Presentation, treatment, and outcomes in patients with spontaneous isolated celiac and superior mesenteric artery dissection

Vasc Med. 2017 Dec;22(6):505-511. doi: 10.1177/1358863X17729770. Epub 2017 Sep 13.

Abstract

Spontaneous isolated celiac or superior mesenteric artery (SMA) dissection (SICMAD) is a rare clinical entity. Not much is known about the natural history and appropriate treatment. We retrospectively queried a prospectively collected institutional radiology database for all patients diagnosed with SICMAD from 1990 to 2017. We identified 42 arteries in 40 patients (83.3% male), mean age 54.8 ± 10.9 years, consisting of 24 celiac arteries and 18 SMA. SMA lesions were longer than celiac lesions (5.15 ± 3.81 vs 2.38 ± 1.40 cm, p = 0.008). Thirty-one patients had follow-up; mean follow-up was 4.9 ± 4.8 years. Morphologic improvement was seen in 20 (48%) arteries. Sakamoto IV lesions were more likely to remodel (OR: 11.26, 95% CI: 1.13, 588.26, p = 0.039), and Sakamoto II lesions less likely to remodel (OR: 0, 95% CI: 0.00, 0.93, p = 0.05). Patients received an average of 2.35 scans during follow-up. Symptom resolution occurred in all symptomatic patients, and 16% of patients had recurrence of symptoms. Follow-up CT scans revealed a stable arterial diameter for the majority of patients. In conclusion, the majority of patients with SICMAD improve with medical therapy alone. Aneurysmal dilatation is uncommon.

Keywords: arterial dissection; computed tomographic angiography (CTA); isolated celiac artery dissection; isolated superior mesenteric artery (SMA) dissection.

MeSH terms

  • Adult
  • Aged
  • Aneurysm, Dissecting / diagnostic imaging
  • Aneurysm, Dissecting / physiopathology
  • Aneurysm, Dissecting / therapy*
  • Celiac Artery* / diagnostic imaging
  • Celiac Artery* / physiopathology
  • Chi-Square Distribution
  • Computed Tomography Angiography
  • Databases, Factual
  • Female
  • Humans
  • Male
  • Mesenteric Artery, Superior* / diagnostic imaging
  • Mesenteric Artery, Superior* / physiopathology
  • Middle Aged
  • Odds Ratio
  • Recovery of Function
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome
  • Vascular Remodeling