Dissecção espontânea do tronco celíaco: qual a melhor abordagem terapêutica?

Abstract

Spontaneous dissection of visceral arteries is a rare event. Sudden abdominal pain in the epigastrium is the most frequent symptom. Advances in imaging techniques have made it easier to diagnose this event, increasing the incidence of visceral artery dissection. Conservative clinical treatment, surgical revascularization and endovascular repair are the three treatment options available. We describe two cases of patients with spontaneous dissection of the celiac trunk that received different treatments based on their clinical presentation and imaging studies. We also conducted a review of studies about this condition in the literature.Keywords: celiac trunk; spontaneous dissection; endovascular. ResumoA dissecção espontânea das artérias viscerais é um evento relativamente raro. Dor abdominal súbita no epigástrio é o sintoma mais frequentemente manifestado pelos pacientes. O avanço das técnicas de exames de imagem possibilitou o diagnóstico deste evento com maior facilidade, aumentando a incidência das dissecções das artérias viscerais. O tratamento clínico conservador, a revascularização cirúrgica, e a terapia endovascular são as três possíveis opções terapêuticas. Neste artigo, relatamos os casos de dois pacientes com dissecção espontânea do tronco celíaco conduzidos de formas diversas, de acordo com a apresentação clínica e exames de imagem, além de realizar uma revisão bibliográfica sobre esta doença.Palavras-chave: tronco celíaco; dissecção espontânea; endovascular.

Spontaneous dissection of the celiac trunk: report of three cases and review of the literature

“…two elastic layers. 1,5,6 Spontaneous arterial dissection is more common among men (at a proportion of five men to each woman) and the mean age of patients is approximately 55 years. 3 Arterial dissection is described as isolated when there is no related aortic dissection and is more often observed in the renal and carotid arteries, but rarely seen in visceral arteries.…”

“…1 Although the condition is rare, its incidence may have been underestimated in the past and it has historically been associated with poor prognosis. The exact cause of spontaneous dissection of visceral arteries is unknown, but arterial hypertension has classically been considered a predisposing factor.…”

“…[2][3][4][5] Abdominal pains are the most common symptom in people who have suffered spontaneous dissection of the celiac trunk, but patients may also exhibit nonspecific symptoms such as weight loss. 1,5 As imaging methods have continually improved, diagnosis of this condition has been facilitated and it should be taken into account during differential diagnosis of epigastric abdominal pain. 1,4 In view of the rarity of the condition, the ideal therapeutic management for dissection of the celiac trunk remains controversial.…”

“…1,5 As imaging methods have continually improved, diagnosis of this condition has been facilitated and it should be taken into account during differential diagnosis of epigastric abdominal pain. 1,4 In view of the rarity of the condition, the ideal therapeutic management for dissection of the celiac trunk remains controversial. [1][2][3][4][5] There are three possible treatment options available: conservative clinical treatment, surgical revascularization or endovascular treatment.…”

“…[1][2][3][4][5] There are three possible treatment options available: conservative clinical treatment, surgical revascularization or endovascular treatment. 1 The objective of this article is to describe three cases of spontaneous dissection of the celiac trunk and to conduct a review of the current literature on the subject.…”