title: Evaluation and management of symptomatic isolated spontaneous celiac trunk dissection.
abstract: The purpose of this study is to describe 10 cases of symptomatic isolated spontaneous celiac trunk dissection (ISCTD) in order to evaluate the initial clinical presentation, diagnosis, treatment modalities and outcomes. A retrospective search was performed from 2009 to 2014 and 10 patients with ISCTD were included in the study. Patients with associated aortic and/or other visceral artery dissection were excluded. The following information was collected from each case: sex, age, associated risk factors, symptoms, diagnostic method, anatomic dissection pattern, treatment modality and outcome. Most patients were male (90%), with an average age of 44.8 years, and the most common symptom was abdominal pain (100%). Hypertension and vasculitis (polyarteritis nodosa) were the most frequent risk factors (40% and 30%, respectively). Diagnosis was made in all patients with computed tomography. Dissection was limited to the celiac trunk in three patients and extended to celiac branches in the other seven. Initial conservative treatment was attempted in every case and was successful in nine patients. In one case, initial conservative treatment was unsuccessful and arterial stenting with coil embolization of the false lumen was performed. After successful initial treatment, late progression of the dissection to aneurysmal dilatation was observed in two patients and it was decided to perform endovascular treatment. Mean follow-up was 19 months, ranging from 2 to 59 months. In conclusion, initial conservative treatment seems adequate for most patients with ISCTD. Long-term follow-up is mandatory, owing to the risk of later progression to aneurysm.
authors.affiliation: Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Francisco Leonardo
authors.initials: FL
authors.lastname: Galastri
authors.affiliation: Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil rafaelnoronha@yahoo.com.br.
authors.forename: Rafael Noronha
authors.initials: RN
authors.lastname: Cavalcante
authors.affiliation: Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Joaquim Mauricio
authors.initials: JM
authors.lastname: Motta-Leal-Filho
authors.affiliation: Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Bruna
authors.initials: B
authors.lastname: De Fina
authors.affiliation: Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Breno Boueri
authors.initials: BB
authors.lastname: Affonso
authors.affiliation: Vascular Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Jorge Eduardo
authors.initials: JE
authors.lastname: de Amorim
authors.affiliation: Vascular Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Nelson
authors.initials: N
authors.lastname: Wolosker
authors.affiliation: Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Felipe
authors.initials: F
authors.lastname: Nasser
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000784:Aortic Dissection / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D058070:Asymptomatic Diseases; D002445:Celiac Artery / Q000000981:diagnostic imaging*; D018450:Disease Progression; D004621:Embolization, Therapeutic / Q000009:adverse effects; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014839:Vomiting / Q000209:etiology
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
keywords: Dissection; celiac artery dissection; endovascular treatment; spontaneous