Current status of spontaneous isolated celiac artery dissection

Abstract

Background This study aimed to evaluate the current status of spontaneous isolated celiac artery dissection (SICAD). Methods The English-language literature published in various databases before December 2020 was reviewed. All case reports and series were included. If multiple reports came from the same hospital and covered the same period, only the most recent report was considered. The clinical characteristics, imaging features, and treatment outcome were analyzed. Results The study enrolled 88 English language publications between January 1959 and December 2020, including 70 case reports, two case series, and 16 clinical studies. Overall, 316 cases of SICAD were reported in the studies, including 268 men and 44 women (unavailable for 4, men: women ratio: 6:1, p < 0.05). The median age was 50.5 years (range: 6–72) in men and 53.9 years (range: 41–67) in women. Most patients (83.54%, 264/316) complained about stomach pain, primarily in the epigastric region (38.61%, 122/316). The misdiagnosis rate in this study was 3.16% (10/316). The most commonly used imaging modality was computed tomography angiography (CTA), with 97.47% (308/316) cases reporting its use in diagnosis and/or management. The rate of symptom improvement with Conservative Management, with or without antithrombotic agents, was 92.45% (98/106) and 96.58% (141/146), respectively. The rate of symptom improvement after surgical recanalization was 100% (13/13). Moreover, endovascular management resulted in a 100% (50/50) symptom improvement rate. Conclusion Conservative management is the first-line treatment for SICAD. The surgical or endovascular intervention had a high technical success rate, suggesting that it should be reserved for patients who have failed conservative treatment.

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

“…SICAD is very rare in clinic 3 . The exact pathogenesis of SICAD remains unknown, and potential risk factors for this condition include hypertension, smoking, atherosclerosis, abdominal surgery or trauma, bromuscular dysplasia, connective tissue disease, pregnancy, vasculitis, tumor, and cystic medial necrosis [8][9][10] . Furthermore, whether patients present with symptoms or the dissection is found incidentally may in uence treatment algorithms 11 .…”

General features, management strategies, and outcomes of symptomatic spontaneous isolated celiac artery dissection

“…The clinical manifestation of SICAD is non-specific, and there is a certain misdiagnosis rate (3). With the increased evaluation of abdominal pain by computed tomography angiography (CTA), SICAD has been diagnosed more frequently in recent years (4,5). However, to the best of our knowledge, just over three hundred cases have been reported in previous literature (2,3,(5)(6)(7)(8)(9).…”

“…With the increased evaluation of abdominal pain by computed tomography angiography (CTA), SICAD has been diagnosed more frequently in recent years (4,5). However, to the best of our knowledge, just over three hundred cases have been reported in previous literature (2,3,(5)(6)(7)(8)(9). Although some cases without symptoms were found accidentally, some patients suffered from refractory symptoms and were even under the potential risk of organ ischemia, aneurysmal dilatation, and arterial rupture (6,(10)(11)(12)(13)(14)(15).…”