Effectiveness of the Conservative Therapy for Symptomatic Isolated Celiac Artery Dissection

Li, Shaoqin; Cheng, Lihua; Tu, Jianfei; Wu, Xia; Wang, Zhongling; Zhang, Dengke; Jiang, Guomin; Jia, Zhongzhi

doi:10.1007/s00270-017-1680-7

Cited by 18 publications

(19 citation statements)

References 19 publications

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“…[ 1 , 3 , 4 , 6 – 8 , 13 , 14 ] Previous studies have revealed that SICAD mainly occurs in male patients in their fifth decade of life (male ratio ranging from 82.6% to 100%; age ranging from 40 to 61 years) and abdominal pain being reported as the most common symptoms ranging from 82.6% to 100%. [ 1 , 6 – 8 , 10 , 15 – 18 ] Results of the current study revealed that demographic characteristics of SICAD patients were similar to those reported in previous studies. In our series, SICAD was more common in men (90.5%; 19/21), smokers (42.9%; 9/21), and hypertensive subjects (38.1%; 8/23).…”

Section: Discussionsupporting

confidence: 85%

“…[ 1 , 4 , 6 – 8 , 10 , 14 – 23 ] Sixteen (10.9%) of these 147 patients treated by conservative management had treatment failure. [ 1 , 6 , 7 , 15 , 18 – 20 , 23 ] Therefore, 10.4% (17/164) patients with SICAD needed invasive treatment as their initial treatment, and conservative management failed in 10.9% (16/147) patients. [ 1 , 4 , 6 – 8 , 10 , 14 – 23 ] CTA findings for 9 patients among 17 patients who initially underwent invasive treatment were described as follows; aneurysmal dilation (n = 5), [ 7 ] extension of celiac branch (n = 2), [ 23 ] huge aneurysm (n = 1), [ 21 ] and celiac trunk rupture (n = 1), [ 20 ] largely correspond to type IV dissection in morphologic classification of current study.…”

Section: Discussionmentioning

confidence: 99%

“…[ 1 , 6 , 18 , 23 ] Five of these 16 patients had worsening symptoms and deteriorating CTA findings at follow-up, though their initial CTA findings were not described in the literature. [ 1 , 6 , 7 , 15 , 18 , 23 ] Eighteen among 164 patients showed type IV dissection on initial CTA. [ 7 , 15 , 21 ] Among them, 7 patients were successfully treated by conservative management and the other 11 patients were managed by invasive treatment.…”

Section: Discussionmentioning

confidence: 99%

“…[ 1 , 6 , 7 , 15 , 18 , 23 ] Eighteen among 164 patients showed type IV dissection on initial CTA. [ 7 , 15 , 21 ] Among them, 7 patients were successfully treated by conservative management and the other 11 patients were managed by invasive treatment. [ 7 , 15 , 21 ] Additionally in 1 prior study, extension of dissection to hepatic or splenic arteries and aneurysmal dilatation have been reported in 44% (10/23) and 39% (9/23) of patients, respectively, ultimately resulting in 33% (4/12) of patients requiring endovascular salvage for aggravating symptom.…”

Section: Discussionmentioning

confidence: 99%

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Natural course and outcomes of spontaneous isolated celiac artery dissection according to morphological findings on computed tomography angiography

Kim¹,

Lee

Kwak

et al. 2018

Medicine

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We aimed to identify natural course and optimal management of spontaneous isolated celiac artery dissection (SICAD) according to morphologic classification determined on computed tomography angiography (CTA), and to investigate the association between symptoms and morphological classification of SICAD.This retrospective observational study included 21 consecutive patients with SICAD from January 2012 to April 2017. Demographic data, clinical features, treatment modalities, follow-up results, and CTA findings including morphologic classification, dissection length, and relative diameter of the true lumen (TLRD) were reviewed. Changes in follow-up CTA were recorded and compared to prior studies to reveal natural course of the disease.The serial changes of SICAD on follow-up CTA according to morphologic classifications were as follows; type I (5/5, no interval change), type IIa (1/1, no interval change), type IIb (1/1, partial remodeling), type IIIa (1/4, complete remodeling; 1/4, partial remodeling; 1/4, no interval change; 1/4, deterioration), type IIIb (4/6, no interval change; 2/6, partial remodeling), and type IV (2/2, no interval change). Thirteen (61.9%) symptomatic and 8 (38.1%) asymptomatic patients were all treated with conservative management with or without antiplatelet and/or anticoagulation therapies. Symptomatic group (SG) more commonly had type IIb, IIIa, IIIb, and IV than asymptomatic group (AG) (SG; 11 patients, AG; 1 patient, P = .002). TLRD in AG was larger than that in SG (SG: 40.5 ± 24.1%, AG: 61.7 ± 7.0%, P = .045).SICAD might be treated by conservative management in stable patients irrespective of the morphologic classification except for with type IV (dissecting aneurysm) and extension of celiac branch who may need an early intervention. Types IIb, IIIa, IIIb, and IV are TLRD are associated with patients’ symptoms. Further studies on extended natural course of SICAD with a larger number of subjects are needed to draw a strong conclusion.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Natural course and outcomes of spontaneous isolated celiac artery dissection according to morphological findings on computed tomography angiography

Kim¹,

Lee

Kwak

et al. 2018

Medicine

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“…11 Complete resolution of the dissecting aneurysm was defined as disappearance of the dissecting aneurysm on images; partial resolution was defined as < 100% shrinkage of the dissecting aneurysm with residual dissecting aneurysm visible on images. 12 Good stent patency was defined as patency of the stented arteries without any evidence of in stent re-stenosis.…”

Section: Definitionsmentioning

confidence: 99%

Endovascular Treatment of Patients with Isolated Mesenteric Artery Dissection Aneurysm: Bare Stents Alone Versus Stent Assisted Coiling

Jia

Chen

et al. 2019

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS Endovascular stenting has been used successfully in the management of symptomatic isolated mesenteric artery dissection (IMAD) aneurysms. However, no study has compared the use of bare stents alone versus stent assisted coiling in IMAD aneurysms. The results of this study indicate that bare stents alone and stent assisted coiling have high technical success rates and demonstrate good mid-term patency in patients with IMAD aneurysms. Bare stents alone may serve as an alternative to stent assisted coiling for the management of IMAD aneurysms. Objective: The aim was to evaluate the outcomes of endovascular treatment with bare stents alone versus stent assisted coiling in isolated mesenteric artery dissection (IMAD) aneurysms. Methods: Patients with an IMAD aneurysm who underwent endovascular stenting between February 2010 and February 2017 at one of three institutions were included in this study. Data regarding technical success, procedure time, symptom resolution, complications, changes in IMAD aneurysm, and stent patency were recorded. Results: A total of 38 patients (35 men) were included, 27 treated with bare stents alone and 11 treated with stent assisted coiling. Technical success was achieved in 100% of patients treated with bare stents and in 81.8% of those treated with stent assisted coiling (p ¼ 0.078). The mean procedure times were 62.6 AE 5.3 min for treatment with bare stents and 116.4 AE 8.4 min for stent assisted coiling (p < 0.001). A total of 23 patients had persistent symptoms before stenting; all symptoms were resolved within 3.0 AE 0.7 days. No procedure related major complications occurred. Over 30.2 AE 18.1 months of follow up, complete resolution of the IMAD aneurysm was achieved in all patients; good stent patency and in stent re-stenosis were achieved in 65.8% and 34.2% patients, respectively. There were no occlusions of the stented arteries. Conclusions: Bare stents alone and stent assisted coiling have high technical success rates and demonstrate good intermediate patency in patients with an IMAD aneurysm. Bare stents alone may serve as an alternative to stent assisted coiling for the management of IMAD aneurysm

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Management Strategy Based on Disease Stages for Patients with Symptomatic Isolated Mesenteric Artery Dissection

Gao

et al. 2020

Annals of Vascular Surgery

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Effectiveness of the Conservative Therapy for Symptomatic Isolated Celiac Artery Dissection

Abstract: Conservative treatment can be applied successfully in most patients with symptomatic ICAD. Most cases of symptomatic ICAD resolve spontaneously within 2 years.

Cited by 18 publications

References 19 publications

Natural course and outcomes of spontaneous isolated celiac artery dissection according to morphological findings on computed tomography angiography

Natural course and outcomes of spontaneous isolated celiac artery dissection according to morphological findings on computed tomography angiography

Endovascular Treatment of Patients with Isolated Mesenteric Artery Dissection Aneurysm: Bare Stents Alone Versus Stent Assisted Coiling

Management Strategy Based on Disease Stages for Patients with Symptomatic Isolated Mesenteric Artery Dissection

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