Robotic system-assisted endovascular treatment of a dissection-related pseudoaneurysm of the celiac axis secondary to fibromuscular dysplasia

Abstract

Spontaneous celiac artery dissection caused by fibromuscular dysplasia is rare. Subsequent thrombosis and occlusion of the celiac trunk can result in intestinal ischemia and hepatic failure. We describe a case of spontaneous celiac artery dissection with an associated pseudoaneurysm caused by fibromuscular dysplasia, extending into the common hepatic artery. An endovascular intervention featuring robotic-assisted celiac artery cannulation with stent-assisted coil embolization resulted in successful treatment.

Visceral Fibromuscular Dysplasia: From asymptomatic disorder to emergency

“…32,33 Subsequent thrombosis and occlusion of the coeliac trunk can result in intestinal ischaemia and hepatic failure. 34 Also in the US FMD Registry, patients with dissection ( Figure 3D) were more likely to experience ischaemic events than those without dissection. 28…”

“…Coeliac trunk as well as SMA dissection may be asymptomatic, which may be explained by the double hepatic blood flow and the good collateral flow, but the most common presenting symptom is abdominal pain . Subsequent thrombosis and occlusion of the coeliac trunk can result in intestinal ischaemia and hepatic failure . Also in the US FMD Registry, patients with dissection (Figure D) were more likely to experience ischaemic events than those without dissection …”

“…Symptomatic VAD can be treated with open or laparoscopic repair surgery (vascular bypass, resection and anastomosis or ligation) or endovascular therapy . Since endovascular therapy (coil embolization or stenting), eventual robotic system‐assisted, has some advantages (ie, faster recovery, fewer complications) compared with surgery, its use has increased . Following a recent review of the literature the initial treatment of SMAD is conservative in the majority of symptomatic patients without accompanying intestinal ischaemia or aneurysm .…”

“…33,46 Since endovascular therapy (coil embolization or stenting), eventual robotic system-assisted, has some advantages (ie, faster recovery, fewer complications) compared with surgery, its use has increased. [32][33][34] Following a recent review of the literature the initial treatment of SMAD is conservative in the majority of symptomatic patients without accompanying intestinal ischaemia or aneurysm. 53 However, an additional treatment is significantly more frequently needed in these patients than in those endovascular treated.…”

A Rare Case of 7 Simultaneous Arterial Dissections and Review of The Literature

“…Various diseases are associated with visceral arterial dissections, including connective tissue diseases (Ehler-Danlos syndrome, Marfan syndrome), Loeys-Dietz syndrome, fibromuscular dysplasia (FMD), and segmental arterial mediolysis. [3][4][5][6][7] Therefore, targeted clinical diagnostic testing and molecular workup is suggested for patients with SMAD.…”