Mid- to Long-Term Outcomes in Management of Spontaneous Isolated Coeliac Artery Dissection (SICAD)

Abstract

WHAT THIS PAPER ADDS Currently, there are no studies showing long-term outcomes in the management of isolated mesenteric artery dissection of the coeliac artery (SICAD). This study selectively performed endovascular intervention for symptomatic SICAD patients and found that there was good long term patency with quick symptom resolution. This study draws attention to the need for proper timing for intervention in SICAD, suggesting that the nature of the disease is not always benign, and endovascular stenting can have good long term results.Objective: Spontaneous Isolated Coeliac Artery Dissection (SICAD) is a rare disease with few reports of management strategies. This study reports the mid-to long-term outcomes of conservative management and endovascular intervention of SICAD treatment. Methods: Sixteen patients presenting with symptomatic SICAD from September 2006 to October 2018 were reviewed retrospectively. The clinical manifestations, initial radiological findings, methods of treatment, and serial follow up studies were analysed. Results: The mean age of the patients was 51.2 AE 7.9 years, with a median follow up of 33.3 (range 1.0e118.9) months. Four patients received early intervention because of aneurysmal dilatation or distal hypoperfusion. Four patients who received conservative management showed progression of disease and were recommended for delayed intervention. Although collaterals prevented further hepatic ischaemia, one of these four patients failed in delayed intervention because of extensive thrombi completely occluding the hepatic artery. In the remaining eight patients who were managed conservatively, three (37.5%) showed regression of disease, one (12.5%) showed partial regression, and five (62.5%) showed no change in intimal flap or thrombosis, but all had symptomatic improvement. The median follow up duration for the seven patients who underwent successful intervention was 77.3 (range 34.3e118.9) months, and all stenting remained patent during the follow up period. Conclusion: Early intervention in symptomatic SICAD patients may be necessary in over 50% of patients, and endovascular stenting has durable long term outcomes.

Management of Spontaneous Isolated Mesenteric Artery Dissection: A Systematic Review

“…Original reports or reports from multi-center collaborations were included. Ninety-seven studies ( 1 …”

Re Durability of Open Repair of Juxtarenal Abdominal Aortic Aneurysms

“…We thank Drs Kakkos, Zampakis, and Verhoeven for their interest in our multicentre study on open juxtarenal abdominal aortic aneurysm repair. 1 Concerning the level of aortic clamping, we reported in this article only juxtarenal abdominal aortic aneurysm (JRAAA) repair defined by no or short proximal aortic neck (<1 cm) without any need for renal revascularisation. This explains why supracoeliac clamping was rarely needed, except in cases of anatomical variations such as renal and superior mesenteric arteries arising from the aorta at the same level or at a short distance.…”

“…After an additional survey, it appears that 5 patients (1.6%) fell into this category, mainly due to age 90 years or to a very limited life expectancy owing to another pathology (e.g., cancer, advanced Alzheimer's disease). We read with great interest the recent article by Kang et al 1 The authors concluded that early intervention in symptomatic spontaneous isolated coeliac artery dissection (SICAD) patients may be necessary in over 50% of patients. However, we would like to elaborate on the endovascular management for SICAD.…”

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aneurysm repair, conducted at five French academic centres. 1 We would like to commend the authors for their restrictive approach regarding the need for supracoeliac clamping in only 3.5% of all cases. This could partly explain their excellent results, as supracoeliac clamping has earlier demonstrated a higher mortality (8.0% vs. 2.8% compared with clamping above one or both renal arteries, p ¼ .023, confirmed on multivariable analysis).

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Endovascular embolization of spontaneous rupture of isolated splenic artery dissection associated with hemosuccus pancreaticus: a case report

“…Splenic artery dissection (SAD) usually originates from dissection of the celiac trunk or the abdominal aorta [ 1 ]. Isolated SAD is extremely rare but life-threatening [ 2 ].…”