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Tresson P, Tawdi M, Rivoire E, Millon A, Passot G, Rouvière O, Long A. Dissection of the Celiac Trunk Is a Mild Disease. Ann Vasc Surg 2024; 105:362-372. [PMID: 38583764 DOI: 10.1016/j.avsg.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND The purpose of this study was to assess whether the presence of an aneurysmal or dissecting arterial disease was a risk factor of poor prognosis in patients presenting a dissection of the celiac trunk (CT). METHODS All patients presenting a CT dissection between January 1, 2014, and June 30, 2022, were included. Patients with a CT dissection due to the extension of an aortic dissection were excluded. Les antécédents familiaux de dissection, de maladie anévrysmale, de maladie athéromateuse ou du tissu conjonctif, la pratique d'une activité physique ou sportive, un effort inhabituel les jours précédant la dissection ainsi qu'un traumatisme étaient recherchés. Family history of dissection, aneurysmal disease, atheromatous or connective tissue disease, physical activity or sport, an unusual effort in the days prior to the dissection and trauma were sought after. Ischemic or aneurysmal complications in the acute phase and the evolution of the dissection were evaluated and compared between patients with an isolated dissection and those presenting an aneurysmal or dissecting arterial disease. RESULTS 45 patients were included in the study. Twenty-three (51.1%) patients presented with symptomatic CT dissection, and 22 (48.9%) with asymptomatic CT dissection. All the patients initially had medical management alone. The mean follow-up was 32 ± 25 months and all patients were asymptomatic at the time last news. 24 (53.3%) presented an isolated CT dissection, and 21 (46.7%) a CT dissection associated with aneurysmal or dissecting arterial disease. There was no significant difference between patients with an isolated CT dissection and those with an associated dissecting or aneurysmal pathology. CONCLUSIONS CT dissection is a stable disease in the midterm, which makes it a mild arterial pathology, with or without aneurysmal or dissecting anomalies in another territory. The mechanical stress exerted on the CT by the arcuate ligament could be responsible for parietal trauma and favor the occurrence of a CT dissection.
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Affiliation(s)
- Philippe Tresson
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service de Chirurgie Vasculaire et Endovasculaire, Bron cedex, France.
| | - Maria Tawdi
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Interne et de Médecine Vasculaire, Lyon cedex, France
| | - Emeraude Rivoire
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Interne et de Médecine Vasculaire, Lyon cedex, France; Université Claude Bernard Lyon 1, LIBM EA7424, Equipe Athérosclérose, Thrombose et Activité Physique, Faculté de Médecine Rockefeller, Lyon, France
| | - Antoine Millon
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service de Chirurgie Vasculaire et Endovasculaire, Bron cedex, France; Université Claude Bernard Lyon 1, LIBM EA7424, Equipe Athérosclérose, Thrombose et Activité Physique, Faculté de Médecine Rockefeller, Lyon, France
| | - Guillaume Passot
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Chirurgie Digestive, Lyon cedex, France
| | - Olivier Rouvière
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Radiologie Urinaire et Vasculaire, Lyon cedex, France
| | - Anne Long
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Interne et de Médecine Vasculaire, Lyon cedex, France; Université Claude Bernard Lyon 1, LIBM EA7424, Equipe Athérosclérose, Thrombose et Activité Physique, Faculté de Médecine Rockefeller, Lyon, France
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Pu Y, Luo Y. Multi-modal imaging for the diagnosis of spontaneous visceral artery dissection: A case report. World J Gastrointest Surg 2024; 16:1430-1435. [PMID: 38817294 PMCID: PMC11135292 DOI: 10.4240/wjgs.v16.i5.1430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 03/26/2024] [Accepted: 04/11/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Spontaneous visceral artery dissection (SVAD) is a rare condition that affects the visceral arteries, such as the celiac, superior mesenteric, and inferior mesenteric arteries, without involving the aorta. Organ ischemia or hemorrhage from vessel rupture can occur in SVAD; therefore, prompt detection and management is essential. Contrast-enhanced computed tomography (CECT) has been used to diagnose most of the previous cases, but few studies have explored the potential of contrast-enhanced ultrasound (CEUS) for early detection of this disease. CASE SUMMARY A 53-year-old male presented with complaints of poor appetite and abnormal liver function for the past 6 months. He had previously undergone transabdominal splenectomy, esophagogastric devascularization, and cholecystectomy for gallstones and severe portal hypertension. Liver ultrasound was performed in our department to assess liver status. An abnormal hepatic artery spectrum was observed, and dissection involving both the celiac artery and the common hepatic artery was observed. A CEUS was then performed and clearly showed the entry site of the intimal tear and the false lumen, and dissection was subsequently confirmed by CECT. The patient was asymptomatic; therefore, treatment to control the blood pressure was provided, and follow-up was recommended. After 6 months of follow-up, the celiac artery was found to be dilated with an adherent thrombus visible in the wall, and the common hepatic artery was occluded with the presence of collateralization. Despite these findings, no significant changes in liver function were observed. CONCLUSION Multi-modal imaging is effective in diagnosing SVAD, and conservative treatment is a choice for asymptomatic patients.
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Affiliation(s)
- Yang Pu
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yan Luo
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Gonzalez-Urquijo M, Vargas JF, Marine L, Mertens N, Valdes F, Bergoeing M, Mertens R. Management of Spontaneous Isolated Celiac Artery Dissection. Ann Vasc Surg 2024; 102:1-8. [PMID: 38307228 DOI: 10.1016/j.avsg.2023.11.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/13/2023] [Accepted: 11/19/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Spontaneous isolated celiac artery dissection (SICAD) is uncommon, with very few series reported in the literature. The present study aims to describe the clinical characteristics and treatment outcomes of patients with SICAD treated at a single Chilean institution over 20 years. METHODS A retrospective review of all patients from a single academic hospital with SICAD diagnosed between January 2003 and March 2023 was performed. Conservative treatment included antiplatelets, anticoagulation, or both. The normal size of a celiac artery in our population was 7.9 ± 0.79 mm in females and 8.3 ± 1.08 mm in males. We defined a celiac artery with a diameter equal to or more than 12.5 mm as an aneurysmal celiac artery. RESULTS The cohort included 27 patients; 77.8% (n = 21) were males. The median age was 51.0 years (range: 38-84 years). Fourteen (51.8%) patients presented with aneurysmal dilatation. Fourteen (51.8%) patients were treated with antiplatelets, 6 (22.2%) patients with anticoagulation, and 7 (25.9%) with anticoagulation and antiplatelets. One patient was treated with endovascular therapy due to a pseudoaneurysm of the celiac artery detected 10 days after conservative treatment with antiplatelets. The median length of hospital stay was 5 days (range: 2-14 days). Complete remodeling was seen in 6 (22.2%) patients, partial remodeling in 10 (37.0%) patients, and no change was seen in 8 (26.9%) patients. Three (11.5%) patients were lost to follow-up. There were no significant differences between treatments and remodeling outcomes (P = 0.729). The median celiac artery diameter of patients with aneurysmal dilatation was 13.5 mm (range: 12.5-20.5 mm). Systemic arterial hypertension was found more commonly in patients who presented with aneurysmal dilatation than in patients without (87.5% vs. 12.5%, respectively, P = 0.016). Mean follow-up was 41.5 months and median follow-up was 16 months (range: 6-204 months). CONCLUSIONS Most patients with SICAD can be treated conservatively with excellent outcomes. Hypertension was more commonly found in patients with SICAD and aneurysmal dilatation.
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Affiliation(s)
- Mauricio Gonzalez-Urquijo
- Departamento de Cirugía Vascular y Endovascular, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Jose Francisco Vargas
- Departamento de Cirugía Vascular y Endovascular, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Leopoldo Marine
- Departamento de Cirugía Vascular y Endovascular, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Nicolas Mertens
- Departamento de Radiología, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Francisco Valdes
- Departamento de Cirugía Vascular y Endovascular, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Michel Bergoeing
- Departamento de Cirugía Vascular y Endovascular, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Renato Mertens
- Departamento de Cirugía Vascular y Endovascular, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
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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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Shang T, Zhou HJ, Wang YS, Qiu C, Chen TC, Sun J, Lu T, Wu Z, Zhang H, Li Z, Li DL. Mid-term Results of the Treatment of Isolated Dissection of the Celiac Artery: A Comparative Analysis of Endovascular Versus Conservative Therapy. J Endovasc Ther 2024; 31:80-88. [PMID: 35852451 DOI: 10.1177/15266028221112254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Endovascular treatment (EVT) is an alternative method used to treat isolated dissection of the celiac artery (IDCA). However, only a few mid-term results have been reported. This study aimed to analyze and compare the outcomes of endovascular and non-operative therapies for IDCA. METHODS Data from a cohort of consecutive IDCA patients enrolled in the study hospital between April 2012 and September 2020 were retrospectively reviewed. Demographic information, imaging features, treatment modalities, and follow-up results of celiac artery remodeling and adverse events were collected and analyzed. RESULTS A total of 87 patients were enrolled in the study. Stents were deployed in 68 patients, and non-operative treatment (blood pressure control and pain management) was continued in the remaining 19 patients who did not receive stenting; among these 19 patients, EVT failed in 6. The mean follow-up period was 37.3 (range, 10-85 months) and 44.0 (range, 9-80 months) months in the EVT and non-operative groups, respectively. During follow-up, the overall complete remodeling (absence of residual dissection with no false lumen or no intramural thrombus) rate was significantly higher in the EVT group than in the non-operative group (87.3% vs 7.1%, p<0.001). The incomplete remodeling (improved true lumen with malabsorption or partial thrombosis of the false lumen) rate was not significantly different between the EVT and non-operative groups (6.3% vs 14.3%; p=0.2984). Meanwhile, the adverse event-free survival rates were 89.0%, 67.0%, and 67.0% at 1, 3, and 5 years, respectively, in the EVT group compared with 39.7% and 29.8% at 1 and 3 years in the non-operative group (p<0.0001). CONCLUSIONS EVT for IDCA may be considered an effective management option with a favorable clinical success rate, an encouraging complete remodeling rate, and a satisfactory adverse event-free survival rate. However, further evaluation with a long-term follow-up is required. CLINICAL IMPACT Endovascular intervention for isolated dissection of the celiac artery has attracted inadequate attention. In this retrospective study with comparative analysis of endovascular versus conservative therapy for isolated dissection of the celiac artery patients, a better complete remodeling rate and a higher adverse event-free survival rate were observed in the endovascular treatment (EVT) group during follow-up, indicating that EVT could be an effective management option for isolated dissection of the celiac artery.
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Affiliation(s)
- Tao Shang
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hua-Ji Zhou
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Vascular Surgery, Ping Hu People's Hospital, Jiaxing, China
| | - Yi-Shu Wang
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chenyang Qiu
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tian-Chi Chen
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jie Sun
- Department of Vascular Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo No.2 Hospital), Ningbo, China
| | - Tian Lu
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ziheng Wu
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongkun Zhang
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhenjiang Li
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dong-Lin Li
- Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Kim SM, Ko H. Spontaneous Celiac Artery Dissection with Splenic Infarction: A Report of Two Cases. Vasc Specialist Int 2023; 39:24. [PMID: 37667822 PMCID: PMC10480045 DOI: 10.5758/vsi.230067] [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: 07/13/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 09/06/2023] Open
Abstract
Spontaneous isolated celiac artery dissection (SICAD) is a rare condition that is characterized by sudden onset abdominal pain, typically occurring in middle-aged men. Although its clinical course is mostly benign, it may progress to true lumen occlusion. No established therapeutic guidelines are available for SICAD associated with splenic infarction. This report describes two patients who presented with sudden onset abdominal pain and were diagnosed with SICAD with splenic infarction based on computed tomography (CT) findings. Patients were treated with bowel rest and anticoagulants. After a week of medical therapy, the abdominal pain resolved. Follow-up CT revealed no progression of the dissection flap. The patients received oral anticoagulants for 3 months and did not experience any symptom recurrence. Medical therapy with anticoagulants may be considered for patients with SICAD and splenic infarction. Associated splenic infarction itself is not an indication for endovascular or surgical intervention for SICAD.
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Affiliation(s)
- Suh Min Kim
- Department of Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyunmin Ko
- Department of Surgery, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
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7
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Risk factor analysis and treatment outcome of patients with spontaneous isolated celiac axis or superior mesenteric artery dissection. J Vasc Surg 2023; 77:150-157. [PMID: 36087832 DOI: 10.1016/j.jvs.2022.08.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/08/2022] [Accepted: 08/30/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Spontaneous isolated mesenteric artery (celiac axis or superior mesenteric artery [SMA]) dissection (IMAD) is a rare clinical entity. The aim of the present study was to examine the patient demographics, comorbidities, clinical and radiologic features, management, and prognosis and to identify the risk factors predictive of symptoms. METHODS We performed a single-center, retrospective review from November 2005 to November 2021 of prospectively collected data from patients with a diagnosis of IMAD. The clinical data and radiologic images were reviewed, and statistical analysis was performed to compare the symptomatic and asymptomatic groups. RESULTS A total of 78 patients were identified. Of the 78 patients, 24 (31%) had had celiac dissections, 51 (65%) had had SMA dissections, and 3 (4%) had had both celiac and SMA dissections. The mean age was 57.7 years (range, 36-84 years), with a male predominance (86%). More than one half (55%) of the patients had had hypertension. In addition, 29 patients (37%) were symptomatic, and 24 (31%) had been admitted to the hospital. The symptomatic patients with celiac axis dissections were more likely to have thrombosis (P = .02), significant stenosis (P = .01) or branch extension (P = .02). The symptomatic patients with SMA dissections were more likely to have a smaller artery diameter (P = .07), a longer dissection length (P = .05), thrombosis (P < .001), significant stenosis (P < .001), or branch extension (P = .003). The symptomatic patients were more likely to have been treated with antiplatelet or anticoagulant therapy (P < .001). Only three patients had undergone an intervention. Seven patients (9%) had died of unrelated causes. The Kaplan-Meier survival analysis showed a 5-year survival rate of 96% and 10-year survival rate of 91%. CONCLUSIONS IMAD is an uncommon disease entity with a risk of visceral ischemia. Nonetheless, most of these patients can be treated conservatively with medication, with only a small minority requiring emergency surgery.
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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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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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Yamamoto H, Matsuoka R, Tsuyuki Y, Kamimura K, Tsukamoto K, Tachibana M, Aoyama T, Kanamori N, Tsutsumi Y. Acalculous Ischemic Cholecystitis Caused by Spontaneous Celiac Artery Dissection. Intern Med 2022; 61:53-58. [PMID: 34176844 PMCID: PMC8810253 DOI: 10.2169/internalmedicine.7793-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 05/11/2021] [Indexed: 11/06/2022] Open
Abstract
We herein report a case of spontaneous isolated dissection of the celiac artery. A Japanese man in his 50s visited an emergency unit, complaining of sudden epigastralgia. Contrast-enhanced computed tomography indicated dissection of the celiac artery with patent false and true lumina, extending to the splenic and common hepatic arteries. On day 3 of hospitalization, the dissection progressed to the proper and right hepatic arteries. Progression of the dissection to the right hepatic artery provoked acalculous ischemic cholecystitis, and cholecystectomy followed. The resected gallbladder revealed extensive aseptic necrosis with little inflammatory reaction, and the gallbladder neck was spared from ischemia.
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Affiliation(s)
| | - Ryota Matsuoka
- Department of Cardiology, Shimada Municipal Hospital, Japan
| | | | | | - Kei Tsukamoto
- Department of Diagnostic Radiology, Shimada Municipal Hospital, Japan
| | | | - Takeshi Aoyama
- Department of Cardiology, Shimada Municipal Hospital, Japan
| | - Norio Kanamori
- Department of Cardiology, Shimada Municipal Hospital, Japan
| | - Yutaka Tsutsumi
- Department of Diagnostic Pathology, Shimada Municipal Hospital, Japan
- Diagnostic Pathology Clinic, Pathos Tsutsumi, Japan
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Li S, Luo J, Yin L, Yan C, Zhu Y, Wang J, Gao Z, Liu Z, Chen B. Aneurysmal celiac trunk dissection caused by median arcuate ligament syndrome successfully treated by endovascular technique: a case report. AME Case Rep 2021; 5:37. [PMID: 34805756 DOI: 10.21037/acr-20-123] [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: 07/08/2020] [Accepted: 06/29/2021] [Indexed: 11/06/2022]
Abstract
Median arcuate ligament syndrome (MALS) is a chronic pathogenic process, resulting from the compression of the celiac axis by fibrous attachments of the diaphragmatic crura which named median arcuate ligament. In clinical, isolated spontaneous superior mesenteric artery (SMA) is common. Whereas, isolated celiac trunk (CA) dissection is rare, it is usually associated with aortic dissection. In this case report, the CA is not only dissected, but also the aneurysm formed. Because the long-time compression of the MALS, relative narrowing of the celiac artery causes the high pressure at the beginning of the CA and that may contribute to the aneurysmal celiac trunk dissection (ACTD). This case described a male patient who underwent hypertension and abdominal pain as their main clinical manifestation. Contrast-enhanced computed tomography angiography (CTA) showed that a slightly stenosed root of the celiac artery during inhalation and severe stenosis of the root during expiration. Moreover, a small intimal tear at the site of celiac artery proximal end with nonruptured aneurysmal dilation located on the celiac trunk. After our carefully examinations, the patient was diagnosed as ACTD caused by MALS. And we applied endovascular technique-stenting in this case. It could not only cover the dissection, but also could obstruct the aneurysm. The patient was in a stable condition after management of ACTD by stenting. Stenting is a safe and effective treatment for ACTD caused by MALS.
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Affiliation(s)
- Sen Li
- Department of Vascular Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiaqing Luo
- Department of General Surgery, Changxing People Hospital, Huzhou, China
| | - Li Yin
- Department of Vascular Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chao Yan
- Department of Vascular Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuhua Zhu
- Department of General Surgery, Changxing People Hospital, Huzhou, China
| | - Jian Wang
- Department of Vascular Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhiwei Gao
- Department of Vascular Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhenjie Liu
- Department of Vascular Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bing Chen
- Department of Vascular Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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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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14
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Gao X, Xie W, Shang D, Liu J, Jin B, Xu YJ. Clinical features and management strategy of symptomatic spontaneous isolated celiac artery dissection. Vascular 2021; 29:865-873. [PMID: 33435814 DOI: 10.1177/1708538120986295] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the clinical features and management strategy for patients with symptomatic spontaneous isolated celiac artery dissection (SICAD). METHODS In this retrospective study, consecutive patients with symptomatic SICAD from two institutions were included. The demographics, clinical manifestations, comorbidities, imaging findings and treatment strategy selection were obtained from the medical records. The general epidemiological data, treatment regimens and clinical and follow-up outcomes were analysed. RESULTS Patients were divided into the conservative treatment group (group A, n = 26) and endovascular treatment group (group B, n = 11). Of these 37 patients, extent of dissection in both groups included only celiac trunk (61.54%% vs. 18.18%, p = 0.03), common hepatic artery (CHA) and splenic artery (SA) (3.85%% vs. 54.55%, p = 0.001), CHA (7.69% vs. 18.18%, p = 0.57), SA (23.08% vs. 9.09, p = 0.65) and left gastric artery (LGA) (3.85% vs. 54.55%, p = 0.99). Of note, the extension of the lesion in group A was shorter than that in group B. In addition, there were significantly more type IIb in group A than in group B (42.31% vs. 9.09%, p = 0.06) and the mean length of dissection in group A was 42.3 ± 54.71 mm which was significantly shorter than that in the group B 58.45 ± 3.71 mm (p =0.04). During a median follow-up of 11.5 months, the 1, 3, 6 and 12 month follow-ups were completed in 100% (37/37), 100% (37/37), 94.59% (35/37) and 91.19% (34/37) of patients, respectively. The cumulative rate of persistent disease stability in patients with endovascular treatment group was higher than in that conservative treatment group at the 3, 6, 9 and 12 months (50% vs. 16.67%, p = 0.001; 80% vs. 37.5%, p =0.03; 100% vs. 62.5%, p = 0.012;100% vs. 91.67%, p = 0.02 respectively). CONCLUSION Most symptomatic SICAD have a tendency to persistent disease stability after conservative treatment. Risk factors for failed conservative treatment were length of dissection and branch involvement. Furthermore, endovascular treatment was associated with a high technical success and persistent disease stability rate, which might be reserved for patients with failed conservative treatment.
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Affiliation(s)
- Xiujuan Gao
- Department of Cerebrovascular Surgery, Binzhou Medical University Hospital, Binzhou, PR China
| | - Weiping Xie
- Department of Rehabilitation Medicine, Peoplement of RehabilDingtao District, Heze City, PR China
| | - Dan Shang
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Jianyong Liu
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Bi Jin
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Ying Jiang Xu
- Department of Interventional Vascular Surgery, Binzhou Medical University Hospital, Binzhou, PR China.,Key Laboratory of Metabolism and Molecular Medicine, The Ministry of Education, Department of Biochemistry and Molecular Biology, Fudan University Shanghai Medical College, Shanghai, PR China
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15
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Henkin S, Wysokinski WE, Tweet M, Shamoun F, Naidu S, Sutkowska K, Bator K, Shields R, Greene E, Keller S, Hodge D, McBane R. Spontaneous visceral artery dissections in otherwise normal arteries: Clinical features, management, and outcomes compared with fibromuscular dysplasia. J Vasc Surg 2020; 73:516-523.e2. [PMID: 32623103 DOI: 10.1016/j.jvs.2020.05.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 05/22/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Visceral artery dissection with otherwise normal-appearing arteries (VADNA), diagnosed on imaging and suggestive of segmental arterial mediolysis, is a poorly understood disease entity. Study objectives were to define the clinical features, management, and outcomes of patients with VADNA compared with patients with fibromuscular dysplasia (FMD). METHODS In this single-center retrospective cohort study, consecutive patients with a diagnosis of VADNA or FMD evaluated in the Mayo Clinic Gonda Vascular Center (January 1, 2000-April 1, 2017) were identified. Patient demographics, symptom presentation, management, composite adverse arterial events (recurrent arterial dissection, stroke or transient ischemic attack, myocardial infarction, mesenteric or renal infarction, or need for revascularization), and overall survival were compared between VADNA and FMD patients. RESULTS There were 103 VADNA patients (age [mean ± standard deviation], 51.7 ± 11.0 years; 27.9% female) and 248 FMD controls (49.8 ± 8.9 years; 81.8% female) identified. The most common symptom for VADNA patients was abdominal or flank pain (80.6%). For FMD, chest pain, headache, and dizziness were more frequent presenting complaints. The median follow-up was longer for VADNA patients (42 months; interquartile range, 9-76 months) compared with FMD patients (19 months; interquartile range, 0.6-52 months; P < .001). During this time interval, there were twofold more composite arterial events in the VADNA group compared with the FMD group (17% vs 8.1%; P = .01). This difference was primarily driven by recurrent dissections. All-cause mortality was low and similar for both groups (3.8% vs 0.4%; P = .10). CONCLUSIONS VADNA patients carry a higher risk of recurrent arterial events compared with those with FMD. This difference was primarily driven by recurrent dissections.
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Affiliation(s)
- Stanislav Henkin
- Cardiovascular Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Waldemar E Wysokinski
- Gonda Vascular Center, Mayo Clinic, Rochester, Minn; Cardiovascular Department, Mayo Clinic, Rochester, Minn
| | - Marysia Tweet
- Cardiovascular Department, Mayo Clinic, Rochester, Minn
| | - Fadi Shamoun
- Cardiovascular Department, Mayo Clinic, Scottsdale, Ariz
| | | | | | - Kaja Bator
- Gonda Vascular Center, Mayo Clinic, Rochester, Minn
| | - Raymond Shields
- Gonda Vascular Center, Mayo Clinic, Rochester, Minn; Cardiovascular Department, Mayo Clinic, Rochester, Minn
| | - Eddie Greene
- Nephrology and Hypertension Division, Mayo Clinic, Rochester, Minn
| | - Shelly Keller
- Gonda Vascular Center, Mayo Clinic, Rochester, Minn; Cardiovascular Department, Mayo Clinic, Rochester, Minn
| | - David Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Fla
| | - Robert McBane
- Gonda Vascular Center, Mayo Clinic, Rochester, Minn; Cardiovascular Department, Mayo Clinic, Rochester, Minn.
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16
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Chaer RA, Abularrage CJ, Coleman DM, Eslami MH, Kashyap VS, Rockman C, Murad MH. The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms. J Vasc Surg 2020; 72:3S-39S. [DOI: 10.1016/j.jvs.2020.01.039] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 12/18/2022]
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17
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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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18
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Birkl J, Kahl T, Thielemann H, Mutze S, Goelz L. Retrospective Analysis and Systematic Review of Isolated Traumatic Dissections of the Celiac Artery. Ann Vasc Surg 2020; 66:250-262. [PMID: 31923601 DOI: 10.1016/j.avsg.2020.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 12/14/2019] [Accepted: 01/01/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Isolated dissections of the celiac artery (CA) after blunt trauma are rarely described. This retrospective analysis and systematic review analyzes epidemiology, radiologic examinations, patterns of injuries, therapeutic measures, clinical courses, and outcomes. METHODS Retrospective analysis of polytraumatized patients admitted between 1997 and 2012 to a trauma center level I. Systematic literature search was carried out on pubmed.gov, eurorad.org, and google.com. RESULTS Isolated traumatic dissections of the CA had an incidence of 0.17% in a retrospective collective (n = 9). Mean age was 31.7 years in 6 male (66.7%) and 3 female (33.3%) patients. Systematic literature search identified 12 primary sources describing 13 males (100%) with a mean age of 41.3 years. Traffic accidents and falls were the most common causes of injury. An intimal flap (77.7%) and a thrombosed false lumen (59.1%) were the most common computed tomographic findings. Twenty-two patients were analyzed, and 16 patients were treated conservatively. The CA was bypassed in 2 symptomatic patients. One patient was treated with a stent. Two patients died because of massive bleeding, and 1 patient died because of liver failure. About 19 discharged patients were asymptomatic on follow-up. Long-term follow-up with magnetic resonance angiography showed stable dissections (n = 1), medium stenosis (n = 1), resolution of the dissection (n = 2), high-grade stenosis of the CA combined with a small pseudoaneurysm (n = 1), or occlusion of the CA with sufficient collateralization (n = 3). Pharmaceutical treatment was individualized with low-molecular-weight heparin, heparin, or warfarin, and acetylicsalicylic acid. CONCLUSIONS Traumatic CA dissections are mostly caused by traffic accidents and falls. Visceral perfusion should be monitored clinically and radiologically. Beginning visceral ischemia requires early invasive treatment. Endovascular and open surgery are possible options. Benefits of specific pharmaceuticals are still up for debate. Follow-up via magnetic resonance imaging or computed tomography angiography is essential to rule out vascular complications. LEVEL OF EVIDENCE III (Retrospective therapeutic study and systematic literature review).
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Affiliation(s)
- Jens Birkl
- Department of General Surgery, Unfallkrankenhaus Berlin, Berlin, Germany; Department of General Surgery, Albertinen Krankenhaus Hamburg, Hamburg, Germany
| | - Thomas Kahl
- Department of Radiology and Neuroradiology, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Henryk Thielemann
- Department of General Surgery, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Sven Mutze
- Department of Radiology and Neuroradiology, Unfallkrankenhaus Berlin, Berlin, Germany; Department for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Leonie Goelz
- Department of Radiology and Neuroradiology, Unfallkrankenhaus Berlin, Berlin, Germany; Department for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany.
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19
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Kang SH, Park HS, Yoon CJ, Shin CS, Yoo KC, Lee T. Mid- to Long-Term Outcomes in Management of Spontaneous Isolated Coeliac Artery Dissection (SICAD). Eur J Vasc Endovasc Surg 2019; 59:247-253. [PMID: 31813666 DOI: 10.1016/j.ejvs.2019.09.510] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 09/09/2019] [Accepted: 09/30/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Spontaneous Isolated Coeliac Artery Dissection (SICAD) is a rare disease with few reports of management strategies. This study reports the mid- to long-term outcomes of conservative management and endovascular intervention of SICAD treatment. METHODS Sixteen patients presenting with symptomatic SICAD from September 2006 to October 2018 were reviewed retrospectively. The clinical manifestations, initial radiological findings, methods of treatment, and serial follow up studies were analysed. RESULTS The mean age of the patients was 51.2 ± 7.9 years, with a median follow up of 33.3 (range 1.0-118.9) months. Four patients received early intervention because of aneurysmal dilatation or distal hypoperfusion. Four patients who received conservative management showed progression of disease and were recommended for delayed intervention. Although collaterals prevented further hepatic ischaemia, one of these four patients failed in delayed intervention because of extensive thrombi completely occluding the hepatic artery. In the remaining eight patients who were managed conservatively, three (37.5%) showed regression of disease, one (12.5%) showed partial regression, and five (62.5%) showed no change in intimal flap or thrombosis, but all had symptomatic improvement. The median follow up duration for the seven patients who underwent successful intervention was 77.3 (range 34.3-118.9) months, and all stenting remained patent during the follow up period. CONCLUSION Early intervention in symptomatic SICAD patients may be necessary in over 50% of patients, and endovascular stenting has durable long term outcomes.
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Affiliation(s)
- So Hyun Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyung Sub Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Chang Jin Yoon
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Chang Sik Shin
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kwon Cheol Yoo
- Department of Surgery, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Taeseung Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; College of Medicine, Seoul National University, Seoul, Republic of Korea.
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20
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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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21
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Wang J, He Y, Zhao J, Yuan D, Xu H, Ma Y, Huang B, Yang Y, Bian H, Wang Z. Systematic review and meta-analysis of current evidence in spontaneous isolated celiac and superior mesenteric artery dissection. J Vasc Surg 2018; 68:1228-1240.e9. [PMID: 30126785 DOI: 10.1016/j.jvs.2018.05.014] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 05/10/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Spontaneous isolated celiac artery dissection (SICAD) and spontaneous isolated superior mesenteric artery dissection (SISMAD) represent the major types of spontaneous visceral artery dissection. However, no quantitative meta-analysis of SICAD and SISMAD is available. The aim of our study was to pool current evidence concerning basic profiles, treatment strategies, long-term adverse events, and morphologic changes of lesioned vessels in SICAD and SISMAD patients. METHODS We searched the MEDLINE, Embase, Scopus, and Cochrane Databases (January 1, 1946-September 21, 2017) for studies of SICAD and SISMAD. Related cohort studies or case series with sample size larger than 10 were included. Two reviewers independently extracted and summarized the data. A random-effects model was used to calculate pooled estimates. RESULTS In total, 43 studies were included. An estimated 8% (95% confidence interval [CI], 0.01-0.21) symptomatic SICAD and 12% (95% CI, 0.06-0.19) symptomatic SISMAD patients with initial conservative management required secondary intervention during follow-up, whereas none of the asymptomatic patients treated conservatively required secondary intervention. As for morphologic changes during follow-up, a higher proportion of SICAD patients (64%; 95% CI, 0.47-0.80) achieved complete remodeling compared with SISMAD patients (25%; 95% CI, 0.19-0.32), and an estimated 6% (95% CI, 0.00-0.16) of SICAD and 12% (95% CI, 0.05-0.20) of SISMAD patients had morphologic progression. Overall, the pooled estimate of long-term all-cause mortality was 0% (95% CI, 0.00-0.03) in SICAD and 1% (95% CI, 0.00-0.02) in SISMAD. When stratified by symptoms, symptomatic patients were associated with a significantly increased probability of accomplishing complete remodeling (odds ratio, 3.95; 95% CI, 1.31-11.85) compared with asymptomatic patients. CONCLUSIONS Initial conservative treatment is safe for asymptomatic SICAD or SISMAD patients. Symptomatic patients managed conservatively have relatively high occurrence of late secondary intervention, which may require closer surveillance, especially in SISMAD because of a lower rate of remodeling.
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Affiliation(s)
- Jiarong Wang
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China; Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yazhou He
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China; Institute of Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh, United Kingdom
| | - Jichun Zhao
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ding Yuan
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China.
| | - Hao Xu
- Department of Biostatistics, School of Public Health, Yale University, New Haven, Conn; Department of Statistics, West China School of Public Health, Sichuan University, Chengdu, China
| | - Yukui Ma
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Huang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Yang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - He Bian
- Department of Statistics, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
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A rare cause of abdominal pain: Fibromuscular dysplasia. JOURNAL DE MÉDECINE VASCULAIRE 2018; 43:329-331. [PMID: 30217349 DOI: 10.1016/j.jdmv.2018.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 06/17/2018] [Indexed: 11/22/2022]
Abstract
A 50-year-old man had a sudden severe abdominal pain. An abdominal enhanced computed tomographic scan revealed irregular stenosis of the celiac artery, dissection of the hepatic artery and of the left common iliac artery, and mid stenosis of the right renal artery with extended renal parenchymal hypodensity. After careful evaluation, the patient was diagnosed with fibromuscular dysplasia. Systematic head and neck CT angiography revealed right vertebral arterial stenosis and saccular aneurysm of the left vertebral artery. We have chosen conservative medical treatment for the multifocal fibromuscular dysplasia.
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Otsuka H, Sato T, Aoki H, Nakagawa Y, Inokuchi S. Optimal Treatment for Ruptured Pancreaticoduodenal Artery Aneurysm Caused by Celiac Artery Obstruction Due to Celiac Artery Dissection. Vasc Endovascular Surg 2018; 52:648-652. [PMID: 29940814 DOI: 10.1177/1538574418784691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A pancreaticoduodenal artery (PDA) aneurysm develops due to increased flow through the pancreaticoduodenal arcade in the setting of celiac or superior mesenteric artery occlusion. Additionally, there is no evidence on the computed tomography scan or angiography images that the dissection process extends to the PDA arcade. Moreover, the optimal treatment protocols for PDA aneurysms with celiac artery obstruction and for celiac artery dissection are controversial. We report 2 cases of ruptured PDA aneurysms caused by celiac artery obstruction due to celiac artery dissection in which the aneurysm was excluded, but celiac artery revascularization was not performed successfully. Our cases indicate that endovascular management for ruptured PDA aneurysms and conservative management for celiac artery obstruction due to celiac artery dissection are feasible as first-line treatment in such cases.
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Affiliation(s)
- Hiroyuki Otsuka
- 1 Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Toshiki Sato
- 1 Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Hiromichi Aoki
- 1 Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Yoshihide Nakagawa
- 1 Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Sadaki Inokuchi
- 1 Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Isehara, Japan
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24
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Natural history of spontaneous isolated celiac artery dissection after conservative treatment. J Vasc Surg 2018; 68:55-63. [PMID: 29398311 DOI: 10.1016/j.jvs.2017.10.077] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 10/21/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Optimal treatment of spontaneous isolated celiac artery dissection (SICAD) is not well established because the natural history of this rare disease is poorly understood. We analyzed the natural history of patients who underwent conservative treatment. METHODS The study included 28 patients with SICAD from December 2008 to January 2017. Our institutional policy of first-line treatment for SICAD patients was conservative, and invasive procedures were reserved for unstable complications such as severe persistent pain, significant organ malperfusion, rapid aneurysmal change, and rupture or concealed rupture. Demographics, clinical features, morphologic characteristics on computed tomography, treatment modalities, and follow-up results of these patients were retrospectively reviewed. RESULTS Mean age was 52 years, and 89% of patients were male; 86% presented with pain, mostly abdominal, and 14% of cases were detected incidentally on abdominal imaging. None of these patients had unstable complications on admission, and all underwent initial conservative treatment. During the follow-up period (22 ± 20 months), aneurysmal change and propagation of thrombosis were noted in one patient and two patients, respectively, all of whom were managed conservatively without adverse clinical events. No difference in clinical and morphologic outcomes was noted between patients who were treated with antihypertensive therapy and those who were not. Patients with intramural hematoma on initial images showed dynamic vascular remodeling (partial to complete resorption) during the follow-up period compared with patients who had dominant intimal flap on initial images. CONCLUSIONS The clinical course of patients with SICAD was benign. Even progressive vascular changes during follow-up did not require invasive treatment. Antihypertensive therapy might not modify the clinical course. The short-term results of conservative management are encouraging, but further evaluation with long-term follow-up in a large population is needed.
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Kim B, Lee BS, Kwak HK, Kang H, Ahn JH. Natural course and outcomes of spontaneous isolated celiac artery dissection according to morphological findings on computed tomography angiography: STROBE compliant article. Medicine (Baltimore) 2018; 97:e9705. [PMID: 29384849 PMCID: PMC5805421 DOI: 10.1097/md.0000000000009705] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
We aimed to identify natural course and optimal management of spontaneous isolated celiac artery dissection (SICAD) according to morphologic classification determined on computed tomography angiography (CTA), and to investigate the association between symptoms and morphological classification of SICAD.This retrospective observational study included 21 consecutive patients with SICAD from January 2012 to April 2017. Demographic data, clinical features, treatment modalities, follow-up results, and CTA findings including morphologic classification, dissection length, and relative diameter of the true lumen (TLRD) were reviewed. Changes in follow-up CTA were recorded and compared to prior studies to reveal natural course of the disease.The serial changes of SICAD on follow-up CTA according to morphologic classifications were as follows; type I (5/5, no interval change), type IIa (1/1, no interval change), type IIb (1/1, partial remodeling), type IIIa (1/4, complete remodeling; 1/4, partial remodeling; 1/4, no interval change; 1/4, deterioration), type IIIb (4/6, no interval change; 2/6, partial remodeling), and type IV (2/2, no interval change). Thirteen (61.9%) symptomatic and 8 (38.1%) asymptomatic patients were all treated with conservative management with or without antiplatelet and/or anticoagulation therapies. Symptomatic group (SG) more commonly had type IIb, IIIa, IIIb, and IV than asymptomatic group (AG) (SG; 11 patients, AG; 1 patient, P = .002). TLRD in AG was larger than that in SG (SG: 40.5 ± 24.1%, AG: 61.7 ± 7.0%, P = .045).SICAD might be treated by conservative management in stable patients irrespective of the morphologic classification except for with type IV (dissecting aneurysm) and extension of celiac branch who may need an early intervention. Types IIb, IIIa, IIIb, and IV are TLRD are associated with patients' symptoms. Further studies on extended natural course of SICAD with a larger number of subjects are needed to draw a strong conclusion.
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Affiliation(s)
| | - Byung Soo Lee
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon
| | - Hyun Kyu Kwak
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon
| | - Hyuncheol Kang
- Department of Applied Statistics, Hoseo University, Asan, Republic of Korea
| | - Jung Hwan Ahn
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon
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Han A, Gwak J, Choi G, Park JJ, Yu B, Lee GJ, Kang JM. Isolated Dissection of the Celiac Artery after Blunt Trauma: A Case Report and Review of Literature. JOURNAL OF TRAUMA AND INJURY 2017. [DOI: 10.20408/jti.2017.30.4.220] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Ahram Han
- Department of Trauma Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Jihun Gwak
- Department of Trauma Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Gangkook Choi
- Department of Trauma Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Jae Jeong Park
- Department of Trauma Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Byungchul Yu
- Department of Trauma Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Gil Jae Lee
- Department of Trauma Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Jin Mo Kang
- Department of Surgery, Gachon University Gil Medical Center, Incheon, Korea
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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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