16. Case Series of Spontaneous Visceral Artery Dissections

Abstract

Spontaneous visceral artery dissections (SVADs) are rare but are being identified more frequently. The most common dissections are celiac artery (CA) and superior mesenteric artery (SMA) dissections. Historically, the majority of diagnosed SVADs were associated with symptoms, including epigastric pain, bloody stool, or nausea; however, with increased cross-sectional imaging, they are being identified more commonly while asymptomatic. Typical patients are Asian males in their fifth or sixth decade of life. Risk factors include smoking and arteriopathies. Most patients have no evidence of peritonitis. CT angiography (CTA) is the diagnostic modality of choice. Previously, patients were often treated with open or endovascular intervention, but now, patients are often managed medically with anticoagulants or antiplatelet medications. It is unclear whether antiplatelets, dual antiplatelet therapy, anticoagulation, or a combination should be the standard for medical management. Blood pressure control is supported as part of medical management, but the target pressure is not clear. The duration of medical management is also unclear. The ideal surveillance method and duration are unknown as most series are relatively short.