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Evaluation and management of symptomatic isolated spontaneous celiac trunk dissection
Journal article   Open access   Peer reviewed

Evaluation and management of symptomatic isolated spontaneous celiac trunk dissection

Francisco Leonardo Galastri, Rafael Noronha Cavalcante, Joaquim Mauricio Motta-Leal-Filho, Bruna De Fina, Breno Boueri Affonso, Jorge Eduardo de Amorim, Nelson Wolosker and Felipe Nasser
Vascular medicine (London, England), Vol.20(4), pp.358-363
08/01/2015
DOI: 10.1177/1358863X15581447
PMID: 25910918
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https://doi.org/10.1177/1358863X15581447View
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Abstract

The purpose of this study is to describe 10 cases of symptomatic isolated spontaneous celiac trunk dissection (ISCTD) in order to evaluate the initial clinical presentation, diagnosis, treatment modalities and outcomes. A retrospective search was performed from 2009 to 2014 and 10 patients with ISCTD were included in the study. Patients with associated aortic and/or other visceral artery dissection were excluded. The following information was collected from each case: sex, age, associated risk factors, symptoms, diagnostic method, anatomic dissection pattern, treatment modality and outcome. Most patients were male (90%), with an average age of 44.8 years, and the most common symptom was abdominal pain (100%). Hypertension and vasculitis (polyarteritis nodosa) were the most frequent risk factors (40% and 30%, respectively). Diagnosis was made in all patients with computed tomography. Dissection was limited to the celiac trunk in three patients and extended to celiac branches in the other seven. Initial conservative treatment was attempted in every case and was successful in nine patients. In one case, initial conservative treatment was unsuccessful and arterial stenting with coil embolization of the false lumen was performed. After successful initial treatment, late progression of the dissection to aneurysmal dilatation was observed in two patients and it was decided to perform endovascular treatment. Mean follow-up was 19 months, ranging from 2 to 59 months. In conclusion, initial conservative treatment seems adequate for most patients with ISCTD. Long-term follow-up is mandatory, owing to the risk of later progression to aneurysm.
 Abdominal Pain - etiology Adult Aneurysm, Dissecting - complications Aneurysm, Dissecting - diagnostic imaging Aneurysm, Dissecting - therapy Anticoagulants - adverse effects Anticoagulants - therapeutic use Asymptomatic Diseases Celiac Artery - diagnostic imaging Disease Progression Embolization, Therapeutic - adverse effects Endovascular Procedures - adverse effects Endovascular Procedures - instrumentation Female Humans Male Middle Aged Platelet Aggregation Inhibitors - adverse effects Platelet Aggregation Inhibitors - therapeutic use Predictive Value of Tests Retrospective Studies Risk Factors Stents Time Factors Tomography, X-Ray Computed Treatment Outcome Vomiting - etiology

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