1
|
Otsu Y, Kuwabara M, Niitsu R, Yamaguchi T, Kodama T. Clinical characteristics and impact of pseudo-lumen blood flow on long-term vessel dilatation in spontaneous isolated dissection of superior mesenteric/celiac artery. Heart Vessels 2024:10.1007/s00380-024-02433-2. [PMID: 38995316 DOI: 10.1007/s00380-024-02433-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 06/20/2024] [Indexed: 07/13/2024]
Abstract
This study aimed to identify the clinical characteristics associated with spontaneous isolated dissection of superior mesenteric artery/celiac artery (SIDSMA/SIDCA). This observational study, conducted at Toranomon Hospital, Japan between 2009 and 2020, analyzed consecutive SIDSMA/SIDCA cases based on radiology data. The study compared clinical characteristics between symptomatic and asymptomatic patients with SIDSMA/SIDCA and investigated factors related to future vessel dilatation. Among 57 cases (44 SIDSMA, 17 SIDCA, and 4 both), the majority were male (87.7%), nearly half having hypertension (43.9%) and smokers (48.9%). Of those, 17 cases (29.8%) were symptomatic; abdominal pain (94.1%), back pain (23.5%), nausea (17.6%) and fever (5.9%). The symptomatic group was younger (52.6 ± 9.4 versus 67.2 ± 7.9 years, P < 0.001), had higher systolic and mean blood pressure (142.6 ± 20.0 versus 129.5 ± 16.5 mmHg, P = 0.017; 96.1 ± 14.6 versus 88.2 ± 17.7 mmHg, P = 0.038), a higher white blood cell count (9975 ± 5032 versus 6268 ± 1991 /µL, P = 0.012), and a higher LDL cholesterol level at diagnosis (129.7 ± 21.7 versus 87.2 ± 25.6 mg/dL, P = 0.002) than the asymptomatic group. The factors associated with future vessel dilatation included the presence of pseudo-lumen flow in the dissection vessel (73.9% versus 41.4%, p = 0.019) and a larger vessel diameter (13.5 ± 2.4 mm versus 11.5 ± 2.1 mm, p = 0.005) at diagnosis after multiple adjustments, pseudo-lumen flow was a predictor of future vessel dilatation (odds ratio, 4.80; 95% confidence interval, 1.11-20.75; p = 0.036). The study revealed that only 30% of SIDSMA/SIDCA cases were symptomatic. Symptomatic cases were generally younger and exhibited higher blood pressure and elevated white blood cell counts. These findings offer valuable insights for the acute diagnosis of SIDSMA/SIDCA.
Collapse
Affiliation(s)
- Yu Otsu
- Department of Cardiology, Toranomon Hospital, 2-2-2, ToranomonTokyo, Minato, 105-8470, Japan
| | - Masanari Kuwabara
- Department of Cardiology, Toranomon Hospital, 2-2-2, ToranomonTokyo, Minato, 105-8470, Japan
| | - Rieko Niitsu
- Department of Cardiology, Toranomon Hospital, 2-2-2, ToranomonTokyo, Minato, 105-8470, Japan
| | - Tetsuo Yamaguchi
- Department of Cardiology, Toranomon Hospital, 2-2-2, ToranomonTokyo, Minato, 105-8470, Japan
| | - Takahide Kodama
- Department of Cardiology, Toranomon Hospital, 2-2-2, ToranomonTokyo, Minato, 105-8470, Japan.
| |
Collapse
|
2
|
Husman R, Tanaka A, Wang SK, Keyhani K, Keyhani A. Spontaneous celiac artery dissection treated by balloon angioplasty. J Vasc Surg Cases Innov Tech 2022; 8:850-853. [PMID: 36545497 PMCID: PMC9761473 DOI: 10.1016/j.jvscit.2022.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 10/03/2022] [Indexed: 11/07/2022] Open
Abstract
Spontaneous isolated celiac artery dissection (SICAD) is a rare condition, defined as dissection of the celiac artery without aortic involvement. Because of its low prevalence, most studies have been limited to case reports and case series. We have described the case of a 44-year-old woman who had presented with symptomatic SICAD that had resulted in compromised flow to the hepatic arteries and was successfully treated with balloon angioplasty. Angioplasty alone might be effective for cases of extensive false lumen thrombosis in SICAD for immediate flow restoration to the true lumen, expediting positive remodeling.
Collapse
Affiliation(s)
| | | | | | | | - Arash Keyhani
- Correspondence: Arash Keyhani, DO, FACS, Division of Vascular Surgery, Department of Cardiothoracic and Vascular Surgery, John P. and Kathrine G. McGovern Medical School, The University of Texas Health Science Center at Houston, 1631 N Loop W, Ste 610, Houston, TX 77008
| |
Collapse
|
3
|
Feng Q, Zhao J, Zang L, Chen Y, Li S. A case report of an isolated superior mesenteric artery dissection caused by childbirth. BMC Gastroenterol 2021; 21:428. [PMID: 34774024 PMCID: PMC8590309 DOI: 10.1186/s12876-021-01994-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 10/26/2021] [Indexed: 12/15/2022] Open
Abstract
Background The isolated superior mesenteric artery dissection (SMAD) is a rare and sporadic cause of acute abdominal pain. It most frequently affects male patients in their fifth to sixth decades, while our patient was a young woman who delivered a baby before the onset of abdominal pain. Possible risk factors for SMAD include hypertension, arteriosclerosis, abnormalities in elastic fibres, trauma, and pregnancy. In our case, delivery was suggested as a risk factor, which has not been reported previously. Case presentation A 27-year-old woman complained of acute severe upper abdominal pain and vomiting for 2 days after delivery. The patient had no significant medical history. Physical examination revealed epigastric mild tenderness. All routine blood tests, blood coagulation analysis, liver function tests and abdomen computed tomography showed no remarkable findings. Computed tomography angiography revealed a marked dissection 3.5 cm below the superior mesenteric artery ostium. Since distal blood flow existed and the patient was in a puerperal state with no evidences of mesenteric ischemia, she was managed conservatively, including intestinal rest by fasting, parenteral nutritional support and antibioticis, without anticoagulants or antiplatelet agents. Fortunately, she recovered smoothly and had no recurrence. Conclusions SMAD is a rare and sporadic cause of acute abdominal pain that occurs in young women after delivery.
Collapse
Affiliation(s)
- Qian Feng
- Department of Gastroenterology, Liaocheng People's Hospital, Liaocheng, China.
| | - Jingrun Zhao
- Department of Gastroenterology, Liaocheng People's Hospital, Liaocheng, China
| | - Lina Zang
- Department of Gastroenterology, Liaocheng People's Hospital, Liaocheng, China
| | - Yuanyuan Chen
- Department of Gastroenterology, Liaocheng People's Hospital, Liaocheng, China
| | - Senlin Li
- Department of Gastroenterology, Liaocheng People's Hospital, Liaocheng, China
| |
Collapse
|
4
|
Shiraki H, Kasamoto M, Yasutomi M, Kaji S, Akutsu K, Furukawa Y, Shimizu W, Inoue N. Clinical Features of Spontaneous Isolated Dissection of Abdominal Visceral Arteries. J Clin Med Res 2020; 12:13-17. [PMID: 32010417 PMCID: PMC6968924 DOI: 10.14740/jocmr3916] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 10/15/2019] [Indexed: 01/20/2023] Open
Abstract
Background Spontaneous isolated dissection of abdominal visceral arteries without aortic dissection is rare and its pathology and prognosis are not yet clear; therefore, therapeutic strategies for this disease have not been established. The present multi-institution investigational study analyzed the clinical features of patients with spontaneous isolated dissection of abdominal visceral arteries. Methods A total of 36 patients diagnosed as spontaneous isolated dissection of abdominal visceral arteries from January 2010 to October 2016 were enrolled. The medical data of the patients were retrospectively reviewed. Imaging characteristics were evaluated. Spontaneous isolated dissection of abdominal visceral arteries was detected on upper abdominal computed tomography examination in almost patients, and was detected on magnetic resonance imaging in one patient. Results Of the 36 cases, 26 cases involved the superior mesenteric artery dissection, nine involved the celiac artery, two involved the splenic artery, one involved the common hepatic artery, one involved the gastroduodenal artery and one involved the left gastric artery. Among the 36 patients, 20 had hypertension and 14 were current smokers. Additionally, only one patient had diabetes and four patients had dyslipidemia. Moreover, 32 cases complained of pain including abdominal pain and back pain, one had cough and three had no symptoms. Of the 36 patients, 34 cases (94.4%) were treated conservatively, and two (5.6%) required intravascular treatment. All patients were discharged without complications. Conclusions Our findings indicate that hypertension and smoking might be closely involved in the pathogenesis of spontaneous isolated dissection of abdominal visceral arteries, whereas dyslipidemia and diabetes might be less involved. Additionally, few asymptomatic patients were accidentally diagnosed, indicating that the absence of symptoms cannot be used to rule out the presence of this disease. Randomized clinical trials cannot be performed because a considerable number of cases are required. Therefore, detailed descriptions of clinical features, as provided in our report, are important.
Collapse
Affiliation(s)
- Hiroaki Shiraki
- Department of Cardiovascular Medicine, Kobe Rosai Hospital, Kobe, Japan
| | - Manabu Kasamoto
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Koichi Akutsu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Nobutaka Inoue
- Department of Cardiovascular Medicine, Kobe Rosai Hospital, Kobe, Japan
| |
Collapse
|
5
|
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: 21] [Impact Index Per Article: 4.2] [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.
Collapse
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
| | | |
Collapse
|
6
|
Wang HT, Yu ZH, Tu C, Lu B. Interventional treatment of isolated dissection of the celiac artery: A case report and literature review. Medicine (Baltimore) 2018; 97:e11026. [PMID: 29901595 PMCID: PMC6024248 DOI: 10.1097/md.0000000000011026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
RATIONALE Isolated dissection of the celiac artery (IDCA) is one of isolated visceral artery dissection, which can occur alone, and can also be complicated with superior mesenteric artery dissection and splenic artery pseudoaneurysm. This disease is very rare in clinic. The exact pathogenesis of IDCA remains unknown. At present, no consensus has yet been reached on the best treatment strategy for this rare disease. In the present study, the clinical data of one IDCA patient diagnosed and treated in our hospital was retrospectively analyzed, and related literatures were reviewed, in order to improve the understanding of the disease. PATIENT CONCERNS The patient was a 49-year-old male, who was admitted in our hospital because of "pain of subxyphoid area for one month". One month before, the patient presented with persistent pain in the subxyphoid area after he had a cold, on paroxysmal exacerbation occurred. After taking "stomach drug", the subjective symptoms eased slightly, but the disease attacked again two hours later. DIAGNOSES The patient was diagnosed with "isolated dissection of the celiac artery" by enhanced CT. INTERVENTIONS The patient was interventionally treated with bare stent implantation. OUTCOMES The symptom of the patient disappeared after interventional therapy. LESSONS In the present study, the clinical symptoms and treatment process of one patient with IDCA were described. The clinical symptoms of IDCA are often atypical, and its incidence is extremely low, therefore it is extremely easily misdiagnosed. The definite diagnosis depends on imaging examination. Interventional therapy is the first choice for treating this disease due to its advantages of small trauma and good curative effect.
Collapse
|
7
|
Yu Z, Kondo N, Chiyoya M, Suzuki Y, Fukuda I. Selection and Determination of Treatment for the Spontaneous Isolated Dissection of the Superior Mesenteric Artery. Ann Vasc Dis 2018; 11:101-105. [PMID: 29682115 PMCID: PMC5882352 DOI: 10.3400/avd.oa.17-00120] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective: This study aimed to clarify the selection and determination of appropriate treatment for acute symptomatic spontaneous isolated dissection of the superior mesenteric artery (SIDSMA). Methods: Data from 10 consecutive patients, who were diagnosed with symptomatic SIDSMA using computed tomography angiography and were managed in our hospital from January 2010 to October 2015, were retrospectively collected and analyzed. Results: There were nine males and one female; mean patient age was 50.3 (range, 35-64) years. All patients experienced acute abdominal pain, and three patients experienced concomitant vomiting. Only one patient exhibited symptoms of suspected peritonitis and intestinal ischemia. Three patients showed improved abdominal pain before admission to our hospital. One patient experienced severe abdominal pain that could not be managed using morphine; he underwent right external iliac to superior mesenteric artery bypass with a great saphenous vein graft. No patient presented with intestinal necrosis. All patients survived, and no patient developed complications during the follow-up period of up to 42 (24.5±16.5) months. Conclusion: Conservative management appears to be the most feasible treatment for SIDSMA. However, open surgery can be performed in patients presenting with any symptoms of intestinal ischemia.
Collapse
Affiliation(s)
- Zaiqiang Yu
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Norihiro Kondo
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Mari Chiyoya
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Yasuyuki Suzuki
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Ikuo Fukuda
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
| |
Collapse
|
8
|
Hosaka A, Nemoto M, Miyata T. Outcomes of conservative management of spontaneous celiac artery dissection. J Vasc Surg 2017; 65:760-765.e1. [DOI: 10.1016/j.jvs.2016.09.058] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 09/23/2016] [Indexed: 10/20/2022]
|
9
|
Hedfi M, Messaoudi Y, Chouchene A. Conservative Management of Isolated Superior Mesenteric Artery and Celiac Trunk Dissection: A Case Report and Literature Review. J Clin Diagn Res 2017; 10:PD24-PD26. [PMID: 28050440 DOI: 10.7860/jcdr/2016/24177.8877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 10/14/2016] [Indexed: 11/24/2022]
Abstract
Isolated arterial dissection without aortic pathology has been rarely reported in mesenteric vessels. The natural history and appropriate treatment for this disease is uncertain because of the scarcity of literature which limits the data available to the clinician, resulting in management challenges. Herein, we report a rare case of a 42-year-old Tunisian man with spontaneous dissection and aneurysmal dilatation of the Celiac Artery (CA) and the Superior Mesenteric Artery (SMA) with partial thrombosis. This case was successfully managed conservatively with heparin infusion and blood pressure control and the patient remained symptom free at 15 months follow up. This case demonstrates that conservative management may be warranted in non-complicated isolated visceral arterial dissection.
Collapse
Affiliation(s)
- Mohamed Hedfi
- Faculty, Department of Surgery, FSI Hospital , Marsa, Tunisia
| | - Yosra Messaoudi
- Faculty, Department of Cardiology, Kairwan Hospital , Jairwan, Kairwan, Tunisia
| | - Adnen Chouchene
- Faculty, Department of Surgery, FSI Hospital , Marsa, Tunisia
| |
Collapse
|
10
|
Ichiba T, Naito H, Nagata T, Masuda R, Hata M, Maeda K. Spontaneous isolated left gastric artery dissection: unusual visceral artery dissection. Acute Med Surg 2016; 3:369-371. [PMID: 29123814 PMCID: PMC5667314 DOI: 10.1002/ams2.191] [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: 10/04/2015] [Accepted: 12/24/2015] [Indexed: 11/12/2022] Open
Abstract
Case A 51-year-old woman visited our emergency department complaining of acute onset of upper abdominal pain and nausea. Abdominal contrast-enhanced computed tomography showed an isolated left gastric artery dissection and pseudoaneurysm. After conservative management for 6 days, endovascular embolization was carried out for treatment of the pseudoaneurysm. Spontaneous dissection of a visceral artery rarely occurs in the case of a left gastric artery. Outcome Contrast-enhanced computed tomography is essential to make an accurate diagnosis and establish a therapeutic strategy. Conclusion We should consider the occurrence of minor visceral artery dissection if a patient has acute abdominal pain without other obvious causes.
Collapse
Affiliation(s)
- Toshihisa Ichiba
- Department of Emergency MedicineHiroshima City HospitalHiroshimaJapan
| | - Hiroshi Naito
- Department of Emergency MedicineHiroshima City HospitalHiroshimaJapan
| | - Takeshi Nagata
- Department of Emergency MedicineHiroshima City HospitalHiroshimaJapan
| | - Rieko Masuda
- Department of Emergency MedicineHiroshima City HospitalHiroshimaJapan
| | - Masako Hata
- Department of Emergency MedicineHiroshima City HospitalHiroshimaJapan
| | - Keisuke Maeda
- Department of Emergency MedicineHiroshima City HospitalHiroshimaJapan
| |
Collapse
|
11
|
Swergold N, Kozusko S, Rivera C, Sturt C. Hypertensive emergency presenting with an isolated celiac artery dissection: A rare case study. Int J Surg Case Rep 2016; 27:147-151. [PMID: 27615054 PMCID: PMC5021788 DOI: 10.1016/j.ijscr.2016.08.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 08/24/2016] [Accepted: 08/24/2016] [Indexed: 11/16/2022] Open
Abstract
To the best of our knowledge, we present the 25th case of isolated celiac artery dissection. This is the first case of hypertensive emergency induced spontaneous isolated celiac trunk dissection in literature. Visceral artery dissection is a rare commodity, and celiac artery dissection is less common than dissection in the SMA. It is a difficult diagnosis to make on history and physical alone, necessitating contrast enhanced CT imaging. Our patient was managed nonoperatively with a labetalol drip and did well.
Introduction To our knowledge the most recent article on celiac dissection was published in 2015 and reported 24 known cases of spontaneous isolated celiac trunk dissection [2]. While some of those cases reported hypertension as a risk factor, no other case presents as hypertensive emergency with an isolated celiac artery dissection. Presentation of case A 43 year-old man with a past medical history of uncontrolled hypertension, for which he had reportedly been non-compliant with follow-up, presented with complaints of severe, sudden-onset epigastric pain which was non-radiating and constant for 1 hour prior to arrival. On CT an intimal flap was noted within the celiac trunk, starting at the origin and extending into the left gastric, splenic, and the common hepatic arteries. Discussion The most common symptom in patients with celiac artery dissection is acute or chronic epigastric or abdominal pain [2,4,9,11]. The crux of the diagnosis of this condition relies on contrast enhanced CT. The superiority of the CT scan is because of the contrast tracking capability [11]. The two most common risk factors for celiac artery dissection are hypertension followed by vasculitis. Patients can be managed nonoperatively or with one of a few operative procedures. Conservative treatment consists of anticoagulants, antihypertensives, and antiplatelet therapy [2]. Conclusion To the best of our knowledge, we present the 25th case of isolated celiac artery dissection. This is the first case of hypertensive emergency induced spontaneous isolated celiac trunk dissection in literature. Our patient was managed primarily with a labetalol drip.
Collapse
Affiliation(s)
- Natalie Swergold
- Barnabas Health, Monmouth Medical Center, Department of Surgery, Long Branch, NJ, United States
| | - Steven Kozusko
- Barnabas Health, Monmouth Medical Center, Department of Surgery, Long Branch, NJ, United States.
| | - Carlos Rivera
- Newark Beth Israel Hospital, Department of Vascular Surgery, Newark, NJ, United States
| | - Cindy Sturt
- Newark Beth Israel Hospital, Department of Vascular Surgery, Newark, NJ, United States
| |
Collapse
|
12
|
A Case of Isolated Celiac Artery Dissection Accompanied by Splenic Infarction Detected by Ultrasonography in the Emergency Department. Case Rep Cardiol 2016; 2016:8608496. [PMID: 27148460 PMCID: PMC4842356 DOI: 10.1155/2016/8608496] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/28/2016] [Indexed: 12/01/2022] Open
Abstract
A 46-year-old male with a history of hypertension visited the emergency department (ED) by ambulance complaining of sudden pain in the left side of his back. Ultrasonography (USG) performed at ED revealed splenic infarction along with occlusion and dissection of the celiac and splenic arteries without abdominal artery dissection. Contrast enhanced computed tomography (CT) revealed the same result. Consequently, spontaneous isolated celiac artery dissection (SICAD) was diagnosed. Because his blood pressure was high (159/70 mmHg), antihypertensive medicine was administered (nicardipine and carvedilol). After his blood reached optimal levels (130/80 mmHg), symptoms disappeared. Follow-up USG and contrast enhanced CT performed 8 days and 4 months after onset revealed amelioration of splenic infarction and improvement of the narrowed artery. Here, we report a case of SICAD with splenic infarction presenting with severe left-sided back pain and discuss the relevance of USG in an emergency setting.
Collapse
|
13
|
Chen ZL, Zhang XC, Pan GR, Sun Y, Xu M, Li XQ. Clinical Features and Therapeutic Options for Isolated Visceral Artery Dissection. Ann Vasc Surg 2016; 30:227-35. [DOI: 10.1016/j.avsg.2015.07.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 07/09/2015] [Accepted: 07/22/2015] [Indexed: 01/20/2023]
|
14
|
Tomita K, Obara H, Sekimoto Y, Matsubara K, Watada S, Fujimura N, Shibutani S, Nagasaki K, Hayashi S, Harada H, Asami A, Uchida N, Kakefuda T, Kitagawa Y. Evolution of Computed Tomographic Characteristics of Spontaneous Isolated Superior Mesenteric Artery Dissection During Conservative Management. Circ J 2016; 80:1452-9. [DOI: 10.1253/circj.cj-15-1369] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Koichi Tomita
- Department of Surgery, Keio University School of Medicine
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine
| | | | | | | | - Naoki Fujimura
- Department of Surgery, Keio University School of Medicine
| | - Shintaro Shibutani
- Department of Surgery (Vascular Surgery), Saiseikai Yokohamashi Tobu Hospital
| | | | - Shinobu Hayashi
- Department of Surgery (Vascular Surgery), Saiseikai Yokohamashi Tobu Hospital
| | - Hirohisa Harada
- Department of Surgery, Tokyo Dental College Ichikawa General Hospital
| | | | | | | | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine
| |
Collapse
|
15
|
Aydin S, Ergun E, Fatihoglu E, Durhan G, Kosar PN. Spontaneous Isolated Celiac Artery and Superior Mesenteric Artery Dissections: A Rare Case. Pol J Radiol 2015; 80:470-2. [PMID: 26543511 PMCID: PMC4610684 DOI: 10.12659/pjr.895048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 07/05/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Arterial dissection is defined as the cleavage of the arterial wall by an intramural hematoma. Reports of dissection of the celiac and/or superior mesenteric artery are rare; as far as we know, only 24 cases of spontaneous isolated celiac trunk dissection, and 71 cases of spontaneous isolated superior mesenteric artery dissection have been reported. CASE REPORT The case presents a 48-year-old male with a sudden-onset epigastric pain. A Computed Tomography Angiography of the thoracoabdominal aorta was applied and dissections of both the celiac artery and SMA were determined. A conservative therapeutic approach was preferred and the patient was discharged with anticoagulant and antihypertensive therapy. CONCLUSIONS Although rare, spontaneous isolated celiac artery and superior mesenteric artery dissections must be kept in mind in the differential diagnosis of the epigastric pain in the emergency room. Contrast-enhanced Computed Tomography Angiography examination is the method of choice in the diagnosis.
Collapse
Affiliation(s)
- Sonay Aydin
- Department of Radiology, Ministry of Health, Ankara Education and Research Hospital, Ankara, Turkey
| | - Elif Ergun
- Department of Radiology, Ministry of Health, Ankara Education and Research Hospital, Ankara, Turkey
| | - Erdem Fatihoglu
- Department of Radiology, Ministry of Health, Ankara Education and Research Hospital, Ankara, Turkey
| | - Gamze Durhan
- Department of Radiology, Ministry of Health, Ankara Education and Research Hospital, Ankara, Turkey
| | - Pinar Nercis Kosar
- Department of Radiology, Ministry of Health, Ankara Education and Research Hospital, Ankara, Turkey
| |
Collapse
|
16
|
Alcantara S, Yang CK, Sasson J, Goss S, Benvenisty A, Todd G, Lantis J. The Evidence for Nonoperative Management of Visceral Artery Dissections: A Single-Center Experience. Ann Vasc Surg 2015; 29:103-8. [DOI: 10.1016/j.avsg.2014.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 08/28/2014] [Accepted: 09/08/2014] [Indexed: 10/24/2022]
|
17
|
Harada W, Mizooka M. [How does the physician interpret the patient's narrative as it relates to the physical exam?; Sudden abdominal pain with cold sweat]. ACTA ACUST UNITED AC 2014; 103:3130-4. [PMID: 25812347 DOI: 10.2169/naika.103.3130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
18
|
Satokawa H, Takase S, Seto Y, Yokoyama H, Gotoh M, Kogure M, Midorikawa H, Saito T, Maehara K. Management strategy of isolated spontaneous dissection of the superior mesenteric artery. Ann Vasc Dis 2014; 7:232-8. [PMID: 25298823 DOI: 10.3400/avd.oa.14-00071] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 06/11/2014] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Isolated spontaneous dissection of the superior mesenteric artery (SMA) is very rare among of the visceral artery dissection and its treatment is not established. In this paper we present our experiences and consider the treatment of isolated SMA dissection. METHODS A retrospective review of our cases from 2005 was performed. Clinical symptoms, radiologic findings and results were evaluated. There were 14 cases of visceral artery dissection, in which all cases were with SMA dissection. There were 12 males and 2 females with a mean age of 57 years (range 41-78 years). RESULTS We categorized SMA dissection into the six types according to the Sakamoto's and Zerbib's classification. One patient with type VI underwent emergent endovascular surgery with stent. One patient with type VI received thrombectomy and intimectomy with open surgery. One patient with type II underwent aneurysmectomy due to enlarged dissected SMA 3 months later from onset. The other eleven patients were managed conservatively. At follow-up, the diameter of SMA did not enlarged and the length of the dissection significantly decreased to 20.7 ± 15.7 mm from 38.0 ± 15.1 mm at onset (p <0.01). After treatment, imaging indicated the following changes in classification: type I, one patient; type II, 4 patients; type IV, 4 patients; complete remodeling, one patient, all without any event during the follow-up period of 5-82 months. CONCLUSION Most patients with isolated visceral artery dissection occurred in superior mesenteric artery and can be treated conservatively; however, endovascular or surgical procedures including laparotomy are indicated when there is suspicion of severe mesenteric ischemia. Because the dissection configuration will change, long term follow-up is necessary. (English translation of Jpn J Vasc Surg 2013; 22: 695-701).
Collapse
Affiliation(s)
- Hirono Satokawa
- Department of Cardiovascular Surgery, Fukushima Medical University, School of Medicine, Fukushima, Fukushima, Japan
| | - Shinya Takase
- Department of Cardiovascular Surgery, Fukushima Medical University, School of Medicine, Fukushima, Fukushima, Japan
| | - Yuki Seto
- Department of Cardiovascular Surgery, Fukushima Medical University, School of Medicine, Fukushima, Fukushima, Japan
| | - Hitoshi Yokoyama
- Department of Cardiovascular Surgery, Fukushima Medical University, School of Medicine, Fukushima, Fukushima, Japan
| | - Mitsukazu Gotoh
- Department of 1st Surgery, Fukushima Medical University, School of Medicine, Fukushima, Fukushima, Japan
| | - Michihiko Kogure
- Department of 1st Surgery, Fukushima Medical University, School of Medicine, Fukushima, Fukushima, Japan
| | - Hirofumi Midorikawa
- Department of Cardiovascular Surgery, Minami Tohoku General Hospital, Kooriyama, Fukushima, Japan
| | - Tomiyoshi Saito
- Department of Circulatory Internal Medicine, Shirakawa Kosei General Hospital, Shirakawa, Fukushima, Japan
| | - Kazuhira Maehara
- Department of Circulatory Internal Medicine, Shirakawa Kosei General Hospital, Shirakawa, Fukushima, Japan
| |
Collapse
|
19
|
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]
|
20
|
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]
|
21
|
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.
Collapse
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
| |
Collapse
|
22
|
Li N, Lu QS, Zhou J, Bao JM, Zhao ZQ, Jing ZP. Endovascular stent placement for treatment of spontaneous isolated dissection of the superior mesenteric artery. Ann Vasc Surg 2013; 28:445-51. [PMID: 24070572 DOI: 10.1016/j.avsg.2013.01.028] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 01/08/2013] [Accepted: 01/10/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) is a rare condition often associated with a poor prognosis. The goal of this study is to assess the efficacy of endovascular treatment of SIDSMA with stenting and investigate the possible therapeutic mechanisms involved. METHODS This is a retrospective review of all patients undergoing endovascular treatment of SIDSMA from January 2009 to December 2011. Patient demographics, history, clinical presentation, laboratory tests, image characteristics, endovascular treatments, and follow-up outcome were analyzed. RESULTS Twenty-four patients with symptoms were treated. All except 1 patient (23 of 24, 96%) underwent successful stent placement (16 with single stent and 7 with overlapping stents). A total of 30 stents (4 balloon-expanded and 26 self-expanding) were placed during the procedures. In the perioperative period and during follow-up, symptom relief was achieved in 20 (83%) patients, and abdominal pain remained unchanged in 4 (17%). No death or serious complications occurred. The median length of hospital stay and follow-up was 3.25 ± 2.23 days (range 2-7 days) and 13.15 ± 8.27 months (range 6-23 months), respectively. Computed tomography angiography (CTA) performed 6 months postoperatively revealed stent patency in 23 cases (100%), false lumen patency in 5 cases (22%), and new development of dissection in the SMA distal to the stent in 1 case (4%). No significant differences were observed in the incidence of false lumen patency between patients treated with a single stent and those treated with overlapping stents, and between patients with and without symptom relief (P > 0.05 for both). CONCLUSIONS For symptomatic SIDSMA patients without intra-abdominal hemorrhage and intestinal infarction, endovascular stent placement is a feasible treatment choice with a high success rate and good clinical outcome. Overlapping stenting may be proposed for patients with aneurysmal dilation. False lumen patency may occur in some cases during follow-up, but it does not affect improvement of SIDSMA symptoms.
Collapse
Affiliation(s)
- Nan Li
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Qing-Sheng Lu
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jian Zhou
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jun-Min Bao
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhi-Qing Zhao
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zai-Ping Jing
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
| |
Collapse
|
23
|
Luan J, Li X. Computed Tomography Imaging Features and Classification of Isolated Dissection of the Superior Mesenteric Artery. Eur J Vasc Endovasc Surg 2013; 46:232-5. [DOI: 10.1016/j.ejvs.2013.04.035] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 04/30/2013] [Indexed: 12/31/2022]
|
24
|
Choi JY, Kwon OJ. Approaches to the management of spontaneous isolated visceral artery dissection. Ann Vasc Surg 2013; 27:750-7. [PMID: 23790761 DOI: 10.1016/j.avsg.2012.09.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 08/24/2012] [Accepted: 09/16/2012] [Indexed: 12/30/2022]
Abstract
BACKGROUND Spontaneous isolated celiac and superior mesenteric artery dissection without aortic dissection is a rare disease. Recently, an increasing number of cases have been diagnosed and the prognosis has improved significantly because of technical progress in computed tomography (CT). However, management approaches vary from conservative treatment or endovascular repair to open surgery. This study analyzed the clinical findings of patients with spontaneous visceral artery dissection, and attempted to illuminate how to manage these cases. MATERIALS AND METHODS From June 2005 to February 2012, a total of 17 patients were diagnosed with spontaneous isolated visceral artery dissection in the authors' hospital (4 celiac arteries, 12 superior mesenteric arteries, and 1 inferior mesenteric artery) based on CT findings. The clinical characteristics, Sakamoto's classification, imaging appearance, and early outcomes of these patients were retrospectively compared. RESULTS The mean age of the patients was 51.47 ± 8.65 years (range, 39-73 years) and the mean follow-up period was 35.18 ± 25.55 months (range, 1-79 months). Fifteen (88.2%) patients had abdominal pain and no ischemic changes of the bowel. The dissections initiated at a mean distance of 13.04 ± 10.41 mm (range, 4.00-43.39 mm) from the origin of the artery, with a mean length of 53.39 ± 28.06 mm (range, 10.00-108.46 mm). There were 4 type I (23.8%), 1 type II (5.9%), 9 type III (52.9%), and 3 type IV (17.6%) dissections according to Sakamoto's classification. Treatments included observation without anticoagulation treatment in 3 patients (17.6%), anticoagulation treatment in 12 (70.6%), and endovascular stenting in 2 (11.8%). The disease stabilized in all patients during follow-up. CONCLUSIONS If bowel perfusion is not compromised and patency is well compensated by collateral circulation, most patients can be managed conservatively with or without anticoagulation treatment. However, patients must be monitored closely and followed up regularly for early detection of progression.
Collapse
Affiliation(s)
- Ji Yoon Choi
- Department of Surgery, Hanyang University Hospital, Seoul, Korea
| | | |
Collapse
|
25
|
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]
|
26
|
Satokawa H, Seto Y, Yamamoto A, Yokoyama H, Kogure M, Satoshi O, Gotoh M. A case report of aneuysmectomy after thrombo-intimectomy for spontaneous isolated superior mesenteric artery dissection. Ann Vasc Dis 2013; 5:204-7. [PMID: 23555512 DOI: 10.3400/avd.cr.12.00005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Accepted: 02/21/2012] [Indexed: 11/13/2022] Open
Abstract
A 53 year-old man was admitted with acute onset of severe abdominal pain, and we performed emergent thrombectomy and intimectomy for acute, complete occlusion of superior mesenteric artery (SMA) due to its spontaneous dissection. However, 4 months later the operated part of the SMA enlarged due to aneurysm and the patient was treated by aneuysmectomy and iliac-mesenteric bypass using a saphenous vein. Aggressive treatment such as surgical or endovascular procedure is necessary for severe ischemia due to SMA dissection.
Collapse
Affiliation(s)
- Hirono Satokawa
- Department of Cardiovascular Surgery, Fukushima Medical University, School of Medicine, Fukushima, Fukushima, Japan
| | | | | | | | | | | | | |
Collapse
|
27
|
Isolated celiac and superior mesenteric artery dissection identified with MDCT: imaging findings and clinical course. J Comput Assist Tomogr 2012; 36:539-45. [PMID: 22992604 DOI: 10.1097/rct.0b013e318265129e] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Isolated celiac or superior mesenteric artery (SMA) dissection is a rare entity in the absence of aortic dissection. Our objective was to detail imaging and clinical course of celiac and or SMA dissections. METHODS We conducted a retrospective search from 2004 to 2010 using "celiac and/or SMA dissection" keywords. Analysis of medical record and imaging at diagnosis and follow-up was performed. Dissections for any reason without aortic dissection were included. RESULTS Twenty-four celiac and 18 SMA dissections were detected in 38 patients. One third of the dissections diagnosed with interactive multiplanar reconstruction/maximum intensity projection (MIP)/3-dimensional (3D) rendering were missed on standard imaging planes. No patients had bowel ischemia or died. Eighty-four percent of the patients were observed, 2 patients received anticoagulation, 2 patients received surgical repair, and 3 patients received stenting. Twenty-three of 25 cases treated with observation exhibited no change or improvement/resolution (2/25) with 20.9-month mean follow-up. CONCLUSION Most isolated celiac and SMA dissections were asymptomatic/incidental, supporting observation and surveillance with intervention reserved for vascular compromise. Interactive multiplanar reconstruction/maximum intensity projection/3D rendering can increase diagnostic sensitivity.
Collapse
|
28
|
Affiliation(s)
| | - Eri Fukaya
- University of Pennsylvania, Philadelphia, PA, USA
| | - Antonio Pena
- University of Pennsylvania, Philadelphia, PA, USA
| | - Emile Mohler
- University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
29
|
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
| |
Collapse
|
30
|
Carter R, O'Keeffe S, Minion DJ, Sorial EE, Endean ED, Sarantis Xenos E. Spontaneous Superior Mesenteric Artery Dissection: Report of 2 Patients and Review of Management Recommendations. Vasc Endovascular Surg 2011; 45:295-8. [DOI: 10.1177/1538574410389341] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Spontaneous superior mesenteric artery dissection is rare and presents with variable symptomatology. Optimal treatment depends on the presentation; asymptomatic patients can be managed expectantly. Endoluminal intervention or open reconstruction is warranted in patients with persistent symptoms or intestinal ischemia. As more of these patients are identified with increasing utilization of computed tomography (CT), our understanding of the pathophysiology and best treatment will improve.
Collapse
Affiliation(s)
- Robert Carter
- Vascular Surgery, University of Kentucky, Lexington, KY, USA
| | - Shane O'Keeffe
- Vascular Surgery, University of Kentucky, Lexington, KY, USA
| | - David J. Minion
- Vascular Surgery, University of Kentucky, Lexington, KY, USA
| | - Ehab E. Sorial
- Vascular Surgery, University of Kentucky, Lexington, KY, USA
| | - Eric D. Endean
- Vascular Surgery, University of Kentucky, Lexington, KY, USA
| | | |
Collapse
|