Management of symptomatic spontaneous isolated visceral artery dissection: is emergent intervention mandatory?
Spontaneous dissection of a visceral artery without associated aortic dissection is rare, although more cases have recently been reported because of the advancement of diagnostic techniques. The risk factors, causes, and natural history of spontaneous isolated visceral artery dissection are unclear. Treatment with open surgery, endovascular stenting, or anticoagulation therapy has been proposed; however, there is no consensus on the optimal management. We present three cases of spontaneous and isolated dissection of visceral arteries. Dissection involved the superior mesenteric artery in one and the celiac artery in two. All three patients presented with acute abdominal pain but lacked any peritoneal irritation. The patients were treated nonoperatively with anticoagulants or antiplatelets. No surgical or endovascular intervention was performed. Follow-up imaging studies demonstrated improvement of the dissection in two patients and no change in one patient. All patients were symptom-free over a mean follow-up of 17 months. Nonoperative treatment with close observation is an acceptable strategy in the management of spontaneous isolated dissection of visceral arteries. Emergent intervention is not mandatory in symptomatic patients without evidence of acute bowel ischemia or hemorrhage.
Zhang
Wayne W
WW
Division of Vascular Surgery, Department of Surgery, Loma Linda University School of Medicine, Loma Linda, California. wwzhang@ahs.llumc.edu
Killeen
J David
JD
Chiriano
Jason
J
Bianchi
Christian
C
Teruya
Theodore H
TH
Abou-Zamzam
Ahmed M
AM
D015746:Abdominal Pain / Q000209:etiology / Q000628:therapy; D000328:Adult; D000784:Aortic Dissection / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D000925:Anticoagulants / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D001416:Back Pain / Q000209:etiology / Q000628:therapy; D002445:Celiac Artery / Q000000981:diagnostic imaging; D004108:Dilatation, Pathologic; D004359:Drug Therapy, Combination; D004638:Emergency Treatment; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging; D008875:Middle Aged; D018579:Patient Selection; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014781:Viscera / Q000098:blood supply*; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D006493:Heparin; D001241:Aspirin