Hypertensive emergency presenting with an isolated celiac artery dissection: A rare case study

Swergold, Natalie; Kozusko, Steven D.; Rivera, Carlos; Sturt, Cindy

doi:10.1016/j.ijscr.2016.08.034

Cited by 5 publications

(4 citation statements)

References 15 publications

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“…After reading the full texts, 18 studies were excluded further as displayed in Figure 1. Eventually, 60 reports (53 case reports [2,3,16–66] and 7 case series [7,11,67–71] ) with 125 ICAD patients were included for detailed information in analysis. According to our definition of age group, 62 cases were young patients and 63 cases were considered as old patients.…”

Section: Resultsmentioning

confidence: 99%

The characteristics and comparison between young and old patients with spontaneous isolated celiac artery dissection: Analysis based on 60 reports

Chen,

Wu,

Wang

et al. 2023

Medicine

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Background and aims: Though increasing studies reported the management of spontaneous isolated celiac artery dissection (ICAD), the characteristics and etiology of ICAD in different age-stage patients have not been well-studied. Our study was designed to describe and further to compare the clinical features of spontaneous ICAD between young and old patients. Methods: We searched PubMed, Embase, and Web of Science up to March 1, 2023 for spontaneous ICAD case reports. Two reviewers screened the titles and abstracts of searched records for qualified reports according to the including and excluding criteria and extracted the data independently. Statistical analysis was performed using SPSS software (version 19.0; IBM Corp, Armonk, NY) and Stata 12.0 (Stata Corp., College Station, TX). Descriptive results were presented as the mean ± standard deviation or percent. The comparison results between young and old patients were displayed as risk ratio (RR) or standardized mean difference (SMD) with its 95% confidence intervals (CI). Results: We totally identified 60 reports in the present analysis. The mean age of patients was 52.4 years, with the majority of patients being male (84.4%). The majority of patients were symptomatic and commonest presentation was abdominal pain (76.7%). Most patients (63.2%) had comorbidities or history and hypertension and smoking were the top 2 conditions with proportion of 63.3% and 40.5% respectively. When comparing young to old patients with ICAD, no significant difference was found in demographic and clinical features including sex, comorbidities/history, and symptoms. However, we found that young patients with ICAD experienced significantly longer dissection length (SMD 1.01, 95% CI 0.16–1.86; P = .015) and distance from ostium (SMD 0.96, 95% CI 0.07–1.85; P = .013), but no significant difference was observed in true lumen compression (SMD −0.39, 95% CI −1.22–0.44; P = .364). In addition, our results showed that ICAD in young patients extending more to distal arteries, including common hepatic artery/hepatic artery (RR 2.04, 95% CI 1.13–3.68; P = .01), splenic artery (RR 2.36, 95% CI 1.24–4.49; P = .017) and left gastric artery (RR 25.42; 95% CI 1.55–417.74; P = .04). Conclusions: Though spontaneous ICAD had multitudinous clinic-pathologic features, it was apt to middle-aged males and symptomatic and abdominal pain was always the commonest presentation. Hypertension and smoking were the top 2 conditions of ICAD patients. There was significant difference between young and old patients in radiographic characteristics of ICAD which may lead to different treatment and outcomes.

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Section: Resultsmentioning

confidence: 99%

The characteristics and comparison between young and old patients with spontaneous isolated celiac artery dissection: Analysis based on 60 reports

Chen,

Wu,

Wang

et al. 2023

Medicine

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“…The most common misdiagnoses were pancreatitis, 14,15 gastritis, ureteral stone, 16 lymphadenopathy, enteritis, 17,18 peptic ulcer, 19 and pancreas cancer. 20,21 Several risk factors can lead to SI-CAD, including a history of smoking, a higher abdominal pressure, [22][23][24][25][26][27][28] vasculitis, 29 autoimmune disorders, 30,31 food consumption, [32][33][34] median arcuate ligament compression syndrome, 8,35 fibrous dysplasia, 27 and myxoid degeneration of the tunica media (Table 2).…”

Section: Resultsmentioning

confidence: 99%

Current status of spontaneous isolated celiac artery dissection

Han

et al. 2022

Vascular

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Background This study aimed to evaluate the current status of spontaneous isolated celiac artery dissection (SICAD). Methods The English-language literature published in various databases before December 2020 was reviewed. All case reports and series were included. If multiple reports came from the same hospital and covered the same period, only the most recent report was considered. The clinical characteristics, imaging features, and treatment outcome were analyzed. Results The study enrolled 88 English language publications between January 1959 and December 2020, including 70 case reports, two case series, and 16 clinical studies. Overall, 316 cases of SICAD were reported in the studies, including 268 men and 44 women (unavailable for 4, men: women ratio: 6:1, p < 0.05). The median age was 50.5 years (range: 6–72) in men and 53.9 years (range: 41–67) in women. Most patients (83.54%, 264/316) complained about stomach pain, primarily in the epigastric region (38.61%, 122/316). The misdiagnosis rate in this study was 3.16% (10/316). The most commonly used imaging modality was computed tomography angiography (CTA), with 97.47% (308/316) cases reporting its use in diagnosis and/or management. The rate of symptom improvement with Conservative Management, with or without antithrombotic agents, was 92.45% (98/106) and 96.58% (141/146), respectively. The rate of symptom improvement after surgical recanalization was 100% (13/13). Moreover, endovascular management resulted in a 100% (50/50) symptom improvement rate. Conclusion Conservative management is the first-line treatment for SICAD. The surgical or endovascular intervention had a high technical success rate, suggesting that it should be reserved for patients who have failed conservative treatment.

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“…A review of the literature identifies risk factors such as hypertension, atherosclerosis, history of blunt or iatrogenic trauma, medial cystic degeneration, pregnancy, fibromuscular disease, and connective tissue disorders. However, some patients have no risk factors [5][6][7][8]. Another hypothesis to explain this phenomenon is "shear stress injury".…”

Section: Etiologymentioning

confidence: 99%

“…IMVAD is diagnosed on a CT scan; however, other modalities such as Doppler ultrasound may have a role in diagnosis [9]. AD poses a risk of bowel ischemia, the progression of dissection, rupture, and bleeding [3,5,7]. Therefore, a high index of suspicion is needed for its diagnosis.…”

Section: Presentation and Diagnosismentioning

confidence: 99%

Isolated Dissections of Superior Mesenteric and Celiac Arteries Associated With Aortic Ectasia

Latif

Fares

Ahmed

et al. 2020

Cureus

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Arterial dissection is defined as a tear in the inner lining of arteries, leading to the passage of blood between the layers and resulting in a false lumen. Arterial dissection involving the aorta is commonly seen in clinical practice; however, dissections involving the celiac and superior mesenteric arteries are quite rare. Even rare are isolated multiple visceral arterial dissections. A 59-year-old male with uncontrolled hypertension presented with epigastric pain. CT angiography revealed isolated dissection of the celiac and superior mesenteric arteries with ascending aortic ectasia, with no features of ischemia or organ dysfunction. He was managed conservatively with analgesics & anticoagulation. Repeat CT angiography after six months of anticoagulation therapy showed no progression of the disease. Isolated multiple visceral arterial dissection is a rare vascular disease that requires a high index of suspicion to diagnose. CT angiography is a useful imaging modality that helps not only in diagnosis but also in choosing a treatment plan. Though treatment options are controversial, conservative treatment with anticoagulation should be considered in uncomplicated cases of visceral arterial dissections.

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Hypertensive emergency presenting with an isolated celiac artery dissection: A rare case study

Cited by 5 publications

References 15 publications

The characteristics and comparison between young and old patients with spontaneous isolated celiac artery dissection: Analysis based on 60 reports

The characteristics and comparison between young and old patients with spontaneous isolated celiac artery dissection: Analysis based on 60 reports

Current status of spontaneous isolated celiac artery dissection

Isolated Dissections of Superior Mesenteric and Celiac Arteries Associated With Aortic Ectasia

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