the superior wall with a consequent 4.3 cm pseudoaneurysm; we adopted an endovascular approach to exclude the lesion by catheterizing the celiac trunk and positioning a vascular plug in the common hepatic artery and a covered stent in the splenic artery; finally we fulfilled the aneurysm sac with Onyx. 30-day control CT scan revealed procedural success. Five years later he came back to our department for an aneurysm relapse in the common hepatic artery. We performed a second endovascular approach with a superselective catheterization of the pancreaticoduodenal arcade in order to exclude the lesion with Onyx and microcoils. Nowadays the patient is in good clinical conditions. Endovascular approach is a valuable method to treat visceral aneurysms; however, long-term imaging follow-up is essential to monitor the risk of relapse.
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