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

Abstract

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.

Management of Spontaneous Isolated Mesenteric Artery Dissection: A Systematic Review

“…Complete remodeling (morphological restitution of the artery to its normal condition) at CT follow-up at median time of 22 months (IQR: 13–31) was found in 43% (95% CI: 43–47) of 593 patients in 20 ( 7 , 20 , 22 , 25 , 33 , 34 , 37 , 44 , 58 , 63 , 65 , 69 , 71 , 77 , 78 , 80 , 81 , 85 , 88 , 89 ) studies on symptomatic IMAD treated conservatively.…”

“…There is no proof that the morphological classification systems of the dissections described by Sakamoto or Yun dictates clinical decision-making. When there is a clinical (7,10,23,24,25,30,33,35,37,40,57,62,63,81,93).…”

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

Spontaneous Celiac Artery Dissection Presenting With Splenic Infarction: A Case Report

“…CT/CTA can show an intimal flap, which is pathognomonic, or an eccentric mural thrombus in the lumen and aneurysmal dilatation of the vessel which is highly suspicious [ 3 , 6 ]. CT/CTA morphological classification (unless showing a dissecting aneurysm) does not affect management [ 7 ].…”

“…Interestingly, there are no guidelines for treatment. Most cases, regardless of their morphological appearance on CTA, are conservatively managed with antihypertensive therapy, with or without antiplatelet and anticoagulation therapy [ 7 ]. Antiplatelet therapy is preferred in patients with stenotic lesions [ 8 ].…”