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Mosquea Gomez ER, Mehta B. When the Tree Branch Affects the Fruits: A Case of Celiac Artery Dissection. Cureus 2024; 16:e56695. [PMID: 38646304 PMCID: PMC11032513 DOI: 10.7759/cureus.56695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 04/23/2024] Open
Abstract
Arterial dissection is a laceration of an artery or arterial bed, that can extend to contiguous arteries and lead to accumulation of blood providing a great risk for thrombi formation, and possible ischemic events. Celiac artery dissection is a very rare pathology, with an unknown prevalence and a pathophysiology that still needs to be elucidated. Diagnosis has increased in the last decade due to higher imaging modalities and accessibility of such that provide simpler identification, as well as which treatment should be applied to a particular patient. In this case report, we present a 44-year-old male with abdominal pain, found to have on computed tomography angiography (CTA) a dissection of the celiac artery with extension to the splenic artery, causing multiple splenic infarcts, demonstrating that such lesions can be the cause of unexplained thrombosis in a certain patient population. Due to its complex presentation, management can differ based on the characteristics of the dissection as well as organ involvement, these modalities range from anticoagulation to surgical or endoscopic intervention. This case highlights the rare occurrence of an isolated dissection at a visceral artery causing thrombosis in a relatively healthy patient.
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Affiliation(s)
| | - Bijal Mehta
- Internal Medicine, Hackensack Meridian Mountainside Medical Center, Montclair, USA
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2
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Uehara H, Okuyama M, Oe Y, Yoshimura T, Gunji T. Sequential Multiple Visceral Artery Dissection within a Short Time, without Aortic Dissection. Ann Vasc Dis 2023; 16:214-218. [PMID: 37779642 PMCID: PMC10539126 DOI: 10.3400/avd.cr.23-00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/19/2023] [Indexed: 10/03/2023] Open
Abstract
A 65-year-old Japanese man without medical history presented with sudden onset lower abdominal pain to our emergency department. Contrast-enhanced computed tomography (CT) revealed dissections of the inferior mesenteric artery and left renal artery with false lumen thrombosis without aortic dissection. He was immediately hospitalized, and conservative treatment was administered. However, on the third-day post-onset, the patient reported severe upper abdominal pain and contrast-enhanced CT showed a new superior mesenteric artery dissection. He continued to receive conservative treatment, and his symptoms improved. He was discharged after ten days of hospitalization.
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Affiliation(s)
- Hiroki Uehara
- Department of Cardiovascular Medicine, Kin-ikyo Chuo Hospital, Sapporo, Hokkaido, Japan
| | - Masaki Okuyama
- Department of Cardiovascular Medicine, Kin-ikyo Chuo Hospital, Sapporo, Hokkaido, Japan
| | - Yutaro Oe
- Department of Cardiovascular Medicine, Kin-ikyo Chuo Hospital, Sapporo, Hokkaido, Japan
| | - Takaki Yoshimura
- Department of Cardiovascular Medicine, Kin-ikyo Chuo Hospital, Sapporo, Hokkaido, Japan
| | - Takahiro Gunji
- Department of Cardiovascular Medicine, Kin-ikyo Chuo Hospital, Sapporo, Hokkaido, Japan
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3
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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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Poggiali E, Negri C, Mosso F, Petrini M, Michieletti E, Vercelli A. A rare and unusual cause of acute abdominal pain: A case of spontaneous isolated dissection of the celiac trunk. EMERGENCY CARE JOURNAL 2022. [DOI: 10.4081/ecj.2022.10988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Spontaneous dissection of the celiac trunk is a rare and uncommon cause of acute abdominal pain. Risk factors, natural history and optimal treatment are still unclear due to the rarity of the disorder. Therapeutic strategies and follow-up procedures are based on limited observations, and the absence of guidelines warrants a patient-tailored approach. We report the case of a 50-year-old woman who presented to our emergency department for epigastric pain, nausea, and vomiting resulting from a spontaneous dissection of the celiac trunk, successfully treated endovascular technique.
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Pateman Aciu S, Petrochko J, Bassik N, Fisher J. Spontaneous isolated celiac and splenic artery dissection with splenic infarction. Radiol Case Rep 2022; 17:2085-2091. [PMID: 35464790 PMCID: PMC9018800 DOI: 10.1016/j.radcr.2022.03.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 03/13/2022] [Indexed: 11/30/2022] Open
Abstract
Spontaneous isolated celiac artery dissection is considered an uncommon clinical condition. Rarer still is spontaneous isolated celiac and splenic artery dissection, with a total of 42 reported cases. There is no known definitive cause of visceral artery dissections, but risk factors include male sex, age in 5th or 6th decade, hypertension, and connective tissue disorders. The presentation varies, diagnosis is principally radiographic, and the mainstay of treatment is anticoagulation or antiplatelet therapy. Splenic infarction is a common finding with splenic artery dissection, although the strength of this association has not previously been reported. Herein we present a case of spontaneous isolated celiac and splenic artery dissection with splenic infarction that was successfully managed with blood pressure control and antiplatelet therapy. We review previous literature, principles of diagnosis and management, and incidence and outcomes of splenic infarction as it related to splenic artery dissection.
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Xu Y, Bu W, Han X, Shen Y, Wu J, Chen G. Current status of spontaneous isolated celiac artery dissection. Vascular 2022:17085381221087812. [PMID: 35440251 DOI: 10.1177/17085381221087812] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study aimed to evaluate the current status of spontaneous isolated celiac artery dissection (SICAD). METHODS The English-language literature published in various databases before December 2020 was reviewed. All case reports and series were included. If multiple reports came from the same hospital and covered the same period, only the most recent report was considered. The clinical characteristics, imaging features, and treatment outcome were analyzed. RESULTS The study enrolled 88 English language publications between January 1959 and December 2020, including 70 case reports, two case series, and 16 clinical studies. Overall, 316 cases of SICAD were reported in the studies, including 268 men and 44 women (unavailable for 4, men: women ratio: 6:1, p < 0.05). The median age was 50.5 years (range: 6-72) in men and 53.9 years (range: 41-67) in women. Most patients (83.54%, 264/316) complained about stomach pain, primarily in the epigastric region (38.61%, 122/316). The misdiagnosis rate in this study was 3.16% (10/316). The most commonly used imaging modality was computed tomography angiography (CTA), with 97.47% (308/316) cases reporting its use in diagnosis and/or management. The rate of symptom improvement with Conservative Management, with or without antithrombotic agents, was 92.45% (98/106) and 96.58% (141/146), respectively. The rate of symptom improvement after surgical recanalization was 100% (13/13). Moreover, endovascular management resulted in a 100% (50/50) symptom improvement rate. CONCLUSION Conservative management is the first-line treatment for SICAD. The surgical or endovascular intervention had a high technical success rate, suggesting that it should be reserved for patients who have failed conservative treatment.
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Affiliation(s)
- Yingjiang Xu
- Department of Interventional Vascular Surgery, 74705Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Wenzhe Bu
- Department of Interventional Radiography, Yantai Qishan Hospital, Yantai, Shandong, China
| | - Xinqiang Han
- Department of Interventional Vascular Surgery, 74705Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Yuguo Shen
- Department of Interventional Vascular Surgery, 74705Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Jian Wu
- Department of Interventional Vascular Surgery, 74705Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Gang Chen
- Department of Interventional Vascular Surgery, 74705Binzhou Medical University Hospital, Binzhou, Shandong, China
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Freeman CL, Lacy AJ, Miner A, Rogers DM, Smith AT, Shah KS. Spontaneous Isolated Celiac Artery Dissection: A Case Report. Clin Pract Cases Emerg Med 2020; 4:414-416. [PMID: 32926700 PMCID: PMC7434257 DOI: 10.5811/cpcem.2020.5.46906] [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: 02/10/2020] [Accepted: 05/11/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction Abdominal pain is a common chief complaint that can represent a wide breadth of diagnoses, ranging from benign to life-threatening. As our diagnostic tools become more sophisticated, we are able to better identify more causes of potentially life-threatening diseases. One such disease that is relatively unfamiliar to clinicians is spontaneous isolated celiac artery dissection (SICAD). Case Report We describe a case of a 46-year-old man who presented to our emergency department with a chief complaint of abdominal pain and was found to have a SICAD and was successfully treated with anticoagulation, antihypertensives, and observation. Conclusion It is important for emergency physicians to keep this potentially life-threatening condition in mind and to know the appropriate first steps once identified.
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Affiliation(s)
- Clifford L Freeman
- Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee
| | - Aaron J Lacy
- Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee
| | - Aubrey Miner
- Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee
| | - Devin M Rogers
- Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee
| | - Austin T Smith
- Intermountain Healthcare, Park City Hospital, Department of Emergency Medicine, Park City, Utah
| | - Karan S Shah
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
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8
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Duraikannu C, Karunakaran P, Haithrous SA, Pulupula VNK. Natural course of incidentally detected isolated Celiac Artery Dissection with hepatic artery occlusion. Radiol Case Rep 2020; 15:479-483. [PMID: 32140191 PMCID: PMC7044499 DOI: 10.1016/j.radcr.2020.01.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/10/2020] [Accepted: 01/20/2020] [Indexed: 11/18/2022] Open
Abstract
Isolated celiac artery dissection (ICAD) is a rare entity with over 160 cases described in literature. We report a case of incidentally detected isolated celiac artery dissection during computed tomography evaluation for occult gastrointestinal bleeding. Though most cases of isolated celiac artery dissection are initially managed conservatively with antiplatelet and anticoagulants, some patients may require endovascular or occasionally surgical treatment. In our case, the celiac artery dissection had already progressed to cause hepatic artery occlusion and secondary collateral formation in the porta hepatis region. We retrospectively analyze the natural course of celiac artery dissection with hepatic artery occlusion in an asymptomatic patient for over 3 years.
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Miranda LE, Leitão L, Jucá N, Lacerda CM. Dissection of the Hepatic Artery: A Rare Cause of Late Ischemia After Liver Transplant. EXP CLIN TRANSPLANT 2019; 18:641-644. [PMID: 31250739 DOI: 10.6002/ect.2019.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hepatic artery dissection is an infrequent vascular complication that can arise after orthotopic liver transplant. Most patients with this complication are diagnosed during the intraoperative period or the first days after liver transplant, with an association shown with living-donor liver transplant. In this study, we discuss a rare case of an extrahepatic artery dissection that was successfully managed through surgical excision and arterial revascularization that was diagnosed 4 years after orthotopic liver transplant. Furthermore, we hypothesize on the potential causes of its occurrence.
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Affiliation(s)
- Luiz Eduardo Miranda
- From the Division of General Surgery and Liver Transplantation, Hospital Oswaldo Cruz, Pernambuco University, Recife, Pernambuco, Brazil
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10
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Van der Niepen P, van Tussenbroek F, Devos H, Debing E, Di Monaco S, Goffette P, Astarci P, Persu A. Visceral Fibromuscular Dysplasia: From asymptomatic disorder to emergency. Eur J Clin Invest 2018; 48:e13023. [PMID: 30156710 DOI: 10.1111/eci.13023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/16/2018] [Accepted: 08/24/2018] [Indexed: 12/24/2022]
Abstract
Fibromuscular dysplasia (FMD) is an idiopathic, segmental, non-atherosclerotic and non-inflammatory disease of the musculature of arterial walls, leading to stenosis of small and medium-sized arteries, mostly involving renal and cervical arteries. As a result of better and more systematic screening, it appears that involvement of the splanchnic vascular bed is more frequent than originally assumed. We review epidemiology, pathogenesis, clinical picture as well as diagnosis and treatment of visceral artery (VA) FMD. The clinical picture is very diverse, and diagnosis is based on CT-, MR- or conventional catheter-based angiography. Involvement of VAs generally occurs among patients with multi-vessel FMD. Therefore, screening for VA FMD is advised especially in renal artery (RA) FMD and in case of aneurysms and/or dissections. Treatment depends on the clinical picture. However, the level of evidence is low, and much of the common practice is extrapolated from visceral atherosclerotic disease.
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Affiliation(s)
- Patricia Van der Niepen
- Department of Nephrology & Hypertension, Universitair Ziekenhuis Brussel. Vrije Universiteit Brussel, Brussels, Belgium
| | - Frank van Tussenbroek
- Department of Radiology, Universitair Ziekenhuis Brussel. Vrije Universiteit Brussel, Brussels, Belgium
| | - Hannes Devos
- Department of Radiology, Universitair Ziekenhuis Brussel. Vrije Universiteit Brussel, Brussels, Belgium
| | - Erik Debing
- Department of Vascular Surgery, Universitair Ziekenhuis Brussel. Vrije Universiteit Brussel, Brussels, Belgium
| | - Silvia Di Monaco
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.,Internal Medicine and Hypertension Division, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Pierre Goffette
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Parla Astarci
- Division of Vascular Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.,Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.,Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
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11
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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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Morgan CE, Mansukhani NA, Eskandari MK, Rodriguez HE. Ten-year review of isolated spontaneous mesenteric arterial dissections. J Vasc Surg 2017; 67:1134-1142. [PMID: 29146096 DOI: 10.1016/j.jvs.2017.08.071] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 08/04/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Isolated spontaneous dissection of the superior mesenteric artery (SMA) and celiac artery (CA) remains a rare condition; however, it has been increasingly noted incidentally on diagnostic imaging. The purpose of this study was to examine the natural history and outcomes of patients presenting with isolated spontaneous mesenteric artery dissection (SMAD). We hypothesized that most SMADs can be treated nonoperatively. METHODS This was a single-center retrospective review of patients presenting with the diagnosis of SMAD between 2006 and 2016. Data analysis included demographics, clinical data, radiologic review, treatment, and outcomes. RESULTS A total of 77 patients were found to have CA dissection, SMA dissection, or both in the absence of aortic dissection diagnosed on computed tomography or magnetic resonance imaging. The average age was 56 years (range, 26-86 years), 80% were male, and 10 patients (13%) had underlying connective tissue disorders. The majority, 64%, presented with symptoms including abdominal pain, back pain, and chest pain; the remaining 36% were asymptomatic. Combined SMA and CA dissection was found in 14 (18%) patients; 33 (43%) presented with isolated CA dissection, and 30 (39%) presented with isolated SMA dissection. Only four patients required intervention. Mesenteric bypass was performed in two patients, and SMA endarterectomy with patch angioplasty was performed in one patient for signs of bowel ischemia. No patient required bowel resection. The two bypasses were anastomosed to a branch of the SMA, and complete lumen restoration was seen on long-term imaging follow-up. One patient underwent stent grafting of the CA and hepatic artery for aneurysmal degeneration 1 month after diagnosis. The remaining 73 patients were managed nonoperatively; 40 (52%) were treated with a short course of anticoagulation, 23 (30%) were treated with antiplatelet therapy, and 10 (13%) were treated with observation alone. No other late interventions or recurrences were noted during a mean follow-up of 21 months. CONCLUSIONS Whereas isolated SMAD poses a risk of visceral ischemia, most patients presenting with this diagnosis can be treated nonoperatively with a short course of antiplatelet or anticoagulant therapy. Only a small number of patients require surgical revascularization for bowel ischemia.
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Affiliation(s)
- Courtney E Morgan
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Neel A Mansukhani
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Mark K Eskandari
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Heron E Rodriguez
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill.
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Tanaka Y, Yoshimuta T, Kimura K, Iino K, Tamura Y, Sakata K, Hayashi K, Takemura H, Yamagishi M, Kawashiri MA. Clinical characteristics of spontaneous isolated visceral artery dissection. J Vasc Surg 2017; 67:1127-1133. [PMID: 29056349 DOI: 10.1016/j.jvs.2017.08.054] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/04/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Spontaneous isolated visceral artery dissection (SIVAD) involving the celiac artery or superior mesenteric artery is rare, but it can be fatal. Given its rare incidence, the clinical characteristics of SIVAD are not fully understood. Therefore, the aim of this study was to investigate the clinical characteristics and prognosis of SIVAD. METHODS We retrospectively reviewed 39 consecutive patients diagnosed with SIVAD from January 2007 to December 2016. Demographic characteristics, symptoms, vital signs, blood examination results, and computed tomography findings were retrieved through medical record review. RESULTS The median age of the patients was 52 years; 94.9% were male, and 64.1% were symptomatic. Median follow-up duration was 11 months. Overall, hypertension (48.7%) and smoking (79.5%) were frequently observed. There were significant differences between symptomatic and asymptomatic patients in white blood cell count and creatine kinase level but not in fibrin degradation products or D-dimer level. There was a significant correlation between symptoms and length of dissection on computed tomography (P < .01). Conservative treatment was performed in 32 patients (82.1%), and only 7 patients required open surgery or intravascular intervention. Notably, the diameter of affected vessels decreased spontaneously with no rupture or symptom recurrence during follow-up, and mortality was 0% at both 30 days and 1 year. CONCLUSIONS The utility of blood examination, especially for fibrin degradation products and D-dimer levels, for diagnosis of SIVAD is limited. A high index of suspicion is warranted in patients presenting with persistent severe abdominal pain. Conservative treatment should be considered first-line therapy in patients without any signs of bowel ischemia or rupture.
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Affiliation(s)
- Yoshihiro Tanaka
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Tsuyoshi Yoshimuta
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Keiichi Kimura
- Department of Thoracic, Cardiovascular, and General Surgery, Kanazawa University, Kanazawa, Japan
| | - Kenji Iino
- Department of Thoracic, Cardiovascular, and General Surgery, Kanazawa University, Kanazawa, Japan
| | - Yudai Tamura
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Kenji Sakata
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Kenshi Hayashi
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Hirofumi Takemura
- Department of Thoracic, Cardiovascular, and General Surgery, Kanazawa University, Kanazawa, Japan
| | - Masakazu Yamagishi
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
| | - Masa-Aki Kawashiri
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
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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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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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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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17
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Kim W, Gandhi RT, Peña CS, Tartaglione RE, Taubman ML, Katzen BT. Robotic system-assisted endovascular treatment of a dissection-related pseudoaneurysm of the celiac axis secondary to fibromuscular dysplasia. J Vasc Surg Cases Innov Tech 2016; 2:145-148. [PMID: 38827192 PMCID: PMC11140368 DOI: 10.1016/j.jvscit.2016.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 06/03/2016] [Indexed: 11/18/2022] Open
Abstract
Spontaneous celiac artery dissection caused by fibromuscular dysplasia is rare. Subsequent thrombosis and occlusion of the celiac trunk can result in intestinal ischemia and hepatic failure. We describe a case of spontaneous celiac artery dissection with an associated pseudoaneurysm caused by fibromuscular dysplasia, extending into the common hepatic artery. An endovascular intervention featuring robotic-assisted celiac artery cannulation with stent-assisted coil embolization resulted in successful treatment.
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Affiliation(s)
- Wonho Kim
- Division of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla
- Herbert Wertheim College of Medicine, Florida International University, Miami, Fla
| | - Ripal T. Gandhi
- Division of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla
| | - Constantino S. Peña
- Division of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla
| | - Robert E. Tartaglione
- Division of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla
| | - Michele L. Taubman
- Division of Vascular Surgery, Miami Cardiac and Vascular Institute, Miami, Fla
| | - Barry T. Katzen
- Division of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Fla
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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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Kaihara T, Komiyama K, Fukamizu S, Ashikaga T, Sakurada H. An isolated spontaneous dissecting celiac artery aneurysm with successful endovascular treatment using stenting and coil embolization. J Cardiol Cases 2016; 13:155-157. [PMID: 30546633 DOI: 10.1016/j.jccase.2016.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 12/29/2015] [Accepted: 01/19/2016] [Indexed: 11/16/2022] Open
Abstract
Isolated spontaneous dissecting celiac artery aneurysm (DCAA) is a rare event. We report the case of a 50-year-old Japanese man with sudden post-prandial epigastric pain. He was diagnosed as having an isolated DCAA based on the results of contrast-enhanced multi-slice computed tomography (CT). Initially, we gave him conservative therapy, but the aneurysm grew and then we performed endovascular treatment. The DCAA did not cause a rupture, and there were rich collateral channels between the superior mesenteric artery and the common hepatic artery. However, the neck of the aneurysm was too broad to indwell coils, and it was thought that coils might drop out from the aneurysm. We chose endovascular therapy with a self-expanding stent and coil embolization, and the aneurysm was extinguished. He was successfully treated and has recovered favorably. To our knowledge, few cases of a DCAA treated with both a self-expanding stent and coil embolization have been reported and this strategy may be one of the endovascular treatment options for a DCAA. More data accumulation of this method and investigation of long-term treatment effect are required in the future. <Learning objective: A dissecting celiac artery aneurysm is a rare event. Conservative, endovascular, and surgical therapies have been described, but no optimum treatment exists. For the present patient, we chose endovascular therapy with a stent and coil embolization, and he was successfully treated. To our knowledge, few cases of this condition treated with both stenting and coiling have been reported. We suggest that this strategy be one of the endovascular treatment options for this condition.>.
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Affiliation(s)
- Toshiki Kaihara
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Kota Komiyama
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Seiji Fukamizu
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Takashi Ashikaga
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Harumizu Sakurada
- Tokyo Metropolitan Health and Medical Treatment Corporation Ohkubo Hospital, Tokyo, Japan
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20
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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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21
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Galastri FL, Cavalcante RN, Motta-Leal-Filho JM, De Fina B, Affonso BB, de Amorim JE, Wolosker N, Nasser F. Evaluation and management of symptomatic isolated spontaneous celiac trunk dissection. Vasc Med 2015; 20:358-63. [DOI: 10.1177/1358863x15581447] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study is to describe 10 cases of symptomatic isolated spontaneous celiac trunk dissection (ISCTD) in order to evaluate the initial clinical presentation, diagnosis, treatment modalities and outcomes. A retrospective search was performed from 2009 to 2014 and 10 patients with ISCTD were included in the study. Patients with associated aortic and/or other visceral artery dissection were excluded. The following information was collected from each case: sex, age, associated risk factors, symptoms, diagnostic method, anatomic dissection pattern, treatment modality and outcome. Most patients were male (90%), with an average age of 44.8 years, and the most common symptom was abdominal pain (100%). Hypertension and vasculitis (polyarteritis nodosa) were the most frequent risk factors (40% and 30%, respectively). Diagnosis was made in all patients with computed tomography. Dissection was limited to the celiac trunk in three patients and extended to celiac branches in the other seven. Initial conservative treatment was attempted in every case and was successful in nine patients. In one case, initial conservative treatment was unsuccessful and arterial stenting with coil embolization of the false lumen was performed. After successful initial treatment, late progression of the dissection to aneurysmal dilatation was observed in two patients and it was decided to perform endovascular treatment. Mean follow-up was 19 months, ranging from 2 to 59 months. In conclusion, initial conservative treatment seems adequate for most patients with ISCTD. Long-term follow-up is mandatory, owing to the risk of later progression to aneurysm.
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Affiliation(s)
| | | | | | - Bruna De Fina
- Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | - Nelson Wolosker
- Vascular Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Felipe Nasser
- Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
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22
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Three Overlapping Balloon-expandable Stents Applied in Coeliac Artery Dissection: Case Report and Literature Review. W INDIAN MED J 2015; 63:791-2. [PMID: 25867568 DOI: 10.7727/wimj.2014.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 04/02/2014] [Indexed: 11/18/2022]
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23
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DiMusto PD, Oberdoerster MM, Criado E. Isolated celiac artery dissection. J Vasc Surg 2015; 61:972-6. [PMID: 25601505 DOI: 10.1016/j.jvs.2014.10.108] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 10/30/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Spontaneous celiac artery dissection is rare, and its natural history is not well studied. The objective of this study was to review our experience with the evaluation and management of this condition. METHODS During the last 8 years, 19 patients (14 men, five women) presented with the diagnosis of spontaneous celiac artery dissection. Each patient's clinical course was retrospectively reviewed, and patients were contacted for assessment of current symptoms. RESULTS All patients had computed tomography scans documenting a celiac artery dissection without concomitant aortic dissection. Ages ranged from 39 to 76 years. Seven patients presented with abdominal pain, and 12 were diagnosed incidentally. All patients were initially treated with observation because none had threatened end organs. Patients presenting with aspirin or clopidogrel therapy were continued on these medications, but no patients were prescribed any medications due to their dissection. Three patients continued to have abdominal pain and eventually underwent celiac artery stenting. Pain improved after the intervention in all three. One patient with aneurysmal degeneration of the celiac artery underwent surgical repair. No other patients required intervention. Eighteen patients had follow-up within a year of data collection in the clinic or over the phone. The average time from the initial diagnosis to follow-up for the entire cohort was 46 months. None had abdominal or back pain related to the celiac dissection, had lost weight, or had to change their eating habits. CONCLUSIONS Celiac artery dissection can be safely managed initially with observation. If abdominal pain is persistent, endovascular stenting may stabilize or improve the pain, and surgical reconstruction can be done for aneurysmal degeneration or occlusion, both unusual events. Long-term anticoagulation does not appear necessary in these patients.
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Affiliation(s)
- Paul D DiMusto
- Section of Vascular Surgery, University of Michigan, Ann Arbor, Mich
| | | | - Enrique Criado
- Section of Vascular Surgery, University of Michigan, Ann Arbor, Mich.
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24
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Clinical features of isolated dissections of abdominal aortic branches. Heart Vessels 2014; 31:1006-9. [PMID: 25421008 DOI: 10.1007/s00380-014-0605-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 11/14/2014] [Indexed: 10/24/2022]
Abstract
Isolated dissection of an abdominal aortic branch is a rare entity, and previous reports regarding the condition have been based only on small case-series studies. Using a national inpatient database in Japan, we describe the clinical features of patients with isolated celiac, superior mesenteric, splenic, and hepatic artery dissections (ICAD, ISMAD, ISAD, and IHAD). We extracted data on inpatients who were diagnosed with ICAD, ISMAD, ISAD, or IHAD from the Japanese diagnosis procedure combination database, including patients' age and sex, putative risk factors (smoking status and specific comorbidities), treatments (blood transfusion, transcatheter arterial embolization (TAE) and surgical procedures), and outcomes (in-hospital complications and death). Among 18.3 million inpatients in the database between July 2010 and March 2013, we identified 276 ICAD, 715 ISMAD, 23 ISAD and 11 IHAD. The percentage of males was 78-92 %, and the mean age was 54.7-56.8 years. Hypertension was seen in 48-65, and 35-65 % were smokers. Fourteen in-hospital deaths were identified in total. In the ICAD group, splenectomy was performed in one patient and TAE was performed in 26 patients. In the ISMAD group, 16 patients received surgical intervention. Most patients with isolated dissection of an abdominal aortic branch were treated conservatively, while a small percentage required TAE or open surgery. A small proportion of dissections resulted in death.
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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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26
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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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27
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Affiliation(s)
- Tsuneaki Kenzaka
- Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Japan
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28
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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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