Presentation, treatment, and outcomes in patients with spontaneous isolated celiac and superior mesenteric artery dissection. (December 2017)

• Record Type: Journal Article
• Authors: DeCarlo, Charles; Ganguli, Suvranu; Borges, Jorge C; Schainfeld, Robert M; Mintz, Ari J; Mintz, Jessica; Jaff, Michael R; Weinberg, Ido
• Is Part Of: Vascular medicine. Volume 22:Number 6(2017)
• Page Start: 505
• Page End: 511
• Publication Date: 2017-12
• Subjects: arterial dissection -- computed tomographic angiography (CTA) -- isolated celiac artery dissection -- isolated superior mesenteric artery (SMA) dissection; Blood-vessels -- Diseases -- Periodicals; Peripheral vascular diseases -- Periodicals; Vascular Diseases -- Periodicals; Vaisseaux sanguins -- Maladies -- Périodiques; Maladies vasculaires périphériques -- Périodiques; 616.13
• DOI: 10.1177/1358863X17729770
• Languages: English
• ISSNs: 1358-863X

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.