Systematic Literature Review on Evaluation and Management of Isolated Spontaneous Celiac Trunk Dissection

Isolated Dissection of the Celiac Artery after Blunt Trauma: A Case Report and Review of Literature

“…Most of the aneurysmal changes after traumatic CA dissection have occurred within 2 months [10], but they have also been detected as late as the fourth year [20], which highlights the importance of long term follow-up for patients with CA dissection.…”

“…However, some authors advocate that these antithrombotic drugs should not be used in acute visceral artery dissections, as it will delay thrombosis of the false lumen and possibly thereby lead to propagation of the dissection [18]. Although there has been no direct comparison, a recent systemic review showed that outcomes of spontaneous CA dissection were good regardless of the conservative treatment chosen [10].…”

“…Some patients with traumatic CA dissections, including ours, have been managed with antiplatelet therapy (n=3; aspirin 81 mg or 100 mg), anticoagulation (n=3; enoxaparin or heparin converted to warfarin for 3 months), or endovascular stenting (n=1) in addition to blood pressure control. Recent experience with nontraumatic isolated CA dissection also supports conservative management with antiplatelet medication, anticoagulants, or no medication in patients without ischemic or hemorrhagic complications [10,[15][16][17]. Antiplatelet drugs or anticoagulants are commonly used to stabilize the injured arterial wall and prevent thrombotic occlusion of the involved arteries.…”

“…However, close observation is important because two lethal ischemic complications, fulminant hepatic failure after traumatic CA dissection [4], and multiple organ ischemia leading to septic shock after spontaneous CA dissection [19], have been reported. Late aneurysmal change is another feared complication, and is detected in 6% of patients with conservatively managed spontaneous CA dissections [10]. Repair is generally necessary when the aneurysm is over 2 to 3 cm in size.…”

“…Whether this is associated with the known male preponderance of spontaneous CA dissection [10] needs to be validated. The traumatic CA dissections were associated with various blunt injuries, and not all were associated with a direct blow to the abdomen, indicating there may be other mechanisms underlying the development of CA dissection.…”