Spontaneous hepatic artery dissection—a rare presentation of fibromuscular dysplasia

Su, Kevin Y.C.; Stanhope, Melanie L.; Kaufman, Brendan P.W.

doi:10.1093/omcr/omw083

Cited by 3 publications

(3 citation statements)

References 7 publications

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“…Patients with isolated celiac artery dissection may present with the medical history (hypertension and genetics), signs, and symptoms consistent with abdominal aortic dissection but lack the physical exam findings of pulse deficit seen in up to 30% of patients with thoracoabdominal aortic dissection [3]. Additionally, liver function test derangements may provide clues of dissection extension from the celiac artery to the hepatic artery [4]. In a case series, vascular complications such as propagation of dissection into surrounding vessels lead to splenic and renal infarcts or hepatic artery aneurysm [2].…”

Section: Discussion/conclusionmentioning

confidence: 99%

A Rare Cause of Acute Abdomen in a 59-Year-Old Male

Bangolo

Pender

Sajja

et al. 2021

Case Rep Gastroenterol

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Celiac artery dissection is often an inconspicuous cause of acute abdomen. Spontaneous celiac artery dissection is most often associated with aortic dissection, and thus isolated spontaneous celiac artery dissection is rare. Herein, we present a case of celiac artery dissection with no aortic involvement. This case emphasizes the importance of including such a condition in the differential diagnosis of patients presenting with acute abdomen.

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Section: Discussion/conclusionmentioning

confidence: 99%

A Rare Cause of Acute Abdomen in a 59-Year-Old Male

Bangolo

Pender

Sajja

et al. 2021

Case Rep Gastroenterol

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“…The goal was to prevent expansion of the false lumen leading to malperfusion and aneurysmal dilatation and rupture. If patients with VAD are asymptomatic and there are no signs of ruptured VA branches or mesenteric ischaemia, conservative treatment (anticoagulant or antiplatelet and antihypertensive therapy) may be appropriate, and follow‐up with CTA or MRA is advised . However, there is also no consensus on type or duration of conservative treatment.…”

Section: Treatmentmentioning

confidence: 99%

“…If patients with VAD are asymptomatic and there are no signs of ruptured VA branches or mesenteric ischaemia, conservative treatment (anticoagulant or antiplatelet and antihypertensive therapy) may be appropriate, and follow-up with CTA or MRA is advised. 33,[47][48][49] However, there is also no consensus on type or duration of conservative treatment. Moreover, a conservative approach may not prevent disease progression.…”

Section: Treatmentmentioning

confidence: 99%

Visceral Fibromuscular Dysplasia: From asymptomatic disorder to emergency

Tussenbroek

Devos

Debing

et al. 2018

Eur J Clin Investigation

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Fibromuscular dysplasia (FMD) is an idiopathic, segmental, non-atherosclerotic and non-inflammatory disease of the musculature of arterial walls, leading to stenosis of small and medium-sized arteries, mostly involving renal and cervical arteries. As a result of better and more systematic screening, it appears that involvement of the splanchnic vascular bed is more frequent than originally assumed. We review epidemiology, pathogenesis, clinical picture as well as diagnosis and treatment of visceral artery (VA) FMD. The clinical picture is very diverse, and diagnosis is based on CT-, MR- or conventional catheter-based angiography. Involvement of VAs generally occurs among patients with multi-vessel FMD. Therefore, screening for VA FMD is advised especially in renal artery (RA) FMD and in case of aneurysms and/or dissections. Treatment depends on the clinical picture. However, the level of evidence is low, and much of the common practice is extrapolated from visceral atherosclerotic disease.

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Dissecting visceral fibromuscular dysplasia reveals a new vascular phenotype of the disease: a report from the ARCADIA-POL study

Warchoł-Celińska

Pieluszczak

Pappaccogli

et al. 2020

Journal of Hypertension

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Objective: Visceral artery fibromuscular dysplasia (VA FMD) manifestations range from asymptomatic to life-threatening. The aim of the study is to evaluate the prevalence and clinical characteristics of VA FMD. Methods: A total of 232 FMD patients enrolled into ongoing ARCADIA-POL study were included in this analysis. All patients underwent detailed clinical evaluation including ambulatory blood pressure monitoring, biobanking, duplex Doppler of carotid and abdominal arteries and whole body angio-computed tomography. Three control groups (patients with renal FMD without visceral involvement, healthy normotensive patients and resistant hypertensive patients) matched for age and sex were included. Results: VA FMD was present in 32 patients (13.8%). Among these patients (women: 84.4%), FMD lesions were more frequent in celiac trunk (83.1%), 62.5% of patients showed at least one visceral aneurysm, and five patients presented with severe complications related to VA FMD. No demographic differences were found between patients with VA FMD and individuals from the three control groups, with the exception of lower weight (P < 0.001) and BMI (P < 0.001) in VA FMD patients. Patients with FMD (with or without visceral artery involvement) showed significantly smaller visceral arterial diameters compared with controls without FMD. Conclusion: Patients with FMD showed smaller visceral arterial diameters when compared with patients without FMD. This may reflect a new phenotype of FMD, as a generalized arteriopathy, what needs further investigation. Lower BMI in patients with VA FMD might be explained by chronic mesenteric ischemia resulting from FMD lesions. FMD visceral involvement and visceral arterial aneurysms in patients with renal FMD are far to be rare. This strengthens the need for a systematic evaluation of all vascular beds, including visceral arteries, regardless of initial FMD involvement.

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Spontaneous hepatic artery dissection—a rare presentation of fibromuscular dysplasia

Cited by 3 publications

References 7 publications

A Rare Cause of Acute Abdomen in a 59-Year-Old Male

A Rare Cause of Acute Abdomen in a 59-Year-Old Male

Visceral Fibromuscular Dysplasia: From asymptomatic disorder to emergency

Dissecting visceral fibromuscular dysplasia reveals a new vascular phenotype of the disease: a report from the ARCADIA-POL study

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