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

doi:10.21203/rs.3.rs-3801303/v1

Download PDF

Article

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

https://doi.org/10.21203/rs.3.rs-3801303/v1

This work is licensed under a CC BY 4.0 License

You are reading this latest preprint version

Objective: Spontaneous isolated celiac artery dissection (SICAD) is a rare condition, and its natural history and outcomes have not been thoroughly studied. The aim of this study was to review our institution’s experience in the evaluation, treatment, and outcomes of patients with SICAD.

Methods: A retrospective review was conducted on 76 patients who presented with SICAD between January 2010 and July 2022. The clinical manifestations, initial radiological findings, methods of treatment and follow-up computed tomography were reviewed, and patients were contacted for assessment of current symptoms.

Results: in this study, a total of 76 patients with SICAD were collected. The mean age of the patients was 52.8±8.7 years. The mean angle between celiac trunk and aorta in symptomatic patients was 57.78 ± 14.94°, and 59.65 ± 20.11° in asymptomatic patients. Of the 76 patients, 27underwent endovascular treatment due to refractory pain or aneurysmal dilatation. Among these 27 patients, 2 experienced failure in the endovascular intervention due to issues with the guide wire reaching the true cavity and challenges in inserting the long sheath behind the celiac artery. The remaining 49 patients were managed conservatively. Within the conservative group, one patient (1.3%) without aneurysmal dilation experienced a recurrence of abdominal pain one year after the initial hospitalization. Subsequent CT revealed slight dilation of the celiac trunk dissection compared to the initial presentation. After rehospitalization and conservative treatment, symptoms improved, and no recurrence have been observed since discharge. It is noteworthy that all patients, whether treated with endovascular or conservative methods, experienced improvement in symptoms.

Conclusions:The symptoms of SICAD may not be influenced by the angle between celiac trunk and aorta. Conservative treatment is effective in more than half of the patients. Even if abdominal pain recurs, as long as the patient’s condition is stable, conservative treatment remains effective. Endovascular treatment had more favorable outcomes in achieving complete remodeling compared to conservative treatment.

Health sciences/Cardiology

Health sciences/Diseases

Health sciences/Medical research

spontaneous celiac artery dissection

computed tomography

angle between celiac trunk and aorta

clinical characteristic

treatment

outcomes

Spontaneous isolated celiac artery dissection (SICAD) without associated aortic dissection is a rare condition. Roughly 200 cases of SICAD have been reported in the literature ^1–5. Because of the increased use of cross-sectional imaging, especially computed tomographic angiography (CTA), many SICAD cases are now found incidentally ⁶. Patients may also present with symptoms, the most common symptom in patients with SICAD is acute or chronic epigastric or abdominal pain ⁷.

SICAD is very rare in clinic ³. The exact pathogenesis of SICAD remains unknown, and potential risk factors for this condition include hypertension, smoking, atherosclerosis, abdominal surgery or trauma, fibromuscular dysplasia, connective tissue disease, pregnancy, vasculitis, tumor, and cystic medial necrosis ^8–10. Furthermore, whether patients present with symptoms or the dissection is found incidentally may influence treatment algorithms ¹¹. A growing number of SICAD cases are treated conservatively by observation, antiplatelet therapy, or anticoagulation, with surgery or endovascular therapy reserved for cases involving bowel ischemia or aneurysmal degeneration ¹². Due to the lack of well-defined observations in the literature, we aimed to investigate our population of patients.

Study design

This is a retrospective observational study that was carried out in accordance with the principles outlined in the Declaration of Helsinki. This study was conducted with an approval from the institutional review board of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. The retrospective study was approved by the institutional research committee of our institution with a waiver of informed consent. From January 2010 to July 2022, a total of 131 patients were diagnosed with SICAD. 76 patients who met the following criteria were included in this study: (1) intimal flap in the celiac trunk with or without the involvement of its branches, and/or thrombosis of the false lumen, (2) the dissection was not related to trauma, abdominal surgery, or other interventions on the artery, (3) with complete medical records. 55 patients out of the total 131 were excluded for the following reasons: (1) they didn’t undergo CT or CTA during follow up, (2) they were lost to contact during follow-up. Clinical information for each patient, including age, gender, past medical history, blood pressure, initial symptoms, initial CT findings, follow-up treatment, and symptom relief, was collected from their medical records.

Computed tomography (CT) imaging

CT angiography (CTA) images were acquired for all patients diagnosed with SICAD during both the initial assessment and follow-up periods. Notable CT findings encompassed the measurement of the angle between the celiac trunk and aorta, identification of an intimal flap, detection of false lumen thrombosis, observation of aneurysmal dilation, and recognition of distal organ ischemia. Aneurysmal dilation was specifically characterized as a diameter increase exceeding 50% of the normal caliber of the celiac artery. Morphological type was defined using the Sakamoto classification as used in the ESVS Guidelines. Type I, patent false lumen featuring both entry and re-entry points; Type II, ‘cul-de-sac’-shaped false lumen without re-entry; Type III, thrombosed false lumen presenting an ulcer-like projection. This projection is defined as a localized blood-filled pouch protruding from the true lumen into the thrombosed false lumen; Type IV, completely thrombosed false lumen without ulcer-like projection. This meticulous classification scheme aimed to precisely categorize and describe the diverse anatomical variations observed in patients with SICAD.

Treatment

Treatment options were determined based on the patient’s symptoms, general condition, and the morphologic characteristics of SICAD as observed in CTA. The therapeutic interventions were categorized into 3 types: observation treatment; endovascular treatment involving coiling or stenting, surgical repair. Observation therapy was indicated for patients without clinical or imaging signs of ruptured arteries or bowel ischemia. The observation approach involved fasting, bowel rest, and rigorous blood pressure management using antihypertensive medication. Antithrombotic and antiplatelet therapies were added at the discretion of the clinician. Endovascular therapy was considered for patients in whom conservative treatment proved ineffective. This ineffectiveness was defined by the aggravation of symptoms and signs, deterioration of organ ischemia, newly appearing organ necrosis, or an increase in the size of an aneurysmal dilation at a high risk of rupture. Surgical treatment was reserved for patients experiencing arterial rupture, intestinal necrosis, or those for whom endovascular treatment was unsuccessful. The choice of treatment was carefully tailored to the individual patient's condition, ensuring a comprehensive and personalized approach to managing SICAD.

Follow up schedule

Patients were assessed at 6 months, 12 months, and yearly thereafter following the treatment. Post-treatment status was monitored through phone contact. Patients were asked about any symptoms of abdominal or back pain at rest, pain after eating, or change in eating habits since the diagnosis of the SICAD. Additionally, information was gathered on current anticoagulant usage and any treatment received at another institutions. Radiographic morphology was followed with serial CTA or CT scans. Follow-up CT scans were analyzed for regression states, which were classified as complete regression, partial regression, no change, or progression of disease.

Statistical analysis

Statistical analysis was performed using SPSS 21.0 software (SPSS Inc., Chicago, IL, USA). Binary variables were recorded as number and percentage. Continuous variables were assessed as mean ± standard deviation or median with interquartile range as appropriate and analysis was completed using Fisher exact, χ² and t-test. A p value < 0.05 was considered to be statistically significant in all analyses.

Patients

From January 2010 to July 2022, a total of 76 patients diagnosed with SICAD were collected in this study. Among them, 27 patients underwent endovascular treatment, while 49 underwent conservative treatment. The median age of the entire cohort was 52.8 years (endovascular: 54.7 ± 7.2 years vs conservative: 51.7 ± 9.3 years; P = 0.148), ranging from 26 to 71 years. Of the 76 patients, 67 were men. 41 (53.9%) patients had hypertension, 1 (1.3%) had a history of stroke, 3 (3.9%) had diabetes, and 6 (7.9%) had coronary artery disease. Additionally, 43 (56.6%) were smokers at the time of diagnosis or before diagnosis, with no significant difference between the endovascular and conservative treatment groups (endovascular: n = 17; 63.0% vs conservative: n = 26; 53.1%; P = 0.405). None of the patients had a history of connective tissue disorders. 60 (78.9%) patients presented with abdominal pain, and none presented with bowel necrosis or arterial rupture. Table 1 summarizes the baseline characteristics of patients admitted for SICAD, categorized by endovascular or conservative management. The morphological type was mostly type II in 30 (39.5%) patients, characterized by a ‘cul-de-sac’-shaped false lumen without reentry. The mean diameter of celiac artery trunk was similar in endovascular and conservative group (endovascular: 8.50 ± 1.64 mm vs conservative: 7.10 ± 1.46 mm; P = 0.768). Aneurysmal change was observed in 20 patients (n = 11; 40.7% vs n = 9; 18.4%; P = 0.034). Distal hypoperfusion was noted in 4 (5.3%) patients, and 15 (19.7%) had simultaneous SMA dissection at the time of diagnosis. The mean angle between celiac trunk and aorta was 58.17 ± 16.04°. In the endovascular group, 2 (7.4%) patients had an angle ≤ 30°; 1 underwent conservative treatment, and the other underwent endovascular treatment. Table 2 presents the characteristics of the disease, and Table 3 shows the results of the analysis of the angle between the celiac trunk and aorta in symptomatic and asymptomatic patients, revealing no significant difference.

Table 1

Baseline patient characteristics of patients admitted for Spontaneous Isolated Celiac Artery Dissection (SICAD), according to endovascular or conservative management.
	Total (n = 76)	Management		P value
	Total (n = 76)	Endovascular (n = 27)	Conservative (n = 49)	P value
Age, y	52.8 ± 8.7	54.7 ± 7.2	51.7 ± 9.3	0.148
Sex, M:F	67:9	25:2	42:7	-
Comorbidities
Hypertension	41 (53.9%)	19 (70.4%)	22 (44.9%)	0.059
History of cerebrovascular accident	1 (1.3%)	1 (3.7%)	0 (0.0%)	1.000
Diabetes mellitus	3 (3.9%)	2 (7.4%)	1 (2.0%)	0.286
Coronary artery disease	6 (7.9%)	1 (3.7%)	5 (10.2%)	0.413
Vasculitis	0 (0.0%)	0 (0.0%)	0 (0.0%)	1.000
Smoking	43 (56.6%)	17 (63.0%)	26 (53.1%)	0.405
Symptoms
Epigastric pain	23 (30.3%)	7 (25.9%)	16 (32.7%)	0.541
Lower abdominal pain	5 (6.6%)	2 (7.4%)	3 (6.1%)	1.000
Generalized abdominal pain	23 (30.3%)	12 (44.4%)	11 (22.4%)	0.046
Flank pain	9 (11.8%)	1 (3.7%)	8 (16.3%)	0.146
Abdominal distention	0 (0.0%)	0 (0.0%)	0 (0.0%)	1.000
Vomiting	1 (1.3%)	0 (0.0%)	1 (2.0%)	1.000

Table 2

Imaging findings of Spontaneous Isolated Coeliac Artery Dissection (SICAD) patients, according to endovascular or conservative management.
Anatomical features	Total (n = 76)	management		P value
Anatomical features	Total (n = 76)	Endovascular (n = 27)	Conservative (n = 49)	P value
Branches opening in false lumen of SICAD
Celiac trunk	48 (63.2%)	12 (44.4%)	36 (73.5%)	0.012
Left gastric artery	6 (7.9%)	2 (7.4%)	4 (8.2%)	1.000
Splenic artery	3 (3.9%)	3 (11.1%)	0 (0.0%)	0.042
Common hepatic artery	2 (2.6%)	1 (3.7%)	1 (2.0%)	1.000
Left gastric + splenic artery	2 (2.6%)	0 (0.0%)	2 (4.1%)	0.546
Splenic + common hepatic artery	12 (15.8%)	8 (29.6%)	4 (8.2%)	0.021
Left gastric + common hepatic artery	1 (1.3%)	1 (3.7%)	0 (0.0%)	0.335
Three branches	2 (2.6%)	0 (0.0%)	2 (4.1%)	0.536
Artery aneurysm	20 (26.3%)	11 (40.7%)	9 (18.4%)	0.034
Simultaneous SMA dissection	15 (19.7%)	4 (14.8%)	11 (22.4%)	0.552
Mean diameter (mm)
aneurysm	13.04 ± 2.54	13.78 ± 2.83	12.13 ± 1.90	0.247
Celiac trunk	7.57 ± 1.51	8.50 ± 1.64	7.10 ± 1.46	0.768
Intimal flap	62 (81.6%)	23 (85.2%)	39 (79.6%)	0.759
Distal hypoperfusion	4 (5.3%)	0 (0.0%)	4 (8.2%)	0.291
Morphological type
I	23 (30.3%)	12 (44.4%)	11 (22.4%)	0.046
II	30 (39.5%)	8 (29.6%)	22 (44.9%)	0.192
III	16 (21.1%)	5 (18.5%)	11 (22.4%)	0.688
IV	7 (9.2%)	2 (7.4%)	5 (10.2%)	1.000
Angle between celiac trunk and aorta	58.17 ± 16.04	56.92 ± 15.84	58.86 ± 16.26	0.616
Angle ≤ 30	2 (2.6%)	2 (7.4%)	0 (0.0%)	0.123

Table 3

Angle between celiac trunk and aorta of Spontaneous Isolated Coeliac Artery Dissection (SICAD) patients, according to symptomatic and asymptomatic patients.
Anatomical features	Total (n = 76)	Symptomatic (n = 61)	Asymptomatic (n = 15)	P value
Angle between celiac trunk and aorta	58.17 ± 16.04	57.78 ± 14.94	59.65 ± 20.11		0.732
Angle ≤ 30	2	1	1	0.379

Treatments

Management strategies were determined based on the patient’s symptoms and imaging findings of the disease. None of the patients underwent surgical therapy, while 27 (35.5%) received endovascular therapy, and 2 (7.4%) of them failed the operation due to failure of the guide wire to the true cavity and difficulty in inserting the long sheath behind the celiac artery. Therefore, these 2 (7.4%) patients underwent antiplatelet therapy and showed symptomatic improvement. The remaining 49 (64.5%) patients were treated conservatively. Among the 27 (35.5%) patients who received endovascular therapy, 2 (7.4%) experienced intervention failure. Stent implantation was performed in 20 (74.1%) patients, coil embolization in 1 (3.7%) patient, and stenting combined with coiling in 4 (14.8%) patients. Details of the treatment of all patients are summarized in Table 4.

Table 4

Treatment of Spontaneous Isolated Celiac Artery Dissection (SICAD) patients.
Treatment
Conservative treatment	49 (64.5%)
Intervention	27 (35.5%)
Surgical	0 (0.0%)
Endovascular	27 (35.5%)
Failed intervention	2 (7.4%)
Stent	20 (74.1%)
Embolization	1 (3.7%)
Stent + embolization	4 (14.8%)

Clinical follow up

Follow up CT scanning revealed significant differences between the endovascular and conservative groups in terms of complete regression of the intimal flap and thrombosis (endovascular: n = 19; 70.4% vs conservative: n = 2; 4.1% P < 0.001). Partial regression occurred in 8 (29.6%) patients in the intervention group and in 25 (51.0%) patients in the conservative group. 21 (27.6%) patients in the conservative group showed no change on imaging during follow up (endovascular: n = 0; 0.0% vs conservative: n = 21; 42.9% P < 0.001). 1 (1.3%) patient in conservative group without aneurysmal dilation had recurrence of abdominal pain 1 year after the initial hospitalization, and CT demonstrated that the celiac trunk dissection was slightly more dilated than before. After rehospitalization and conservative treatment, symptoms improved, and there has been no recurrence since discharge (Fig. 1). All patients’ symptoms improved after endovascular or conservative treatment. (Table 5)

Overall, the median follow-up period of the entire patient cohort was 28.7 (1.2–74.4) months, and all patients reported symptomatic relief at their last follow up. For patients who underwent endovascular treatments, the median follow-up was 31.5 (2.5–66.1) months, and all stents remained patent without any stent-graft-related complications on their last follow up CT scan.

Table 5

Results of the endovascular and conservative treatment for Spontaneous Isolated Celiac Artery Dissection (SICAD) patients.
		management		P value
	Total	Endovascular	Conservative
Follow up results	(n = 76)	(n = 27)	(n = 49)
Follow-up CT results
Complete regression	21 (27.6%)	19 (70.4%)	2 (4.1%)	0.000
Partial regression	33 (43.4%)	8 (29.6%)	25 (51.0%)	0.072
No change	21 (27.6%)	0 (0.0%)	21 (42.9%)	0.000
Aggravating in SICAD	1 (1.3%)	0 (0.0%)	1 (2.0%)	1.000
Readmission related to dissection	1 (1.3%)	0 (0.0%)	1 (2.0%)	1.000
Symptoms improving	76 (100.0%)	27 (100.0%)	49 (100.0%)	-
Median follow up period, mo	28.7(1.2–74.7)	31.5(2.5–66.1)	27.1(1.2–74.7)	0.366

This study described the clinical presentation, follow-up and outcomes of both endovascular and conservative treatments of SICAD. The angle between celiac trunk and the aorta was not significantly different between symptomatic and asymptomatic patients. A total of 76 patients were treated, with 27 receiving endovascular intervention, and all stents remained patent during a median follow up of 27.1 months. 49 patients received conservative treatment, except for one patient whose symptoms recurred 1 year after initial hospitalization, the symptoms of other patients have resolved.

The etiology of SICAD is unknown, with risk factors including hypertension, smoking, atherosclerosis, connective tissue diseases, vasculitis, and congenital disorders causing arterial wall weakening (e.g., Ehlers-Danlos Syndrome) ^8–10. Abdominal pain is the most common symptom of SICAD. In our study, the patients exhibited similar characteristics, with approximately half having a history of hypertension and being smokers. Especially, 61 (80.3%) patients presented with symptoms. This emphasizes that although SICAD is rare, after ruling out diseases that can cause abdominal pain, it is necessary to consider whether the patient has SICAD ¹³. CTA for patients with abdominal pain may allow for the early diagnosis of SICAD.

The anatomic characteristics of SICAD have been previously described, including the mean diameter of celiac artery, intimal flap, extension into distal branches, and hypoperfusion ^{14, 15}. Consistent with previous studies, our cohort showed that the dissection mostly extended to the celiac trunk, with 19.7% of patients also having simultaneous SMA dissection. Additionally, we measured the angle between the celiac trunk and the aorta. The average angle was 58.17 ± 16.04°, and there was no significant difference in the angle between symptomatic and asymptomatic patients. The symptoms of SICAD may not be influenced by the angle between the celiac trunk and the aorta.

The management option depends on the clinical features and hemodynamic status of the patients. Currently, there is no consensus on the treatment of SICAD because of the variability in clinical presentation and the course of the disease. Conservative treatment involves hydration, bowel rest, blood pressure control with antihypertensive agents (beta blockers or non-beta blockers), antithrombotic therapy (anticoagulation or antiplatelets), and antilipidemic therapy ^{16, 17}. Li Cheng et al. ¹⁸ suggested that complete remodeling of symptomatic SICAD can be achieved in most patients with conservative treatment within 2 years of diagnosis. However, the comorbidities of SICAD may be complex, and the use of antithrombotic agents should be based on multiple considerations ¹⁷. In our study, the symptoms of patients who underwent antithrombotic therapy mostly improved without the need for secondary intervention, and half of the patients showed partial regression on CT follow-up. Only 1 patient without aneurysmal dilation experienced a recurrence of abdominal pain 1 year after initial hospitalization, and CT demonstrated that the celiac trunk dissection was slightly more dilatable than before. After rehospitalization and conservative treatment, symptoms improved and have not recurred since discharge. Regarding the treatment of patients after the recurrence of symptoms, the treatment strategies still need to be determined according on the patients’ conditions.

There is a lack of criterion of endovascular therapy in SICAD. The aims of endovascular treatment are to seal off the false lumen and re-establish blood flow ¹⁹. Endovascular treatment options include stent placement, thrombolytic therapy, embolectomy, and balloon angioplasty ²⁰. Indications for endovascular treatment may include persistence or progression of symptoms despite conservative treatment, refractory pain, aneurysmal dilation (especially ≥ 2 cm), extension of dissection, rupture, and suspected bowel ischemia ^{3, 15, 21, 22}. In our study, 20 (26.3%) patients met the criteria for dissection aneurysms (aneurysm diameter 1.5 times that of the celiac trunk), but only 11 patients received endovascular treatment, and none had a diameter ≥ 2 cm. Additionally, a study on spontaneous isolated celiac or superior mesenteric artery dissection showed no ruptures and only one artery greater than 2 cm in 39 patients over a follow-up period of nearly 5 years ²³.

A previous retrospective study suggested that endovascular intervention may be necessary in over 50% of symptomatic SICAD patients and showed good long-term patency with rapid symptom resolution ¹⁵. In our cohort, 27 (35.5%) patients underwent endovascular intervention. Follow up CT scanning of these 27 patients showed that SICAD exhibited complete or partial regression, and none of the patients needed secondary endovascular intervention. In contrast, follow-up CT scans of patients who underwent conservative treatment showed that SICAD mostly exhibited partial regression or no change. Endovascular treatment had more favorable outcomes in terms of complete remodeling compared to conservative treatment. However, symptoms resolved in all patients in our study regardless of treatment modality.

The current study has some limitations. Firstly, it was a retrospective analysis, which comes with inherent limitations, such as selection bias. Secondly, the sample size was relatively small, and there were some losses during follow-up, potentially impacting the interpretability of the results. Thus, further studies with larger sample sizes and longer follow-up periods are necessary. Thirdly, only a few patients underwent CT rather than CTA during follow-up, and the results of the follow-up CT for these patients might be biased. Finally, the data were obtained from a single center, which may limit the generalizability of the findings.

The symptoms of SICAD may not be influenced by the angle between the celiac trunk and the aorta. Conservative treatment is efficient in more than half of patients. Even if abdominal pain recurs, conservative treatment remains effective as long as the patient’s condition is stable. Endovascular treatment has more favorable outcomes in terms of complete remodeling than conservative treatment.

Author Contributions: Xinyang Zhang and Feng Zhu contributed equally to this work and drafted the manuscript. Conceptualization, Xinyang Zhang, Liqiang Zhang, Feng Zhu; methodology, Xinyang Zhang, Feng Zhu, Chao Guo; information collection and analysis, Xinyang Zhang, Feng Zhu, Liqang Zhang; writing-original draft preparation, review and editing, Xinyang Zhang, Feng Zhu, Liqang Zhang, Chao Guo; supervision, project administration, funding acquisition, Dan Shang, Chunting Li. All authors have read and agreed to the published version of the manuscript.

Funding: this research was funded by the National Natural Science Foundation of China, No. 81700425.

Informed Consent Statement: The retrospective study was approved by the institutional research committee of our institution with a waiver of informed consent.

Conflicts of Interest: The authors declare no conflict of interest.

Data Availability: All data generated or analyzed during this study are included in this published article.

Glehen O, Feugier P, Aleksic Y, Delannoy P, Chevalier JM. Spontaneous dissection of the celiac artery. Ann Vasc Surg. 2001;15(6):687–92.
Nordanstig J, Gerdes H, Kocys E. Spontaneous isolated dissection of the celiac trunk with rupture of the proximal splenic artery: a case report. Eur J Vasc Endovasc Surg. 2009;37(2):194–7.
DiMusto PD, Oberdoerster MM, Criado E. Isolated celiac artery dissection. J Vasc Surg. 2015;61(4):972–6.
Sun J, Li DL, Wu ZH, He YY, Zhu QQ, Zhang HK. Morphologic findings and management strategy of spontaneous isolated dissection of the celiac artery. J Vasc Surg. 2016;64(2):389–94.
Wang HC, Chen JH, Hsiao CC, Jeng CM, Chen WL. Spontaneous dissection of the celiac artery: a case report and literature review. Am J Emerg Med. 2013;31(6):1000.e3-5.
Tanaka Y, Yoshimuta T, Kimura K, Iino K, Tamura Y, Sakata K, et al. Clinical characteristics of spontaneous isolated visceral artery dissection. J Vasc Surg. 2018;67(4):1127–33.
Zeina AR, Nachtigal A, Mahamid A, Soimu U, Ashkenazi I, Oster M. Isolated spontaneous dissection of a visceral artery: a rare cause of epigastric pain. Emerg Radiol. 2015;22(3):215–20.
Wang J, He Y, Zhao J, Yuan D, Xu H, Ma Y, et al. Systematic review and meta-analysis of current evidence in spontaneous isolated celiac and superior mesenteric artery dissection. J Vasc Surg. 2018;68(4):1228-40.e9.
Xu Y, Bu W, Han X, Shen Y, Wu J, Chen G. Current status of spontaneous isolated celiac artery dissection. Vascular. 2022:17085381221087812.
Gao X, Xie W, Shang D, Liu J, Jin B, Xu YJ. Clinical features and management strategy of symptomatic spontaneous isolated celiac artery dissection. Vascular. 2021:1708538120986295.
Galastri FL, Cavalcante RN, Motta-Leal-Filho JM, De Fina B, Affonso BB, de Amorim JE, et al. Evaluation and management of symptomatic isolated spontaneous celiac trunk dissection. Vasc Med. 2015;20(4):358–63.
Otsuka H, Sato T, Aoki H, Nakagawa Y, Inokuchi S. Optimal management strategy for spontaneous isolated dissection of a visceral artery. Vascular. 2018;26(2):169–74.
Aono J, Kikuchi K, Higashi H, Saito M, Sumimoto T. Epigastric and chest pain in celiac artery dissection: spontaneous isolated dissection of the celiac trunk. Eur Heart J Cardiovasc Imaging. 2016;17(3):315.
Sun J, Li D-l, Wu Z-h, He Y-y, Zhu Q-q, Zhang H-k. Morphologic findings and management strategy of spontaneous isolated dissection of the celiac artery. Journal of Vascular Surgery. 2016;64(2):389–94.
Kang SH, Park HS, Yoon CJ, Shin CS, Yoo KC, Lee T. Mid- to Long-Term Outcomes in Management of Spontaneous Isolated Coeliac Artery Dissection (SICAD). Eur J Vasc Endovasc Surg. 2020;59(2):247–53.
Kim SR, Park TK, Choi SH, Kim SM, Choe YH, Heo SH, et al. Natural history of spontaneous isolated celiac artery dissection after conservative treatment. Journal of Vascular Surgery. 2018;68(1):55–63.
Zhou F, Zheng Z, Pan Y. General features, management strategies, and outcomes of symptomatic spontaneous isolated celiac artery dissection. Front Surg. 2022;9:972276.
Li S, Cheng L, Tu J, Jiao Y, Wu X, Wang Z, et al. Effectiveness of the Conservative Therapy for Symptomatic Isolated Celiac Artery Dissection. CardioVascular and Interventional Radiology. 2017;40(7):994–1002.
Zhang T, Zhang X, Zhang X, Jiang J, Zhou B. Endovascular treatment of isolated spontaneous celiac artery dissection. Vascular. 2012;20(2):118–20.
Choi JY, Kwon OJ. Approaches to the management of spontaneous isolated visceral artery dissection. Annals of Vascular Surgery. 2013;27(6):750–7.
Gao X, Xie W, Shang D, Liu J, Jin B, Xu YJ. Clinical features and management strategy of symptomatic spontaneous isolated celiac artery dissection. Vascular. 2021;29(6):865–73.
Sun J, Li DL, Wu ZH, He YY, Zhu QQ, Zhang HK. Morphologic findings and management strategy of spontaneous isolated dissection of the celiac artery. Journal of Vascular Surgery. 2016;64(2):389–94.
DeCarlo C, Ganguli S, Borges JC, Schainfeld RM, Mintz AJ, Mintz J, et al. Presentation, treatment, and outcomes in patients with spontaneous isolated celiac and superior mesenteric artery dissection. Vasc Med. 2017;22(6):505–11.

No competing interests reported.

Download PDF

Editorial decision: Revision requested
17 Feb, 2024
Reviews received at journal
29 Jan, 2024
Reviewers agreed at journal
29 Jan, 2024
Reviews received at journal
25 Jan, 2024
Reviewers agreed at journal
24 Jan, 2024
Reviewers agreed at journal
22 Jan, 2024
Reviewers invited by journal
17 Jan, 2024
Editor assigned by journal
16 Jan, 2024
Editor invited by journal
30 Dec, 2023
Submission checks completed at journal
30 Dec, 2023
First submitted to journal
24 Dec, 2023

You are reading this latest preprint version

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

Status:

Version 1

Abstract

Figures

Introduction

Methods

Study design

Computed tomography (CT) imaging

Treatment

Follow up schedule

Statistical analysis

Results

Patients

Treatments

Clinical follow up

Discussion

Conclusions

Declarations

References

Additional Declarations

Status:

Version 1