Clinical usefulness of endoscopic ultrasound for optimized patient management with visceral artery dissection

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Background and Objectives:We evaluated the clinical usefulness of endoscopic ultrasound (EUS) in diagnosing visceral vascular dissection and in assessing morphological and hemodynamic characteristics required for optimized patient management.Methods:EUS was performed in 62 patients with clinically suspected visceral artery dissection as determined by computed tomography scan between February 2012 and December 2016. Conventional B-mode, color Doppler, and contrast-enhanced harmonic-EUS (CEH-EUS) were done to evaluate vascular status of celiac artery and superior mesenteric artery.Results:EUS and CEH-EUS identified all the visceral vascular dissections. Five patients (8%) underwent surgical or radiological intervention, whereas the others were managed conservatively with or without anticoagulation therapy. Vascular stenosis was more severe in patients who underwent surgical or radiological intervention (92% ± 8% vs. 67% ± 20%, P = 0.007). The severe vascular stenosis was associated with surgical or radiological intervention rather than conservative management (hazard ratio [HR] 1.34, 95% confidence interval [CI] 1.07–1.68, P = 0.01). The presence of false lumen thrombi (HR 0.24, 95% CI 0.025–2.301, P = 0.22) and collateral circulation (HR 0.30, 95% CI 0.04–2.06, P = 0.22) tended to predict conservative management of visceral vascular dissection without statistical significance. In multivariate analysis, degree of vascular stenosis was the only significant factor predicting surgical or radiological intervention in visceral vascular dissection.Conclusions:EUS may be a promising diagnostic modality to assess the visceral artery dissection without exposure to radiation. Moreover, EUS is a useful tool to determine the appropriate treatment options for patients with visceral artery dissection based on the degree of vascular stenosis.