Clinical Features of Spontaneous Isolated Dissection of Abdominal Visceral Arteries

Abstract

Background: Spontaneous isolated dissection of abdominal visceral arteries without aortic dissection is rare and its pathology and prognosis are not yet clear; therefore, therapeutic strategies for this disease have not been established. The present multi-institution investigational study analyzed the clinical features of patients with spontaneous isolated dissection of abdominal visceral arteries. Methods: A total of 36 patients diagnosed as spontaneous isolated dissection of abdominal visceral arteries from January 2010 to October 2016 were enrolled. The medical data of the patients were retrospectively reviewed. Imaging characteristics were evaluated. Spontaneous isolated dissection of abdominal visceral arteries was detected on upper abdominal computed tomography examination in almost patients, and was detected on magnetic resonance imaging in one patient. Results: Of the 36 cases, 26 cases involved the superior mesenteric artery dissection, nine involved the celiac artery, two involved the splenic artery, one involved the common hepatic artery, one involved the gastroduodenal artery and one involved the left gastric artery. Among the 36 patients, 20 had hypertension and 14 were current smokers. Additionally, only one patient had diabetes and four patients had dyslipidemia. Moreover, 32 cases complained of pain including abdominal pain and back pain, one had cough and three had no symptoms. Of the 36 patients, 34 cases (94.4%) were treated conservatively, and two (5.6%) required intravascular treatment. All patients were discharged without complications. Conclusions: Our findings indicate that hypertension and smoking might be closely involved in the pathogenesis of spontaneous isolated dissection of abdominal visceral arteries, whereas dyslipidemia and diabetes might be less involved. Additionally, few asymptomatic patients were accidentally diagnosed, indicating that the absence of symptoms cannot be used to rule out the presence of this disease. Randomized clinical trials cannot be performed because a considerable number of cases are required. Therefore, detailed descriptions of clinical features, as provided in our report, are important.

Spontaneous isolated celiac and splenic artery dissection with splenic infarction

“…Our case exemplifies the possibility of an acute, unpredictable presentation. This is in contrast with reports of patients presenting asymptomatically [11] , [19] , [20] , [25] . Remarkably, one patient with spontaneous isolated celiac artery dissection without splenic artery involvement presented asymptomatically and was stable for 101 months [6] .…”

“…Other risk factors include hypertension, sleep apnea, smoking, trauma, and connective tissue disease. Spontaneous isolated visceral artery dissections are not believed to be related to atherosclerosis [6] , [19] .…”

“…This is a relatively rare occurrence. Involvement of the SMA is most common, followed by the celiac artery [19] . The dissection can spread along the involved vessel's wall and involve its branches, including the splenic artery.…”

Management of Spontaneous Isolated Mesenteric Artery Dissection: A Systematic Review

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

Antithrombotic therapy has no beneficial effect in conservative treatment of spontaneous isolated superior mesenteric arterial dissection

“…Spontaneous isolated superior mesenteric artery dissection (SISMAD) is a rare mesenteric arterial disorder [ 1 2 3 4 5 6 7 8 9 ]. However, its incidence is increasing with increased diagnosis due to the development and widespread application of CT [ 1 3 5 6 7 10 11 12 ]. Some authors have suggested connective tissue disorders as a possible cause of SISMAD [ 1 13 ], but the exact underlying cause of this disorder is unclear [ 8 9 14 ].…”