Unusual presentation and treatment of spontaneous celiac artery dissection

Abstract

The management options of an isolated celiac artery dissection include medical, open surgical, and endovascular techniques. Which strategy is chosen depends on the severity of the dissection, collateral circulation to the liver, the patient's hemodynamic status, and the surgeon's expertise. We describe an unusual case of celiac artery dissection involving splenic and hepatic arteries complicated by hemorrhage. The patient was successfully treated by coil embolization of the splenic and gastric branches. Hepatic arterial blood flow was preserved with a stent graft extending from the origin of the gastroduodenal artery to the orifice of the celiac artery.

Three Overlapping Balloon-expandable Stents Applied in Coeliac Artery Dissection:Case Report and Literature Review

“…Fenestration was used to recover blood flow in the coeliac artery in the early stage, but long-term complications were bound to occur because the false lumen existed (5); a single naked stent could be applied to repair smaller tears but not bigger tears because endoleak could not be eliminated (6); naked stents associated with spring coils applied in coeliac artery dissection had an immediate therapeutic effect and thorough elimination of endoleak, but the technique was complex in manipulation and had the risk of rupture of dissection. It was suitable for local dissection and not for dissection with a big false lumen (7); covered stents were the best option for patients with rupture of coeliac artery dissection because bleeding could be stopped promptly (8). But previous covered stents had guide catheters with bigger calibres and bad compliance, so it was difficult for them to be entered into the coeliac artery with a bigger angle against the abdominal aorta, and arteries were easily damaged.…”

CT imaging findings and endovascular management of isolated spontaneous dissecting aneurysm of celiac artery

“…The appropriate treatment option should be chosen based on the severity of the dissection, presence of associated complications, status of collateral pathways, patient's hemodynamic status, and the surgeon's expertise. [13] Conservative medical management using anticoagulative, antiplatelet, and antihypertensive therapy may be advocated in some asymptomatic uncomplicated cases. [5] Routine follow-up CT angiography should be performed in incidentally detected cases in which only medical management is planned.…”

Disección aneurismática del tronco celíaco, una entidad infrecuente

“…Se ha observado que el antecedente de cirugía abdominal o peritonitis puede favorecer esta enfermedad debido a alteraciones en la pared del vaso, que se basan en fenómenos de microtraumatismos por las altas presiones abdominales generadas durante estos procesos (3,4). El 18 % de los pacientes presentan un aneurisma aórtico en el momento del diagnóstico, el 38 % lo tienen a otro nivel abdominal, y entre el 18 % y el 67 %, a nivel periférico (5,7).…”

“…Estudios recientes han comparado los resultados de la terapia endovascular con los de la cirugía convencional, observando resultados similares, lo que implica una nueva opción terapéutica, ya que, de esta manera, puede ser posible reducir el tiempo de hospitalización y disminuir la morbilidad y la mortalidad. Sin embargo, se necesitan más estudios para confirmar esta teoría (4,14,15).…”

“…Su incidencia dentro del total de los aneurismas oscila entre el 0,005 % y 0,2 % (2). Los casos informados han tenido diferentes etiologías (3,4), así como varias manifestaciones clínicas (2,3,5). A lo largo de los años, se han desarrollado diferentes tratamientos.…”