Celiac Artery Dissection Research Articles

A Case Treated with Open Surgery for Rupture of the Splenic Artery Aneurysm Due to Isolated Spontaneous Celiac Artery Dissection (ISCAD)

A Case Treated with Open Surgery for Rupture of the Splenic Artery Aneurysm Due to Isolated Spontaneous Celiac Artery Dissection (ISCAD)

Ten-year review of isolated spontaneous mesenteric arterial dissections

ObjectiveIsolated spontaneous dissection of the superior mesenteric artery (SMA) and celiac artery (CA) remains a rare condition; however, it has been increasingly noted incidentally on diagnostic imaging. The purpose of this study was to examine the natural history and outcomes of patients presenting with isolated spontaneous mesenteric artery dissection (SMAD). We hypothesized that most SMADs can be treated nonoperatively. MethodsThis was a single-center retrospective review of patients presenting with the diagnosis of SMAD between 2006 and 2016. Data analysis included demographics, clinical data, radiologic review, treatment, and outcomes. ResultsA total of 77 patients were found to have CA dissection, SMA dissection, or both in the absence of aortic dissection diagnosed on computed tomography or magnetic resonance imaging. The average age was 56 years (range, 26-86 years), 80% were male, and 10 patients (13%) had underlying connective tissue disorders. The majority, 64%, presented with symptoms including abdominal pain, back pain, and chest pain; the remaining 36% were asymptomatic. Combined SMA and CA dissection was found in 14 (18%) patients; 33 (43%) presented with isolated CA dissection, and 30 (39%) presented with isolated SMA dissection. Only four patients required intervention. Mesenteric bypass was performed in two patients, and SMA endarterectomy with patch angioplasty was performed in one patient for signs of bowel ischemia. No patient required bowel resection. The two bypasses were anastomosed to a branch of the SMA, and complete lumen restoration was seen on long-term imaging follow-up. One patient underwent stent grafting of the CA and hepatic artery for aneurysmal degeneration 1 month after diagnosis. The remaining 73 patients were managed nonoperatively; 40 (52%) were treated with a short course of anticoagulation, 23 (30%) were treated with antiplatelet therapy, and 10 (13%) were treated with observation alone. No other late interventions or recurrences were noted during a mean follow-up of 21 months. ConclusionsWhereas isolated SMAD poses a risk of visceral ischemia, most patients presenting with this diagnosis can be treated nonoperatively with a short course of antiplatelet or anticoagulant therapy. Only a small number of patients require surgical revascularization for bowel ischemia.

Isolated Celiac Artery Dissection as a Cause of Acute Post-Prandial Abdominal Pain

Isolated Celiac Artery Dissection as a Cause of Acute Post-Prandial Abdominal Pain

Gangrenous Cholecystitis Secondary to Extension of Celiac Artery Dissection into Hepatic Artery

Gangrenous Cholecystitis Secondary to Extension of Celiac Artery Dissection into Hepatic Artery

MTHFR C677T Genotype as a Cause of Celiac Artery Dissection Leading to Abdominal Pain

MTHFR C677T Genotype as a Cause of Celiac Artery Dissection Leading to Abdominal Pain

Presentation, treatment, and outcomes in patients with spontaneous isolated celiac and superior mesenteric artery dissection.

Spontaneous isolated celiac or superior mesenteric artery (SMA) dissection (SICMAD) is a rare clinical entity. Not much is known about the natural history and appropriate treatment. We retrospectively queried a prospectively collected institutional radiology database for all patients diagnosed with SICMAD from 1990 to 2017. We identified 42 arteries in 40 patients (83.3% male), mean age 54.8 ± 10.9 years, consisting of 24 celiac arteries and 18 SMA. SMA lesions were longer than celiac lesions (5.15 ± 3.81 vs 2.38 ± 1.40 cm, p = 0.008). Thirty-one patients had follow-up; mean follow-up was 4.9 ± 4.8 years. Morphologic improvement was seen in 20 (48%) arteries. Sakamoto IV lesions were more likely to remodel (OR: 11.26, 95% CI: 1.13, 588.26, p = 0.039), and Sakamoto II lesions less likely to remodel (OR: 0, 95% CI: 0.00, 0.93, p = 0.05). Patients received an average of 2.35 scans during follow-up. Symptom resolution occurred in all symptomatic patients, and 16% of patients had recurrence of symptoms. Follow-up CT scans revealed a stable arterial diameter for the majority of patients. In conclusion, the majority of patients with SICMAD improve with medical therapy alone. Aneurysmal dilatation is uncommon.

Medical therapy and intervention do not improve uncomplicated isolated mesenteric artery dissection outcomes over observation alone

ObjectiveIsolated dissection of the mesenteric vessels is rare but increasingly recognized. This study aimed to evaluate patient characteristics, primary treatment, and subsequent outcomes of mesenteric dissection using multi-institutional data. MethodsAll patients at participant hospitals between January 2003 and December 2015 with dissection of the celiac artery (or its branches) or dissection of the superior mesenteric artery (SMA) were included. Patients with an aortic dissection were excluded. Demographic, treatment, and follow-up data were collected. The primary outcomes included late vessel thrombosis (LVT) and aneurysmal degeneration (AD). ResultsTwelve institutions identified 227 patients (220 with complete treatment records) with a mean age of 55 ± 12.5 years. Median time to last follow up was 15 months (interquartile range, 3.8-32). Most patients were men (82% vs 18% women) and symptomatic at presentation (162 vs 65 asymptomatic). Isolated SMA dissection was more common than celiac artery dissection (n = 158 and 81, respectively). Concomitant dissection of both arteries was rare (n = 12). The mean dissection length was significantly longer in symptomatic patients than in asymptomatic patients in both the celiac artery (27 vs 18 mm; P = .01) and the SMA (64 vs 40 mm; P < .001). Primary treatment was medical in 146 patients with oral anticoagulation or antiplatelet therapy (n = 76 and 70, respectively), whereas 56 patients were observed. LVT occurred in six patients, and 16 patients developed AD (3% and 8%, respectively). For symptomatic patients without evidence of ischemia (n = 134), there was no difference in occurrence of LVT with medical therapy compared with observation alone (9% vs 0%; P = .35). No asymptomatic patient (n = 64) had an episode of LVT at 5 years. AD rates did not differ among symptomatic patients without ischemia treated with medical therapy or observed (9% vs 5%; P = .95). Surgical or endovascular intervention was performed in 18 patients (3 ischemia, 13 pain, 1 AD, 1 asymptomatic). Excluding the patients treated for ischemia, there was no difference in LVT with surgical intervention vs medical management (one vs five; P = .57). ConclusionsAsymptomatic patients with isolated mesenteric artery dissection may be observed and followed up with intermittent imaging. Symptomatic patients tend to have longer dissections than asymptomatic patients. Symptomatic isolated mesenteric artery dissection without evidence of ischemia does not require anticoagulation and may be treated with antiplatelet therapy or observation alone.

Effectiveness of the Conservative Therapy for Symptomatic Isolated Celiac Artery Dissection

To investigate the effectiveness of the conservative therapy for symptomatic isolated celiac artery dissection (ICAD). Patients with symptomatic ICAD diagnosed on CT between February 2006 and June 2016 at three institutions were included. During the study period, a total of 24 patients (22 men, 2 women) were included in this retrospective study. Patients most commonly presented with epigastric pain (n=21) or back pain (n=3). Initial CT findings included celiac arterial calcification (n=3); compression of the true lumen (n=24), including stenosis of the true lumen <50% (n=14) or ≥50% (n=10); completely thrombosed (n=11) or partially thrombosed (n=5) false lumen; no thrombosis of the false lumen but presence of dissecting aneurysm (n=8); and dissection extending to the common hepatic (n=1) or splenic (n=6) artery. Twenty-three patients recovered after conservative treatment, and one patient who failed conservative treatment recovered after surgical therapy. Of the 23 patients who received conservative treatment, complete or partial remodeling of ICAD was achieved in 18 (78.3%) and 5 (21.7%) patients during 22.1±13.3months of follow-up. Conservative treatment can be applied successfully in most patients with symptomatic ICAD. Most cases of symptomatic ICAD resolve spontaneously within 2years.

Disección aneurismática del tronco celíaco, una entidad infrecuente

Spontaneous and isolated celiac artery dissection is a rare clinical disease. It is the fourth cause of abdominal aneurysms behind those that occur in the splenic, hepatic, and superior mesenteric arteries. It is important to suspect the diagnosis of this entity whose clinical symptoms are unspecific. We report the case of a 60 year-old male treated in our hospital because of this illness, and present a review of this pathology, specially focused on the diagnosis and the different treatments available.

Outcomes of conservative management of spontaneous celiac artery dissection

ObjectiveSpontaneous celiac artery (CA) dissection without associated aortic dissection is a rare condition. Although this condition has been diagnosed more frequently with the advent of improved diagnostic imaging modalities, its pathogenesis and treatment strategy remain to be established. The present study examined the clinical features and outcomes of conservative management of this disease. MethodsThe study included 12 patients (10 men and two women) in whom spontaneous CA dissection was diagnosed between 2007 and 2015. The medical records of each patient were retrospectively reviewed. ResultsThe mean age at diagnosis was 56.4 years (range, 42-77 years). Eight patients presented with abdominal or back pain, and the remaining four patients were asymptomatic and diagnosed incidentally. Four patients had a history of hypertension, and six had a history of smoking. Celiac trunk compression by the median arcuate ligament was found in two patients. The dissection extended into the common hepatic artery in five patients and into the splenic artery in four patients. Retroperitoneal hemorrhage was found in 2 patients, splenic infarction in 3, and transient mild liver dysfunction in 2. All patients were treated conservatively: two patients received short-term anticoagulation and antiplatelet therapy, and antihypertensive treatment was initiated in three patients. The mean follow-up period was 35.5 months (range, 5-101 months). Distal extension of the dissection occurred in one patient within a week of the initial symptom, which was also managed conservatively. Late aneurysmal degeneration was not observed in any of the patients, and none required endovascular or surgical treatment. ConclusionsIf the general condition of the patient is stable, then CA dissection can be managed with careful conservative treatment, even in patients with associated retroperitoneal hemorrhage. Long-term anticoagulation or antiplatelet medication may not be necessary in most patients with this condition.

Clinical presentation, management, follow-up, and outcomes of isolated celiac and superior mesenteric artery dissections

ObjectiveIsolated visceral artery dissections are rare entities with no current consensus guidelines for treatment and follow-up. This study aims to evaluate the presentation, management, outcomes, and follow-up practices for patients with isolated visceral artery dissections and to compare those with and without symptoms. MethodsIn this retrospective analysis, we identified all patients with isolated celiac artery and/or isolated superior mesenteric artery dissections at a single institution between September 2006 and December 2014. Patients with concomitant aortic dissections were excluded. Cases were stratified by symptom status. Presentation, anatomic findings, treatment, outcomes, and follow-up imaging were then compared between symptomatic and asymptomatic patients. ResultsWe identified 25 patients including 15 with symptoms and 10 without. There were no differences in patient comorbidities; however, symptomatic patients more frequently presented with thrombus (n = 10; 67% vs n = 1; 10%; P = .01) and inflammation (n = 8; 53% vs n = 1; 10%; P = .04), and trended toward increased stenosis (n = 12; 80% vs n = 4; 40%; P = .09) compared with asymptomatic patients. All asymptomatic patients were treated with observation alone with vessel diameter enlargement noted in 33% (n = 2) of patients on follow-up imaging. Among symptomatic patients, standard treatment included a short course of anticoagulation (mean, 4.5 months) with lifelong antiplatelet therapy. Three patients underwent operative intervention for persistent or worsening symptoms, two during the index admission and one 10 months after presentation for chronic abdominal pain. Approximately 70% (n = 17) of patients in each group had follow-up imaging (computed tomography angiography: n = 14; 56%; magnetic resonance angiography: n = 4; 16%; ultrasound: n = 13; 52%). Among patients treated nonoperatively, no patients complained of symptoms at follow-up, and 50% of those with inflammation on initial imaging had resolution. Twenty-five percent (n = 4) of patients had an increase in vessel size; however, all vessels remained less than 2 cm in maximal diameter. There were no ruptures or related deaths in either group. ConclusionsAmong patients with visceral artery dissection, no ruptures occurred but diameter enlargement was documented. This disease progression suggests that routine surveillance may be appropriate; however, transitioning early to ultrasound imaging should be considered to decrease radiation, contrast, and associated costs.

The Loop Technique

Purpose: To describe a bailout technique for use during branched/fenestrated thoracoabdominal aortic aneurysm (TAAA) repair to address celiac artery (CA) dissection. Technique: The technique is demonstrated in a 69-year-old man who underwent fenestrated stent-graft repair of a 6-cm type III TAAA. The main fenestrated stent-graft was positioned without difficulty, and the renal and superior mesenteric arteries were stented. A stent-graft was placed in the CA, but angiography showed the vessel to be occluded by dissection beyond the stent-graft. Wire manipulations to regain access to the true lumen culminated in perforation. At this point, the gastroduodenal artery was catheterized with a 0.035-inch guidewire, which was advanced in retrograde fashion into the CA true lumen and then snared back to the left brachial artery forming a loop. After exchange for a 0.014-inch system, self-expanding stents were deployed into the hepatic artery. Postoperative recovery was uneventful, and the patient was discharged on day 6. At 1-year follow-up, the patient was doing very well. Imaging demonstrated no endoleak, no graft migration, and sac shrinkage to a diameter of 5.1 cm. Conclusion: The “loop technique” can be a very useful and effective bailout maneuver in regaining access to the true lumen of a dissected CA in patients undergoing branched/fenestrated thoracoabdominal aortic aneurysm repair.

IP227. Outcome of Conservative Management of Spontaneous Celiac Artery Dissection

Spontaneous celiac artery dissection without associated aortic dissection is rare. Although this condition has become better known with improvements in diagnostic imaging modalities, its treatment strategy remains to be established. The present study examined the clinical features and outcomes of conservative management of the disease. This study included 12 patients (10 men and 2 women) in whom spontaneous celiac artery dissection was diagnosed between 2007 and 2015. The medical records of each patient were retrospectively reviewed. The mean age at diagnosis was 56 years (range, 42-77 years). Eight patients presented with abdominal or back pain, while the remaining 4 patients were asymptomatic and diagnosed incidentally. Four patients had a history of hypertension and 6 had a history of smoking. Celiac trunk compression by median arcuate ligament was found in 2 patients. The dissection extended into the common hepatic artery in 5 patients and into the splenic artery in 4 patients. Retroperitoneal hemorrhage was found in 2 patients, splenic infarction in 3 patients, and transient mild liver dysfunction in 1 patient. All patients were treated conservatively. Two patients received short-term anticoagulation and antiplatelet therapy, and antihypertensive treatment was initiated in 3 patients. The mean follow-up period was 30 months (range, 2-95 months). One patient experienced distal extension of the dissection within a week of the initial symptom, which was managed conservatively. Late aneurysmal degeneration was not observed in any of the patients, and none required endovascular or surgical treatment. Celiac arterial dissection can be managed with careful conservative treatment if the general condition of the patient is stable. Antihypertensive therapy without long-term anticoagulation or antiplatelet medication may be adequate in most patients with this condition.

Intercostal Artery Reconstruction: The Simple and Effective Technique on Spinal Cord Protection during Thoracoabdominal Aortic Replacement

To retrospectively analyze the role of intercostal artery reconstruction in the spinal cord protection for patients undergoing extensive thoracoabdominal aortic aneurysm repair. From August 2007 to 2014, thoracoabdominal aortas (Crawford II) of 81 consecutive patients with mean age 39.4 ± 10.32years were repaired. Seventy-three of these patients (90.12%) were diagnosed with aortic dissection in our group, 25 (30.86%) with Stanford type A dissection and 48 (59.26%) with Stanford B aortic dissection. All 25 patients with type A dissection have previously undergone surgical procedures which include Bentall's procedures in 11 cases, ascending aortic replacement in 6 cases, and total aortic arch replacement in 8 cases. All procedures were performed under profound hypothermia with interval cardiac arrest after making a thoracoabdominal incision. Extracorporeal circulation was instituted with 2 arterial cannulae and a single venous cannula in the right atrium. T6-T12 intercostal arteries and L1 and L2 lumbar arteries were formed to a neo-intercostal artery in place and were connected to an 8mm branch for maintaining spinal cord blood perfusion. Visceral arteries were joined into a patch and anastomosed to the end of the main graft. The left renal artery was anastomosed to an 8mm branch or joined to the patch. The other 10mm branches were anastomosed to iliac arteries. With 100% follow-up, early mortality was 7.4%. Six deaths were recorded; 1 patient died of cerebral hemorrhage, 3 of renal failure, 1 of heart failure because of myocardial infarction, and the last one died from the rupture of celiac artery dissection. The rate of postoperative spinal cord deficits was 3.7%, 2 patients with paraplegia and 1 patient with paraparesis. None had bladder or rectum dysfunction. Neo-intercostal arteries were clogged in 12 patients within follow-up period and formed pseudoaneurysm in 2 patients with Marfan syndrome. The mean survival time in this group was 54.22 ± 3.03months (95% confidence interval 44.37-59.90months) with survival rate of 92.37% after 1year, 89.02% after 2years, and 85.54% after 5years. All patients were free from spinal cord deficits. Intercostal artery reconstruction is an effective technique for spinal cord protection in patients with the thoracoabdominal aortic repair. It can achieve favorable results and avoid spinal cord deficits with long-term follow-up.

Impact of Noninvasive Conservative Medical Treatment for Symptomatic Isolated Celiac Artery Dissection.

There is no definite consensus regarding the management of symptomatic isolated celiac artery dissection (ICAD), and the effect of conservative medical treatment has never been evaluated. We enrolled 13 consecutive symptomatic ICAD patients without signs of arterial rupture between 2006 and 2015. All patients received noninvasive conservative medical treatment. The epidemiology, radiological findings and prognostic effect of conservative medical treatment on outcomes were retrospectively assessed. ICAD usually developed in middle-aged men around 50 years old who had a history of smoking. The patients typically presented with acute continuous epigastric pain at rest and with abdominal tenderness on physical examination. On enhanced computed tomography at presentation, the false lumen was found to be double-barreled in 2 patients (15.4%), partially thrombosed in 1 (7.7%), and completely thrombosed in 10 (76.9%). Dissection of associated branches was found in the left gastric artery in 1 patient (7.7%), common hepatic artery in 5 (38.5%), and splenic artery in 7 patients (53.8%). Malperfusion was not found in the stomach or liver but was found in the spleen in 4 patients (30.8%). During a median follow-up period of 376 (165-602) days, all patients were alive without any antiplatelet, anticoagulant, endovascular or surgical treatment. Symptomatic ICAD without arterial rupture can be safely treated with conservative medical therapy over the short term. (Circ J 2016; 80: 1445-1451).

A Case of Isolated Celiac Artery Dissection Accompanied by Splenic Infarction Detected by Ultrasonography in the Emergency Department.

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.

Thinking Outside the Bowels: An Atypical Cause of Acute Abdominal Pain

Introduction: Isolated spontaneous celiac artery dissection is an extremely rare entity with its occurrence without aortic dissection even rarer. We report a case of isolated spontaneous celiac artery dissection in the absence of autoimmune disease. Case Presentation: A 48-year-old male with a past medical history of migraines presents with acute, severe, persistent epigastric pain with radiation to the left upper quadrant and left paraspinal area. Cross sectional imaging performed reveals celiac artery dissection (Figure 1) without signs of an underlying vasculitis. An extensive rheumatologic evaluation undertaken was unremarkable with the only laboratory abnormality being a mildly elevated lipase level. Given his concomitant history of headaches, a temporal artery biopsy obtained was unrevealing. Blood cultures and ECHO were unremarkable for signs of thromboembolic disease and abdominal pain did not resolve with empiric trial of systemic steroids. Interval CT angiogram 2 weeks after presentation reveals no change in dissection; at this juncture, a diagnosis of isolated spontaneous celiac artery dissection was made with anticoagulation commenced and resultant clinical and radiological improvement observed (Figure 1).Figure 1Conclusion: Isolated spontaneous celiac artery dissection is a rare phenomenon with the exact etiology and natural history to date remaining an enigma. Ideal treatment modalities still remain to be clearly defined with anticoagulation, stent placement, and surgery employed. Our case demonstrates the efficacy of medical management in such a rare condition.

Spontaneous Celiac Artery Dissection Leading to Acute Pancreatitis

Spontaneous Celiac Artery Dissection Leading to Acute Pancreatitis

Isolated Celiac Artery Dissection in Blunt Abdominal Trauma

Isolated Celiac Artery Dissection in Blunt Abdominal Trauma

Celiac Artery Dissection

Introduction Isolated spontaneous celiac artery dissection is an uncommon diagnosis and is rarely considered in patients presenting with acute epigastric pain. To our knowledge, there is only one case of spontaneous celiac artery dissection associated with heavy weight lifting in an otherwise healthy individual previously reported in literature. Spontaneous arterial dissection is five times more common in men than in women and the average patient age is approximately 55 years. Other associations previously reported are hypertension, arteriosclerosis, degeneration of arterial wall, trauma, pregnancy and arteriopathy. The typical symptom of dissection is acute abdominal pain. Complications of the condition include aneurysm formation, rupture, abdominal organ ischemia or infarction, especially in the liver or spleen, and pancreatitis with elevated lipase levels. 9 We report a case of celiac artery dissection presumably associated with heavy weight lifting in a construction worker.