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Bax M, Romanov V, Junday K, Giannoulatou E, Martinac B, Kovacic JC, Liu R, Iismaa SE, Graham RM. Arterial dissections: Common features and new perspectives. Front Cardiovasc Med 2022; 9:1055862. [PMID: 36561772 PMCID: PMC9763901 DOI: 10.3389/fcvm.2022.1055862] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
Arterial dissections, which involve an abrupt tear in the wall of a major artery resulting in the intramural accumulation of blood, are a family of catastrophic disorders causing major, potentially fatal sequelae. Involving diverse vascular beds, including the aorta or coronary, cervical, pulmonary, and visceral arteries, each type of dissection is devastating in its own way. Traditionally they have been studied in isolation, rather than collectively, owing largely to the distinct clinical consequences of dissections in different anatomical locations - such as stroke, myocardial infarction, and renal failure. Here, we review the shared and unique features of these arteriopathies to provide a better understanding of this family of disorders. Arterial dissections occur commonly in the young to middle-aged, and often in conjunction with hypertension and/or migraine; the latter suggesting they are part of a generalized vasculopathy. Genetic studies as well as cellular and molecular investigations of arterial dissections reveal striking similarities between dissection types, particularly their pathophysiology, which includes the presence or absence of an intimal tear and vasa vasorum dysfunction as a cause of intramural hemorrhage. Pathway perturbations common to all types of dissections include disruption of TGF-β signaling, the extracellular matrix, the cytoskeleton or metabolism, as evidenced by the finding of mutations in critical genes regulating these processes, including LRP1, collagen genes, fibrillin and TGF-β receptors, or their coupled pathways. Perturbances in these connected signaling pathways contribute to phenotype switching in endothelial and vascular smooth muscle cells of the affected artery, in which their physiological quiescent state is lost and replaced by a proliferative activated phenotype. Of interest, dissections in various anatomical locations are associated with distinct sex and age predilections, suggesting involvement of gene and environment interactions in disease pathogenesis. Importantly, these cellular mechanisms are potentially therapeutically targetable. Consideration of arterial dissections as a collective pathology allows insight from the better characterized dissection types, such as that involving the thoracic aorta, to be leveraged to inform the less common forms of dissections, including the potential to apply known therapeutic interventions already clinically available for the former.
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Affiliation(s)
- Monique Bax
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Valentin Romanov
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Keerat Junday
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Eleni Giannoulatou
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Boris Martinac
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Jason C. Kovacic
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
- St. Vincent’s Hospital, Darlinghurst, NSW, Australia
- Icahn School of Medicine at Mount Sinai, Cardiovascular Research Institute, New York, NY, United States
| | - Renjing Liu
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Siiri E. Iismaa
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Robert M. Graham
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
- St. Vincent’s Hospital, Darlinghurst, NSW, Australia
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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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Ullah W, Mukhtar M, Abdullah HM, Ur Rashid M, Ahmad A, Hurairah A, Sarwar U, Figueredo VM. Diagnosis and Management of Isolated Superior Mesenteric Artery Dissection: A Systematic Review and Meta-Analysis. Korean Circ J 2019; 49:400-418. [PMID: 31074212 PMCID: PMC6511528 DOI: 10.4070/kcj.2018.0429] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/11/2019] [Accepted: 03/13/2019] [Indexed: 12/17/2022] Open
Abstract
The objective of this study was to analyze the three different management modalities for isolated superior mesenteric artery (SMA) dissection. We did a comprehensive literature search and found 703 articles on the initial search, out of which 111 articles consisting of 145 patients were selected for analysis. The mean age was 55.7 years (standard deviation,9.7;33-85) and 80.6% were male. These patients were managed conservatively (41.3%), endovascularly (28.1%) or surgically (30%). The median follow-up was 10 months (interquartile range [IQR], 4-18 months), 12 months (IQR, 6-19 months) and 14 months (IQR, 6-20 months) respectively. Contrast-enhanced computed tomography (CT) was the most commonly used diagnostic tool in the conservative group (43.8%), while conventional CT scan was the most widely used in endovascular (58.1%) and surgical group (50%). 17% percent of the conservative group had SMA angiography for diagnosis, while this was less than 3% in the other groups. Of these patients, 96.7%, 97.4%, and 100.0% recovered successfully in the conservative, endovascular, and surgical groups respectively. There was no significant difference in the mortality between the three groups (Pearson χ²=0.482). This suggests a conservative and endovascular approach could be used in most patients, which can reduce costs and surgery-related morbidity and mortality. Surgical management should be reserved for cases having infarction or widespread bowel ischemia and in cases where other treatment modalities fail.
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Affiliation(s)
- Waqas Ullah
- Department of Internal Medicine, Abington Hospital - Jefferson Health, Abington, PA, USA.
| | - Maryam Mukhtar
- Department of Internal Medicine, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Hafez Mohammad Abdullah
- Department of Internal Medicine, University of South Dakota Sanford School of Medicine, SD, USA
| | - Mamoon Ur Rashid
- Department of Internal Medicine, Florida Hospital Orlando, Orlando, FL, USA
| | - Asrar Ahmad
- Department of Internal Medicine, Abington Hospital - Jefferson Health, Abington, PA, USA
| | - Abu Hurairah
- Department of Gastroenterology, Advent Health Orlando, FL, USA
| | - Usman Sarwar
- Department of Internal Medicine, Abington Hospital - Jefferson Health, Abington, PA, USA
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Katirci Y, Karamercan MA, Ramadan H, Baran NT, Aksoy O, Coskun F. Spontaneous Ruptured Splenic Artery Aneurysm: A Case Report. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791302000410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Splenic artery aneurysms are rare and occur predominantly in women. Most of them are asymptomatic until the aneurysms rupture. We report a previously healthy 46-year-old female who attended emergency department with abdominal pain for four hours. She had left upper quadrant tenderness and pulsatile mass. Laboratory tests showed her haematocrit 29.8%. Subsequent examinations with ultrasound and computed tomography (CT) showed a large aneurysm of the splenic artery and a heterogeneous hypodense shadows around the aneurysmal sac and perihepatic area. Just after CT scan she collapsed and was taken into emergency surgery. Splenectomy was performed following the ligation of splenic artery proximal to lesion. On the fifth day, she was discharged from the hospital with complete recovery. This case report highlights that rapid resuscitation, diagnostic imaging, surgical consultation, and subsequent laparotomy remain the priorities in patient management.
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Affiliation(s)
- Y Katirci
- Ankara Research and Training Hospital, Ministry of Health, Department of Emergency Medicine, Ankara Egitim Arastirma Hastanesi Acil Tip Klinigi, 06340 Ulucanlar - Ankara, Turkey
| | | | - H Ramadan
- Ankara Research and Training Hospital, Ministry of Health, Department of Emergency Medicine, Ankara Egitim Arastirma Hastanesi Acil Tip Klinigi, 06340 Ulucanlar - Ankara, Turkey
| | - NT Baran
- Ankara Research and Training Hospital, Ministry of Health, Department of Emergency Medicine, Ankara Egitim Arastirma Hastanesi Acil Tip Klinigi, 06340 Ulucanlar - Ankara, Turkey
| | - O Aksoy
- Ankara Research and Training Hospital, Ministry of Health, Department of Emergency Medicine, Ankara Egitim Arastirma Hastanesi Acil Tip Klinigi, 06340 Ulucanlar - Ankara, Turkey
| | - F Coskun
- Ankara Research and Training Hospital, Ministry of Health, Department of Emergency Medicine, Ankara Egitim Arastirma Hastanesi Acil Tip Klinigi, 06340 Ulucanlar - Ankara, Turkey
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Tana M, Tana C, Schiavone C, Verdiani V, Palermo C, Alessandri M, Giamberardino MA, Montagnani A. Spontaneous dissection of the celiac artery in the young: a case report and systematic review of the literature. Hosp Pract (1995) 2017; 45:258-264. [PMID: 28891374 DOI: 10.1080/21548331.2017.1378059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 09/07/2017] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The spontaneous isolated celiac artery dissection (siCAD) represents a challenging cause of abdominal pain and complete information regarding incidence, etiology and risk factors in the young is still lacking. In this study, we report a case of siCAD occurred in a young woman and we systematically searched for information on siCADs in literature databases. METHODS PubMed/Embase and Cochrane were searched for, using the following terms: Isolated celiac trunk dissection, isolated celiac artery dissection, celiac artery dissection, celiac trunk dissection, spontaneous isolated visceral artery dissection, spontaneous isolated dissection of visceral arteries, isolated celiac artery dissection in the young, isolated celiac trunk dissection in the young. Patients were included if they were younger than 50 years, if they had a spontaneous etiology and a selective involvement of the celiac artery (with or without involvement of its branches). RESULTS 180 studies were found, and 18 remained after screening. Twenty-one patients (male = 19, female = 2) with siCADs were included. Mean age was 44.71 ± 3.61 years. Hypertension was the most prevalent comorbidity. All patients presented with abdominal pain, more often located in the epigastrium (n = 11). Almost all patients underwent CT to confirm the diagnosis. A conservative treatment was adopted in 13 patients while an invasive approach was adopted in 8 patients (endovascular approach in 7). DISCUSSION siCADs represent a rare but important cause of vascular dissection in the young. Uncomplicated cases can be safely treated with conservative strategies. The surgical or endovascular repair is indicated when dissections complicate or symptoms persist despite an adequate conservative treatment.
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Affiliation(s)
- Marco Tana
- a Internal Medicine Unit , Grosseto , Italy
| | - Claudio Tana
- b Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department , University-Hospital of Parma , Parma , Italy
| | - Cosima Schiavone
- c Department of Internistic Ultrasound , "G. d'Annunzio" University of Chieti , Chieti , Italy
| | | | | | | | - Maria Adele Giamberardino
- e Ce.S.I.-Met , "G. D'Annunzio" University of Chieti , Chieti , Italy
- f Geriatrics Clinic, Department of Medicine and Science of Aging , "G. D'Annunzio" University of Chieti , Chieti , Italy
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Otsuka H, Sato T, Aoki H, Nakagawa Y, Inokuchi S. Optimal management strategy for spontaneous isolated dissection of a visceral artery. Vascular 2017; 26:169-174. [DOI: 10.1177/1708538117722879] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives To describe our clinical experiences and recommend a management strategy for spontaneous isolated dissection of a visceral artery. Methods A retrospective study of patients from December 2005 to December 2015 was performed. Thirty-two patients had spontaneous isolated dissection of a visceral artery. Clinical features, computed tomography findings, the treatment method, and follow-up results were evaluated. Results There were 28 men and 4 women (mean age, 54 years). Dissection locations were the celiac artery in 10, superior mesenteric artery in 17, and celiac artery and superior mesenteric artery in 5 patients. Celiac artery stenosis existed with spontaneous isolated dissection of a visceral artery at a high rate. After diagnosis, the blood pressure of all patients was immediately controlled to a lower level. Three patients with arterial rupture and one patient with bowel infarction underwent operations for complications. Overall, the treatment of dissection involved drug therapy alone. The last follow-up computed tomography results of the true lumen residual ratio and the length of the dissected artery improved compared to the values on admission; the maximum diameter of the dissected artery did not enlarge. Eleven patients almost completely improved. No patients had any adverse event. Conclusions Most patients with spontaneous isolated dissection of a visceral artery can be first treated conservatively for dissection with strict blood pressure control and surveillance.
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Affiliation(s)
- Hiroyuki Otsuka
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Isehara City, Japan
| | - Toshiki Sato
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Isehara City, Japan
| | - Hiromichi Aoki
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Isehara City, Japan
| | - Yoshihide Nakagawa
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Isehara City, Japan
| | - Sadaki Inokuchi
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Isehara City, Japan
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George J, Nathani H, Hu A, Al-Mukhtar A. Atypical presentation of a spontaneous coeliac artery dissection resulting in jejunal ischaemia. BMJ Case Rep 2017; 2017:bcr-2016-218182. [PMID: 28219909 DOI: 10.1136/bcr-2016-218182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe a case of a 59-year-old man with no significant medical history apart from a hiatus hernia and depression who presented with periumbilical pain which woke him at night. Before this he had 6 weeks of generalised abdominal pain. Blood tests were relatively normal and CT revealed some ill-defined stranding around the coeliac artery. He was diagnosed with a spontaneous coeliac artery dissection. Given the complexity of the case, a multidisciplinary team approach was adopted. He was managed conservatively and improved significantly over the next few days. Further investigations confirmed ischaemic changes to the distal duodenum and proximal jejunum. He has since been followed-up with CT scans and has had no further episodes 12 months from his initial admission.
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Affiliation(s)
- Jayan George
- Department of Hepatobiliary Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Harsh Nathani
- Department of Hepatobiliary Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Andrew Hu
- Department of Hepatobiliary Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Ahmed Al-Mukhtar
- Department of Hepatobiliary Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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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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Lim JY, Choi YH, Lee SH. Unusual presentation and treatment of isolated spontaneous gastric artery dissection. Clin Exp Emerg Med 2016; 3:112-115. [PMID: 27752628 PMCID: PMC5051608 DOI: 10.15441/ceem.15.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 04/16/2016] [Accepted: 04/19/2016] [Indexed: 11/23/2022] Open
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Ma L, Chen K, Lu Q, Ling W, Luo Y. Case report of hepatic artery dissection secondary to hepatic artery pseudoaneurysm after living donor liver transplantation. BMC Gastroenterol 2016; 16:44. [PMID: 27036207 PMCID: PMC4818394 DOI: 10.1186/s12876-016-0458-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 03/19/2016] [Indexed: 02/06/2023] Open
Abstract
Background Hepatic artery pseudoaneurysm (HAP) and Hepatic artery dissection are rare vascular complications after living donor liver transplantation (LDLT), which may lead to graft loss and death of the recipients. Conventional gray-scale and Doppler ultrasound, as well as contrast-enhanced ultrasound (CEUS), play important roles in identifying vascular complications in the early postoperative period and during follow-up. We report a case of hepatic artery dissection secondary to HAP after LDLT, which was diagnosed and followed for one year by ultrasound. To the best of our knowledge, few studies have reported similar cases after liver transplantation in the English literature. Case presentation A 43-year-old man underwent right-lobe LDLT for treatment of a severe acute hepatitis B infection and was followed up with ultrasound examinations for one year. Conventional gray-scale and Doppler ultrasound combined with contrast-enhanced ultrasound (CEUS) accurately revealed the occurrence of HA dissection secondary to HAP and accompanied by thrombosis and collateral circulation, as well as secondary biliary complications, which provided a prompt diagnosis and guidance for the treatment. Conclusion Our case suggests that ultrasound can help detect hepatic artery pseudoaneurysm and dissection, as well as secondary biliary lesions after LDLT in an accurate and timely manner and provide useful information for the treatment chosen. CEUS shows potential as an important complementary technique to gray-scale and Doppler ultrasound.
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Affiliation(s)
- Lin Ma
- Department of Ultrasound, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan Province, 610041, China
| | - Kefei Chen
- Department of liver and Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Qiang Lu
- Department of Ultrasound, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan Province, 610041, China
| | - Wenwu Ling
- Department of Ultrasound, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan Province, 610041, China
| | - Yan Luo
- Department of Ultrasound, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan Province, 610041, China.
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Isolated Celiac and Splenic Artery Dissection: A Case Report and Review of the Literature. Case Rep Vasc Med 2016; 2015:194079. [PMID: 26819797 PMCID: PMC4706899 DOI: 10.1155/2015/194079] [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: 09/22/2015] [Revised: 12/13/2015] [Accepted: 12/15/2015] [Indexed: 11/18/2022] Open
Abstract
An isolated dissection of the celiac artery is an extremely rare condition that requires a high level of suspicion to evoke the diagnosis. Once established, the natural course is unpredictable in view of the discrepancies in its management requiring a case-by-case analysis. In this paper, we report an unusual case of spontaneous abdominal pain that was diagnosed with celiac and splenic artery rupture secondary to physical stress. This paper underlines the necessity to maintain a high level of suspicion for arterial dissections and we also review the management plan in such cases.
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Lee SI, Kim JJ, Yang HJ, Lee K. Spontaneous dissection of celiac trunk with concurrent splenic artery dissection. Clin Exp Emerg Med 2015; 2:256-259. [PMID: 27752606 PMCID: PMC5052905 DOI: 10.15441/ceem.15.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 08/21/2015] [Accepted: 08/22/2015] [Indexed: 11/23/2022] Open
Abstract
Isolated spontaneous dissection of the celiac trunk is rarely diagnosed in acute abdominal pain. We present two cases of celiac trunk and splenic artery dissection with splenic infarction. Patients were successfully managed and stabilized by medical treatment. Isolated celiac trunk dissection can be fatal, therefore providers should be careful not to overlook this entity.
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Affiliation(s)
- Seo In Lee
- Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Jin Joo Kim
- Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Hyuk Jun Yang
- Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Keun Lee
- Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon, Korea
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Isolated spontaneous dissection of a visceral artery: a rare cause of epigastric pain. Emerg Radiol 2014; 22:215-20. [DOI: 10.1007/s10140-014-1255-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 07/09/2014] [Indexed: 10/25/2022]
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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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Untereiner X, Kretz B, Camin-Kretz A, Tibuleac A, Gu WM, Faller B, Matysiak L. Dissecting Aneurysm of the Celiac Trunk: A Case Report. Ann Vasc Surg 2014; 28:1037.e1-4. [DOI: 10.1016/j.avsg.2013.08.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 07/19/2013] [Accepted: 08/12/2013] [Indexed: 10/25/2022]
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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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Melo ELA, Siqueira RA, Paula FTMD. Spontaneous dissection of the celiac trunk: report of three cases and review of the literature. J Vasc Bras 2014. [DOI: 10.1590/jvb.2014.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Spontaneous dissection of the celiac trunk is quite an uncommon medical condition, with few case reports in the medical literature. Sudden epigastric abdominal pain is the most common complaint reported by patients, but due to the rarity of this disease in clinical practice and the nonspecific nature of its symptoms, a high degree of clinical suspicion is needed to establish diagnosis. However, improvements in imaging techniques are facilitating diagnosis of this clinical entity, increasing its detection rate. The ideal treatment has not yet been fully established in the literature and the available therapeutic strategies are conservative medical treatment, surgical revascularization or endovascular intervention. In this article we report on three cases of spontaneous dissection of the celiac trunk and conduct a review of the literature on this disease
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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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Neychev V, Krol E, Dietzek A. Unusual presentation and treatment of spontaneous celiac artery dissection. J Vasc Surg 2013; 58:491-5. [DOI: 10.1016/j.jvs.2012.10.136] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 10/08/2012] [Accepted: 10/16/2012] [Indexed: 11/29/2022]
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Spontaneous dissection of the celiac artery: a case report and literature review. Am J Emerg Med 2013; 31:1000.e3-5. [DOI: 10.1016/j.ajem.2013.02.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 02/02/2013] [Indexed: 11/18/2022] Open
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Sequential Multiple Visceral Arteries Dissections Without Aortic Involvement. Ann Vasc Surg 2013; 27:497.e9-13. [DOI: 10.1016/j.avsg.2012.05.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 03/01/2012] [Accepted: 05/06/2012] [Indexed: 11/19/2022]
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22
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Galastri FL, Nasser F, Affonso BB, Amorim JED, Travassos FB. Dissecção espontânea do tronco celíaco: qual a melhor abordagem terapêutica? J Vasc Bras 2013. [DOI: 10.1590/s1677-54492013000100014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A dissecção espontânea das artérias viscerais é um evento relativamente raro. Dor abdominal súbita no epigástrio é o sintoma mais frequentemente manifestado pelos pacientes. O avanço das técnicas de exames de imagem possibilitou o diagnóstico deste evento com maior facilidade, aumentando a incidência das dissecções das artérias viscerais. O tratamento clínico conservador, a revascularização cirúrgica, e a terapia endovascular são as três possíveis opções terapêuticas. Neste artigo, relatamos os casos de dois pacientes com dissecção espontânea do tronco celíaco conduzidos de formas diversas, de acordo com a apresentação clínica e exames de imagem, além de realizar uma revisão bibliográfica sobre esta doença.
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Affiliation(s)
| | - Felipe Nasser
- Universidade de São Paulo; Hospital Israelita Albert Einstein, Brasil
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23
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Lee CH, Jang LC. A Dissecting Aneurysm of the Common and Proper Hepatic Artery with Dissection of the Celiac Axis and the Superior Mesenteric Artery. Vasc Specialist Int 2012. [DOI: 10.5758/kjves.2012.28.2.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Chung Heon Lee
- Department of Surgery, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Lee Chan Jang
- Department of Surgery, Chungbuk National University College of Medicine, Cheongju, Korea
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24
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Zhang T, Zhang X, Zhang X, Jiang J, Zhou B. Endovascular treatment of isolated spontaneous celiac artery dissection. Vascular 2012; 20:118-20. [PMID: 22472366 DOI: 10.1258/vasc.2011.cr0302] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This report presents the case of a patient with isolated spontaneous celiac artery dissection. The patient developed acute abdominal pain that was induced by eating. Computed tomography and selective angiography revealed an intimal flap that separated the true and false lumens located 3 cm from the origin of the celiac artery. We treated the patient with a stent that was deployed endovascularly into the celiac artery to seal the entry site. Postoperative angiography revealed that the graft was patent and the follow-up period was uneventful. The etiology, clinical features, diagnostic modalities and treatment options of isolated spontaneous celiac artery dissection are reported.
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Affiliation(s)
- Tao Zhang
- Department of Vascular Surgery, Peking University People's Hospital, No. 11 Xizhimen South Street, West District, Beijing 100044, China
| | - Xiaoming Zhang
- Department of Vascular Surgery, Peking University People's Hospital, No. 11 Xizhimen South Street, West District, Beijing 100044, China
| | - Xuemin Zhang
- Department of Vascular Surgery, Peking University People's Hospital, No. 11 Xizhimen South Street, West District, Beijing 100044, China
| | - Jingjun Jiang
- Department of Vascular Surgery, Peking University People's Hospital, No. 11 Xizhimen South Street, West District, Beijing 100044, China
| | - Bingying Zhou
- Biological and Biomedical Sciences Program, University of North Carolina, Chapel Hill, NC 27599, USA
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25
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Sarkar J, Plackett TP, Kellicut DC, Edwards KD. A case report of coeliac artery dissection following a motor vehicle collision. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.injury.2011.10.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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26
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Batt M, Baque J. Successful percutaneous embolization of a symptomatic celiac artery dissection with aneurysmal dilation with detachable vascular plugs. J Vasc Surg 2011; 54:1812-5. [DOI: 10.1016/j.jvs.2011.05.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 04/04/2011] [Accepted: 05/07/2011] [Indexed: 11/16/2022]
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27
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Genc V, Cetinkaya OA, Kayilioglu I, Karaca AS, Cipe G, Unal AE. Splenic infarction as a complication of celiac artery thromboembolism: an unusual cause of abdominal pain. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011; 81:360-2. [PMID: 22148131 PMCID: PMC3229007 DOI: 10.4174/jkss.2011.81.5.360] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 06/15/2010] [Accepted: 06/18/2010] [Indexed: 11/30/2022]
Abstract
Splenic infarction is a relatively uncommon diagnosis and this clinical presentation can mimic other causes of acute abdominal pain. Cardiologic and hematologic disorders are common reasons for this entity. There have been a few series and single case reports of splenic infarction published in peer-reviewed medical journals. We report a 53-year-old patient who had splenic infarction caused by celiac artery thromboembolism. The importance of this case, without any etiological predisposing factors, is that this kind of clinical situation should be considered in the differential diagnosis of abdominal pain.
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Affiliation(s)
- Volkan Genc
- Department of Surgery, Ankara University School of Medicine, Ankara, Turkey
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28
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Sugiura T, Imoto K, Uchida K, Yanagi H, Machida D, Okiyama M, Yasuda S, Takebayashi S. Fibromuscular dysplasia associated with simultaneous spontaneous dissection of four peripheral arteries in a 30-year-old man. Ann Vasc Surg 2011; 25:838.e9-11. [PMID: 21616635 DOI: 10.1016/j.avsg.2011.02.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2010] [Revised: 12/02/2010] [Accepted: 02/08/2011] [Indexed: 11/28/2022]
Abstract
A 30-year-old man had a sudden bout of severe abdominal pain. An enhanced computed tomographic scan revealed dissections of the celiac artery, superior mesenteric artery, left renal artery, and right external iliac artery; stenosis of the right renal artery; and left kidney infarction. After careful evaluation, the patient was diagnosed with fibromuscular dysplasia (medial dysplasia), based on the findings obtained from the enhanced computed tomographic scan. This case is extremely rare because fibromuscular dysplasia occurred concurrently with simultaneous spontaneous dissections of four peripheral arteries in a young man.
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Affiliation(s)
- Tadahisa Sugiura
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan.
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29
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Silvestre JMDS, Sardinha WE, Piazzalunga M, Fernandes B, Motta F, Silvestre GDS. Dissecção isolada do tronco celíaco: relato de caso. J Vasc Bras 2010. [DOI: 10.1590/s1677-54492010000300010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A dissecção espontânea isolada do tronco celíaco sem a dissecção concomitante da aorta é uma condição rara, pouco descrita na literatura. O objetivo do presente trabalho é descrever um caso dessa entidade clínica em um paciente masculino, 74 anos, assintomático, cujo diagnóstico foi feito por ultrassonografia e confirmado com angiotomografia computadorizada. O paciente tem sido acompanhado com sucesso mediante observação clínica por um período de 25 meses.
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30
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Abstract
Spontaneous visceral artery dissection is an uncommon event with an unpredictable natural history with superior mesenteric artery being the most common affected artery. It is most often asymptomatic and usually diagnosed at autopsy. Pre-disposing factors are not specific but have been suggested to be pre-existing vascular disease, hypertension and pregnancy. Spontaneous resolution, definitive occlusion of the artery, and formation of an aneurysm with associated complications are some other possible outcomes. Isolated dissection of the celiac artery (CA) is rare and there are only a few cases reported in the literature. We present a case of a 65 year old male with spontaneous celiac artery dissection and provide a review of the current literature about imaging findings and management of this entity.
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Affiliation(s)
- Sandeep Vaidya
- University of Washington Medical Center, Department of Interventional Radiology, Seattle, WA, USA
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31
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Kelekis NL, Athanassiou E, Loggitsi D, Moisidou R, Tzovaras G, Fezoulidis I. Acute occlusion of the celiac axis and its branches with perforation of gastric fundus and splenic infarction, findings on spiral computed tomography: a case report. CASES JOURNAL 2010; 3:82. [PMID: 20403212 PMCID: PMC2856538 DOI: 10.1186/1757-1626-3-82] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Accepted: 07/27/2009] [Indexed: 11/10/2022]
Abstract
We present the contrast-enhanced spiral CT findings in a case of acute celiac artery occlusion with gastric perforation and total splenic infarction. Spiral CT depicted thrombus in the celiac axis and its branches, stenosis of the superior mesenteric artery, splenic infarction and lack of enhancement of the gastric wall with a large necrotic gap. Spiral CT enabled prompt diagnosis and therapy in this rare condition in a patient with suspicion of acute mesenteric ischemia.
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Affiliation(s)
- Nikolaos L Kelekis
- 2nd Department of Radiology, National and Kapodistrian University of Athens, General University Hospital Attikon, Rimini 1str, 12462, Athens, Greece.
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32
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Mousa AY, Coyle BW, Affuso J, Haser PB, Vogel TR, Graham AM. Nonoperative Management of Isolated Celiac and Superior Mesenteric Artery Dissection: Case Report and Review of the Literature. Vascular 2009; 17:359-64. [DOI: 10.2310/6670.2009.00053] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Isolated dissection of the origin of both celiac and superior mesenteric arteries is a rare vascular pathology with limited management guidelines. The presentation is generally nonspecific, most often manifesting with epigastric pain radiating to the back. A high diagnostic index of suspicion and stepwise management are essential for a successful outcome. This case report details the clinical course of a 57-year-male who presented with a 2-week history of epigastric discomfort with back pain and was found to have focal celiac artery dissection with aneurysmal dilation of 1.2 cm. His vital signs were stable, and the physical examination was unremarkable. At this time, he was placed on antiplatelet medication and was scheduled for endovascular repair of his celiac aneurysm with a covered stent graft. Two weeks later, recurrent abdominal pain prompted a repeat computed tomographic scan that revealed sequential superior mesenteric artery (SMA) dissection. The patient was admitted and anticoagulated. A complete workup ruled out underlying collagen vascular and autoimmune pathology. He remained stable, with significant symptomatic improvement. After 6 months, anticoagulation was discontinued and antiplatelet therapy was instituted for long-term management. Subsequent operative or endovascular intervention was not required. The patient was continuing to do well on his 18-month clinical follow-up. There are 71 cases of SMA and 12 cases of celiac artery dissection in the literature. This report outlines this rare presentation of isolated, proximal sequential celiac artery and SMA dissection. This case illustrates that conservative management may be warranted in uncomplicated, isolated visceral arterial dissection.
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Affiliation(s)
- Albeir Y. Mousa
- *Division of Vascular Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Brian W. Coyle
- *Division of Vascular Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - John Affuso
- *Division of Vascular Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Paul B. Haser
- *Division of Vascular Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Todd R. Vogel
- *Division of Vascular Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Alan M. Graham
- *Division of Vascular Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ
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33
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Une cause rare de douleur épigastrique : la dissection spontanée isolée du tronc cœliaque, à propos d’un cas. ACTA ACUST UNITED AC 2009; 34:275-8. [DOI: 10.1016/j.jmv.2009.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Accepted: 04/15/2009] [Indexed: 11/23/2022]
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34
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Takach TJ, Madjarov JM, Holleman JH, Robicsek F, Roush TS. Spontaneous splanchnic dissection: application and timing of therapeutic options. J Vasc Surg 2009; 50:557-63. [PMID: 19540708 DOI: 10.1016/j.jvs.2009.02.244] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Revised: 02/17/2009] [Accepted: 02/21/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Spontaneous splanchnic dissection (SSD) occurs infrequently and has a poorly defined natural history. Few studies address the application, timing, and consequences of therapeutic options. Our goal was to apply conservative (non-operative) management in the care of each patient, reserving interventions for specific indications that may be predictive of adverse outcomes. METHODS Between 2003 and 2008, 10 consecutive patients (mean age 54.7-years-old, 70.0% male) presented with 11 SSDs involving either the celiac artery (n = 6), superior mesenteric artery (n = 3), or both (n = 1). Each patient had acute, spontaneous onset of persistent abdominal pain and was diagnosed with SSD following multidetector row computed tomographic angiography (CTA). Non-operative management (anticoagulation, anti-impulse therapy, analgesics, and serial CTA examinations) was initially used in 9 patients. Endovascular (n = 2) or operative (n = 2) intervention was performed either immediately (n = 1) or following failed medical management (n = 3) in 4 patients for specific indications that included persistent symptoms (n = 3), expansion of false lumen (n = 3), and/or radiologic malperfusion (n = 3). RESULTS All patients were asymptomatic after successful non-operative management or following intervention. No morbidity occurred. Upon complete follow-up (mean 13.4 months, range, 2 to 36 months), all patients remained asymptomatic. Preservation of distal perfusion with either thrombosis or ongoing regression of false lumen was achieved in 5 patients who received only non-operative management and in 4 patients following intervention. A stable chronic dissection was present in 1 patient who had only non-operative management. CONCLUSION Successful outcomes following SSD may be achieved with either non-operative therapy alone or intervention if persistent symptoms, expansion of false lumen, and/or malperfusion occur. The unpredictable response of the false lumen to conservative management mandates close, long-term follow-up. Endovascular and operative interventions produced similar outcomes in a small number of patients with limited follow-up. Although SSD is currently perceived as rare, the increasing use of CTA may prove that the true incidence has been underestimated.
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Affiliation(s)
- Thomas J Takach
- Department of Cardiothoracic and Vascular Surgery, Carolinas Heart Institute, Carolinas Health Care System, Charlotte, NC 28232-2861, USA.
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35
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Spontaneous isolated superior mesenteric artery dissection: a case report and literature review with management algorithm. Ann Vasc Surg 2009; 23:788-98. [PMID: 19467833 DOI: 10.1016/j.avsg.2008.12.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2008] [Accepted: 12/08/2008] [Indexed: 12/24/2022]
Abstract
BACKGROUND An isolated spontaneous superior mesenteric artery (SMA) dissection is the most frequent type of digestive artery dissection. Hepatic, splenic, left gastric, and celiac artery dissections are much less frequently observed. Dissection of the SMA is usually an extension of an aortic dissection. A true isolated SMA dissection is a relatively rare clinical cause of abdominal pathology. Only 106 cases (including the present case) of isolated spontaneous SMA dissection without associated aortic dissection were identified from the literature. METHODS Our vascular team managed a 56-year-old woman with spontaneous SMA dissection conservatively. Prior to the initiation of systemic anticoagulation, she underwent diagnostic laparoscopy. A repeat angiogram done at 2 months showed complete resolution of the dissection. She has been repeatedly examined for 5 years, which is the longest follow-up mentioned in the literature. CONCLUSION To our knowledge, this is the first case wherein laparoscopy was used to confirm the absence of mesenteric ischemia in acute presentation of SMA dissection. Using information from a review of the literature, we have designed a management protocol for this rare condition.
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36
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Nordanstig J, Gerdes H, Kocys E. Spontaneous Isolated Dissection of the Celiac Trunk with Rupture of the Proximal Splenic Artery: A Case Report. Eur J Vasc Endovasc Surg 2009; 37:194-7. [DOI: 10.1016/j.ejvs.2008.10.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Accepted: 10/15/2008] [Indexed: 10/21/2022]
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Abstract
The long-standing discussion concerning the mere existence of single vessel abdominal artery disease can be closed: chronic gastrointestinal ischaemia (CGI) due to single vessel abdominal artery stenosis exists, can be treated successfully and in a safe manner. The most common causes of single vessel CGI are the coeliac artery compression syndrome (CACS) in younger patients, and atherosclerotic disease in elderly patients. The clinical symptoms of single vessel CGI patients are postprandial and exercise-related pain, weight loss, and an abdominal bruit. The current diagnostic approach in patients suspected of single vessel CGI is gastrointestinal tonometry combined with radiological visualisation of the abdominal arteries to define possible arterial stenosis. Especially in single vessel abdominal artery stenosis, gastrointestinal tonometry plays a pivotal role in establishing the diagnosis CGI. First-choice treatment of single vessel CGI remains surgical revascularisation, especially in CACS. In elderly or selected patients endovascular stent placement therapy is an acceptable option.
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Affiliation(s)
- Désirée van Noord
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Centre's, Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands
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38
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Leon LR, Mills JL, Jordan W, Morasch MM, Kovacs M, Becker GJ, Arslan B. The Risks of Celiac Artery Coverage During Endoluminal Repair of Thoracic and Thoracoabdominal Aortic Aneurysms. Vasc Endovascular Surg 2008; 43:51-60. [DOI: 10.1177/1538574408322655] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The risks of purposeful celiac artery coverage during endovascular thoracic aortic aneurysm repair (TEVAR) to obtain an adequate distal landing zone have received scant scientific attention. Patients undergoing TEVAR at 6 tertiary centers from January 2000 to June 2007 were identified (n = 434); cases requiring celiac artery exclusion (n = 19; 4.4% of the total) were analyzed. The mean follow-up was 8.7 months (range, 0.2-21.2). The mean patients' age was 73.6 years (range, 56-86); 57.9% were men. The mean aneurysm diameter was 6.7 cm (range, 5-8.6). In 2 patients, the celiac artery balloon occlusion test was performed prior to TEVAR. In both, intact collateral foregut circulation was seen. Both underwent TEVAR without celiac artery revascularization; 1 did well, whereas the other developed foregut ischemia. In 16 cases (84.2%), the celiac artery was not revascularized prior to TEVAR. In those patients, 19 complications were reported (3 deaths; 2 paraplegia). No similar events occurred in those who underwent celiac artery revascularization (n = 3). Celiac artery coverage during TEVAR is required in 4.4% of cases. TEVAR correlated with a nonnegligible number of major complications. Complications were more frequent and severe in patients who did not have celiac artery revascularization prior to TEVAR. Specific celiac artery coverage complications are rare and not readily predictable based on preprocedure arteriography.
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Affiliation(s)
- Luis R. Leon
- Southern Arizona Veterans Affairs Health Care System (SAVAHCS), Tucson, Arizona, , University of Arizona Health Science Center (AHSC), Tucson, Arizona
| | - Joseph L. Mills
- University of Arizona Health Science Center (AHSC), Tucson, Arizona, Southern Arizona Veterans Affairs Health Care System (SAVAHCS), Tucson, Arizona
| | | | | | - Margaret Kovacs
- Baptist Cardiac & Vascular Institute of Miami, Miami, Florida
| | - Gary J. Becker
- Southern Arizona Veterans Affairs Health Care System (SAVAHCS), Tucson, Arizona, University of Arizona Health Science Center (AHSC), Tucson, Arizona
| | - Bulent Arslan
- University of Virginia Health System, Charlottesville, Virginia
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40
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D'Ambrosio N, Friedman B, Siegel D, Katz D, Newatia A, Hines J. Spontaneous Isolated Dissection of the Celiac Artery: CT Findings in Adults. AJR Am J Roentgenol 2007; 188:W506-11. [PMID: 17515339 DOI: 10.2214/ajr.06.0315] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Our objective was to describe the CT features of spontaneous isolated celiac artery dissection in a series of six otherwise healthy patients with acute abdominal pain. CONCLUSION Although once believed rare, isolated spontaneous celiac artery dissection should be considered in the diagnosis of acute abdominal pain, especially in middle-aged adults.
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Affiliation(s)
- Nicholas D'Ambrosio
- Department of Radiology, Long Island Jewish Medical Center, 270-05 76th Ave., New Hyde Park, NY 11040, USA.
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41
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Woolard JD, Ammar AD. Spontaneous dissection of the celiac artery: A case report. J Vasc Surg 2007; 45:1256-8. [PMID: 17543692 DOI: 10.1016/j.jvs.2007.01.048] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Accepted: 01/11/2007] [Indexed: 11/30/2022]
Abstract
Spontaneous dissection of visceral arteries is rare in the absence of concurrent dissection of the aorta, iatrogenic injury from instrumentation, or trauma. We describe a spontaneous dissection of the celiac artery that was identified by computed tomographic scan in an otherwise healthy man with acute onset abdominal pain and no identifiable causes of dissection. The patient was successfully managed medically. Although endovascular treatment or surgical intervention is the procedure of choice for complicated cases, medical management with close observation is an acceptable management strategy for stable, uncomplicated cases of spontaneous celiac artery dissection.
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Affiliation(s)
- Jason D Woolard
- Department of Surgery, The University of Kansas School of Medicine-Wichita, Wichita, KS 67214, USA
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42
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Cognet F, Ben Salem D, Dranssart M, Cercueil JP, Weiller M, Tatou E, Boyer L, Krausé D. Chronic mesenteric ischemia: imaging and percutaneous treatment. Radiographics 2002; 22:863-79; discussion 879-80. [PMID: 12110715 DOI: 10.1148/radiographics.22.4.g02jl07863] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Chronic mesenteric ischemia (CMI) is rare and is often diagnosed late. Fatal malabsorption-related complications or acute ischemic events occur in the absence of treatment. Diagnosis depends on careful acquisition of a medical history and elimination of other conditions. No sensitive and specific tests are available for functional diagnosis of CMI. If other causes of abdominal pain and weight loss have been confidently ruled out, evidence of visceral artery occlusion at noninvasive imaging (Doppler ultrasonography, computed tomographic angiography, and magnetic resonance angiography) suggests CMI. Until the 1990s, open surgery was considered the treatment of choice; percutaneous transluminal angioplasty (PTA) was reserved for patients for whom surgery carried a high risk. However, open surgery carries a nonnegligible risk of morbidity and mortality. In recent years, PTA with stent placement has been recognized as a minimally invasive means of obtaining good long-term results with an acceptable recurrence rate and consequently has been suggested for primary treatment of CMI. New treatments including administration of fibrinolytic agents before PTA of chronic occlusions, routine revascularization of one or more arteries, and stent placement will probably be validated in the near future. Similarly, new data on selection of the best approach will become available soon.
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Affiliation(s)
- François Cognet
- Department of Radiology and Imaging, Dijon University Hospital, France.
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