Characteristics and diagnostic pitfalls of spontaneous visceral artery dissection in the emergency department

Nonami, Suguru; Nakanishi, Taizo; Tanizaki, Shinsuke; Matsumoto, Takashi; Sera, Makoto; Maeda, S.; Ishida, Hiroshi

doi:10.1016/j.ajem.2016.02.073

Cited by 13 publications

(16 citation statements)

References 15 publications

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“…In Nonami's study, type III and IV IMAD accounted for 72.5% of the 40 patients with acute onset of abdominal pain. 2 It was speculated that patients with type III and type IV lesions were more likely to develop symptoms. The dissection length in type III and type IV IMAD was significantly longer than that in the type I and II IMAD (p ¼ .001).…”

Section: Discussionmentioning

confidence: 99%

“…4,7,8 The other three types of dissection are more likely to develop progressive false lumen dilatation. 2,6,7 Studies have shown that the false lumen of type II IMAD may readily enlarge. 14 In the present series, conservative treatment was performed in 81.2% of the patients, and 91.1% of these were successfully treated with conservative treatment alone.…”

Section: Discussionmentioning

confidence: 99%

“…The initial manifestation of IMAD is usually acute abdominal pain, which is suspected to be caused by bowel ischaemia or other visceral organ. 2,3 About one third of all patients with IMAD tend to be asymptomatic. 4e7 IMAD is most frequently diagnosed by computed tomography (CT), and is classified using Sakamoto's classification or Yun's classification according to the CT features.…”

Section: Introductionmentioning

confidence: 99%

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Correlation Between Computed Tomography Features and Clinical Presentation and Management of Isolated Superior Mesenteric Artery Dissection

Zhang

Xiang

Yang

et al. 2018

European Journal of Vascular and Endovascular Surgery

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Correlation Between Computed Tomography Features and Clinical Presentation and Management of Isolated Superior Mesenteric Artery Dissection

Zhang

Xiang

Yang

et al. 2018

European Journal of Vascular and Endovascular Surgery

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“…21 In some reports, isolated CA dissection has also been initially treated with conservative therapy safely. 22,23 There is no consensus on optimizing blood pressure to achieve adequate visceral perfusion. 24 At our hospital, the blood pressure of all patients was controlled to a lower level (100-120 mmHg) using a treatment similar to that for type B acute aortic dissection to decrease hemodynamic stress on the dissected artery.…”

Section: Discussionmentioning

confidence: 99%

Optimal management strategy for spontaneous isolated dissection of a visceral artery

et al. 2017

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Objectives To describe our clinical experiences and recommend a management strategy for spontaneous isolated dissection of a visceral artery. Methods A retrospective study of patients from December 2005 to December 2015 was performed. Thirty-two patients had spontaneous isolated dissection of a visceral artery. Clinical features, computed tomography findings, the treatment method, and follow-up results were evaluated. Results There were 28 men and 4 women (mean age, 54 years). Dissection locations were the celiac artery in 10, superior mesenteric artery in 17, and celiac artery and superior mesenteric artery in 5 patients. Celiac artery stenosis existed with spontaneous isolated dissection of a visceral artery at a high rate. After diagnosis, the blood pressure of all patients was immediately controlled to a lower level. Three patients with arterial rupture and one patient with bowel infarction underwent operations for complications. Overall, the treatment of dissection involved drug therapy alone. The last follow-up computed tomography results of the true lumen residual ratio and the length of the dissected artery improved compared to the values on admission; the maximum diameter of the dissected artery did not enlarge. Eleven patients almost completely improved. No patients had any adverse event. Conclusions Most patients with spontaneous isolated dissection of a visceral artery can be first treated conservatively for dissection with strict blood pressure control and surveillance.

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“…Spontaneous multiple artery dissection (SMAD) is a relatively rare phenomenon which usually involves up to 3 visceral arteries. 1 The primary presentation may include nonspecific abdominal or flank pain in the presence of uncontrolled hypertension. Symptoms may vary depending on the involved artery as well as the extent of lumen injury.…”

Section: Introductionmentioning

confidence: 99%

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

Komem

Halevy

Griton

et al. 2019

Vasc Endovascular Surg

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Objective: Spontaneous multiple artery dissection is a relatively rare phenomenon. Early clinical signs are often nonspecific, making it difficult to diagnose. Case Report: This is a case of a 51-year-old female who presented with spontaneous dissection of 4 visceral arteries, both iliac arteries, and of the right internal carotid artery. The patient underwent urgent successful endovascular repair. Later complications included acute respiratory distress syndrome and pneumonia after massive blood transfusion. She recovered gradually and was discharged after 21 days. Due to this rare presentation, genetic investigation was performed in search of a connective tissue disorder. Results revealed a new COL3A1 subtype mutation. The pathogenicity of this variant remains unclear. Conclusion: We recommend a high index of suspicion for visceral artery dissection in the differential diagnosis for abdominal pain with concurrent uncontrolled hypertension. Early diagnosis and intervention are crucial to reducing the mortality rate.

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Characteristics and diagnostic pitfalls of spontaneous visceral artery dissection in the emergency department

Cited by 13 publications

References 15 publications

Correlation Between Computed Tomography Features and Clinical Presentation and Management of Isolated Superior Mesenteric Artery Dissection

Correlation Between Computed Tomography Features and Clinical Presentation and Management of Isolated Superior Mesenteric Artery Dissection

Optimal management strategy for spontaneous isolated dissection of a visceral artery

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

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