Natural course and outcomes of spontaneous isolated celiac artery dissection according to morphological findings on computed tomography angiography

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Abstract

We aimed to identify natural course and optimal management of spontaneous isolated celiac artery dissection (SICAD) according to morphologic classification determined on computed tomography angiography (CTA), and to investigate the association between symptoms and morphological classification of SICAD.

This retrospective observational study included 21 consecutive patients with SICAD from January 2012 to April 2017. Demographic data, clinical features, treatment modalities, follow-up results, and CTA findings including morphologic classification, dissection length, and relative diameter of the true lumen (TLRD) were reviewed. Changes in follow-up CTA were recorded and compared to prior studies to reveal natural course of the disease.

The serial changes of SICAD on follow-up CTA according to morphologic classifications were as follows; type I (5/5, no interval change), type IIa (1/1, no interval change), type IIb (1/1, partial remodeling), type IIIa (1/4, complete remodeling; 1/4, partial remodeling; 1/4, no interval change; 1/4, deterioration), type IIIb (4/6, no interval change; 2/6, partial remodeling), and type IV (2/2, no interval change). Thirteen (61.9%) symptomatic and 8 (38.1%) asymptomatic patients were all treated with conservative management with or without antiplatelet and/or anticoagulation therapies. Symptomatic group (SG) more commonly had type IIb, IIIa, IIIb, and IV than asymptomatic group (AG) (SG; 11 patients, AG; 1 patient, P = .002). TLRD in AG was larger than that in SG (SG: 40.5 ± 24.1%, AG: 61.7 ± 7.0%, P = .045).

SICAD might be treated by conservative management in stable patients irrespective of the morphologic classification except for with type IV (dissecting aneurysm) and extension of celiac branch who may need an early intervention. Types IIb, IIIa, IIIb, and IV are TLRD are associated with patients’ symptoms. Further studies on extended natural course of SICAD with a larger number of subjects are needed to draw a strong conclusion.

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Most cited references 23

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Current strategy for the treatment of symptomatic spontaneous isolated dissection of superior mesenteric artery.

Choon Min, Sang-Hyuk Min, Bong-June Yoon … (2011)

Spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) is extremely rare. Various treatment options are currently available, including conservative management, anticoagulation, endovascular stenting, and surgical repair. Herein, we present our experience in the treatment of symptomatic SIDSMA. A retrospective study was conducted on 14 consecutive patients with symptomatic SIDSMA between January 2000 and January 2010. All patients had acute onset abdominal pain. The decision to intervene was based on patient symptoms and signs, as well as the morphologic characteristics of superior mesenteric artery (SMA) dissection on computed tomography (CT) angiography. Endovascular stenting (ES) was indicated in patients with severe compression of the true lumen or dissecting aneurysm likely to rupture. Self-expandable stents were placed via a right common femoral approach. None of the patients underwent anticoagulation, and patients who underwent ES were maintained on antiplatelet therapy for 3 months postoperatively. The median age of the study subjects was 59 years (range, 50-75 years). The median follow-up time was 27.5 months (range, 2-64 months). Treatment included conservative management without the use of anticoagulation in seven patients, ES in six, and necrotic bowel resection in one. Four patients with severe compression of the true lumen or large dissecting aneurysm underwent ES as a primary treatment. ES was additionally performed in two patients in whom initial conservative treatment failed (increasing dissecting aneurysm at 7-day follow-up CT scan in one and a reappearance of abdominal pain after resuming diet in the other). The median fasting time was significantly shorter in patients with primary ES (2.5 days) than in those managed conservatively (8.0 days). No complications associated with the SIDSMA or ES were developed. The patency of stents was demonstrated on follow-up CT scans up to 60 months (range, 1-60 months). Conservative management without anticoagulation can be applied successfully to the patients with symptomatic SIDSMA. Primary endovascular stenting is indicated if patients have suspected bowel ischemia, compression of the true lumen of the SMA >80%, or SMA aneurysm of >2.0 cm in diameter on initial CT scan. Endovascular stenting can also be provided to the patients in whom initial conservative treatment failed, as a rescue therapy. Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

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Spontaneous isolated dissection of the celiac artery: CT findings in adults.

John Hines, David Siegel, Diana N. D'Ambrosio … (2007)

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. 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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Isolated spontaneous dissection of the splanchnic arteries.

Hirokazu Nagawa, Motoaki Shirakawa, Tetsuro Miyata … (2008)

Isolated dissection of a splanchnic artery, including the celiac artery, superior mesenteric artery (SMA), and inferior mesenteric artery, and their branches, is a relatively rare condition. This study was conducted to define the characteristics of patients with splanchnic artery dissection and the clinical course of isolated splanchnic artery dissection. The records of 19 patients were reviewed to survey demographic data, the location of dissection, symptoms, diagnostic modalities, treatment, and long-term outcome. The locations of dissection were the superior mesenteric artery (SMA) in 11 patients, celiac artery in 3, both celiac artery and SMA in 2, and common hepatic artery, celiac artery to splenic artery, and celiac artery to proper hepatic artery in 1 each. In all but one with systemic sclerosis and Sjögren syndrome, the underlying cause of dissection was unclear. There were 12 asymptomatic and seven symptomatic patients. All cases were diagnosed by computed tomography. Surgical treatment was performed in one patient with a large aneurysm of the common hepatic artery, and the remaining 18 patients were followed-up conservatively. The mean follow-up duration was 20.9 +/- 25.4 months (range, 2-116 months). No expansion or progression of the false lumen was observed in these patients. Patients with spontaneous dissection of the splanchnic arteries are often asymptomatic, and in this series, none developed significant end organ ischemia. Most patients with this rare condition can be managed expectantly with clinical follow-up including computed tomography imaging to assess aneurysm formation.

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Journal

Journal ID (nlm-ta): Medicine (Baltimore)

Journal ID (iso-abbrev): Medicine (Baltimore)

Journal ID (publisher-id): MEDI

Title: Medicine

Publisher: Wolters Kluwer Health

ISSN (Print): 0025-7974

ISSN (Electronic): 1536-5964

Publication date Collection: February 2018

Publication date (Electronic): 02 February 2018

Volume: 97

Issue: 5

Electronic Location Identifier: e9705

Affiliations

[a ]Department of Radiology

[b ]Department of Emergency Medicine, Ajou University School of Medicine, Suwon

[c ]Department of Applied Statistics, Hoseo University, Asan, Republic of Korea.

Author notes

[∗ ]Correspondence: Jung Hwan Ahn, Department of Emergency Medicine, Ajou University School of Medicine, Woncheon-dong, Yeongtong-gu, Suwon, 443-721, Republic of Korea (e-mail: erdrajh@ 123456naver.com ).

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Publisher ID: MD-D-17-04494 Accession ID: 09705

DOI: 10.1097/MD.0000000000009705

PMC ID: 5805421

PubMed ID: 29384849

SO-VID: 53745ce3-5bd3-4205-9f23-e7f3ffd05b8f

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This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

History

Date received : 19 July 2017

Date revision received : 14 December 2017

Date accepted : 2 January 2018

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Keywords: abdominal pain,celiac artery,computed tomography angiography,dissection,mesenteric ischemia

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Keywords: abdominal pain, celiac artery, computed tomography angiography, dissection, mesenteric ischemia

Natural course and outcomes of spontaneous isolated celiac artery dissection according to morphological findings on computed tomography angiography : STROBE compliant article

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Most cited references 23

Current strategy for the treatment of symptomatic spontaneous isolated dissection of superior mesenteric artery.

Spontaneous isolated dissection of the celiac artery: CT findings in adults.

Isolated spontaneous dissection of the splanchnic arteries.

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