title: Outcomes of conservative management of spontaneous celiac artery dissection.
abstract: OBJECTIVE
  Spontaneous celiac artery (CA) dissection without associated aortic dissection is a rare condition. Although this condition has been diagnosed more frequently with the advent of improved diagnostic imaging modalities, its pathogenesis and treatment strategy remain to be established. The present study examined the clinical features and outcomes of conservative management of this disease.
  
  
  METHODS
  The study included 12 patients (10 men and two women) in whom spontaneous CA dissection was diagnosed between 2007 and 2015. The medical records of each patient were retrospectively reviewed.
  
  
  RESULTS
  The mean age at diagnosis was 56.4 years (range, 42-77 years). Eight patients presented with abdominal or back pain, and the remaining four patients were asymptomatic and diagnosed incidentally. Four patients had a history of hypertension, and six had a history of smoking. Celiac trunk compression by the median arcuate ligament was found in two patients. The dissection extended into the common hepatic artery in five patients and into the splenic artery in four patients. Retroperitoneal hemorrhage was found in 2 patients, splenic infarction in 3, and transient mild liver dysfunction in 2. All patients were treated conservatively: two patients received short-term anticoagulation and antiplatelet therapy, and antihypertensive treatment was initiated in three patients. The mean follow-up period was 35.5 months (range, 5-101 months). Distal extension of the dissection occurred in one patient within a week of the initial symptom, which was also managed conservatively. Late aneurysmal degeneration was not observed in any of the patients, and none required endovascular or surgical treatment.
  
  
  CONCLUSIONS
  If the general condition of the patient is stable, then CA dissection can be managed with careful conservative treatment, even in patients with associated retroperitoneal hemorrhage. Long-term anticoagulation or antiplatelet medication may not be necessary in most patients with this condition.
authors.affiliation: Department of Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan. Electronic address: hosaka-a@umin.ac.jp.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Hosaka
authors.affiliation: Department of Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Nemoto
authors.affiliation: Vascular Center, Sanno Hospital and Sanno Medical Center, Tokyo, Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Miyata
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D000925:Anticoagulants / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D058070:Asymptomatic Diseases; D001416:Back Pain / Q000209:etiology; D002445:Celiac Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014041:Tokyo; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D000959:Antihypertensive Agents; D010975:Platelet Aggregation Inhibitors