title: Management of spontaneous isolated visceral artery dissection.
abstract: BACKGROUND
  Spontaneous isolated dissection of the celiac artery (CA) or the superior mesenteric artery (SMA) is rare but increasingly recognized because of widespread use of advanced abdominal imaging technology. Indications for specific therapeutic options and long-term outcomes are not well defined. This study analyzed clinical features, management strategies, and outcomes for patients with spontaneous visceral artery dissections.
  
  
  METHODS
  Medical records of all patients diagnosed with CA or SMA dissections at 2 institutions (Scripps Green Hospital and San Diego Kaiser Medical Center) between January 2005 and January 2014 were retrospectively reviewed. Patient demographics included age, symptoms, associated comorbidities, and type of intervention. Anatomic features including length of dissection and entry point were measured. Efficacy of the various treatments was compared on the basis of symptom resolution and clinical course.
  
  
  RESULTS
  Over an 8-year period, 23 patients with a diagnosis of visceral artery dissection were identified. Eighteen (78%) patients were men. Most patients (78%) were symptomatic on initial presentation with abdominal or back pain. Treatment included observation in 4, anticoagulation in 13, and endovascular stenting in 6 patients. The mean follow-up was 23.8 months. No patient required bowel resection. Twenty of twenty-three patients reported resolution of symptoms at follow-up.
  
  
  CONCLUSIONS
  In this series, all patients with isolated visceral artery dissection had favorable outcomes, with no significant morbidity or mortality. Conservative management with anticoagulation is recommended as the first-line therapy. When conservative management fails, endovascular therapy is the treatment of choice.
authors.affiliation: University of California at San Diego Health Center, San Diego, CA. Electronic address: s2ko@ucsd.edu.
authors.forename: Sae Hee
authors.initials: SH
authors.lastname: Ko
authors.affiliation: Kaiser Permanente, San Diego, CA.
authors.forename: Robert
authors.initials: R
authors.lastname: Hye
authors.affiliation: Scripps Clinic Torrey Pines, La Jolla, CA.
authors.forename: David A
authors.initials: DA
authors.lastname: Frankel
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D000925:Anticoagulants / Q000627:therapeutic use*; D001416:Back Pain / Q000209:etiology; D002140:California; D057510:Endovascular Procedures / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014781:Viscera / Q000098:blood supply*; D055815:Young Adult
chemical_list: D000925:Anticoagulants