Morphologic characteristics and management strategy of symptomatic spontaneous isolated celiac artery dissection_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

PENG Zhenyu , HUA Zhaohui , JIAO Zhouyang , XU Peng , CAO Hui , LIU Shirui ,  LI Zhen

Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, P. R. China;

Corresponding author：

LI Zhen, Email: lizhen1029@hotmail.com

Keywords：

symptomatic spontaneous isolated celiac artery dissection; morphological classification; treatment strategy; arterial reconstruction

DOI：

10.7507/1007-9424.202102055

Video：

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Objective To summarize the clinical morphological classification feature of symptomatic spontaneous isolated celiac artery dissection (SICAD), basing on the relative diameter of the true lumen (TLRD) and type of lesion, and then summarize the reasonable clinical treatment strategies and timing of arterial reconstruction.Methods Retrospectively analyzed the imaging data, treatment methods, perioperative complications, and follow-up results of 26 symptomatic SICAD patients admitted to the Department of Endovascular Surgery of The First Affiliated Hospital of Zhengzhou University from May 2012 to May 2019, patients were divided into conservative treatment group (n=12) and endovascular intervention group (n=14) according the treatment, and then compared the clinical data of the two groups.Results Twelve patients in the conservative treatment group had an average of 12.6 days (5–22 days) and discharged from hospital with better condition, of which 11 patients’ TLRD≥30%. In the endovascular intervention group, 2 patients continued to aggravate the symptoms at the 3rd day of admission and received endovascular intervention, the remaining 12 patients’ symptoms were not significantly relieved or the symptoms reappeared after averaged 11.4 days, whose TLRD<30% or diameter >1.5 cm. Compared with the endovascular intervention group, the duration of symptoms was shorter (P=0.04), proportions of back pain (P=0.02) and chest pain (P=0.04) were lower, TLRD value and proportion of TLRD value>30% (subtype of a) were higher (P=0.01, P=0.02). The average follow-up duration of 26 patients was 28.2 months (12–83 months). The follow-up results of all patients in the conservative treatment group were good and no relevant symptoms had appeared since discharge. One patient in the endovascular intervention group had transient liver function damage, 1 patient had severe deformation of the proximal end of the stent at 1 year after implantation of the celiac artery stent. The remaining patients were stable with no progress.Conclusions For symptomatic SICAD, if the clinical symptoms are stable after hospitalization, conservative medication and close imaging follow-up are preferred, if there is no relief of symptoms, continuous organ perfusion and other manifestations based on medication, endovascular intervention can be considered for arterial reconstruction, the early and medium follow-up results were satisfactory under this treatment algorithm. In addition, there are differences in TLRD value between the conservative treatment group and the endovascular intervention group, suggesting that TLRD as the morphological characteristics of the classification has a potential guiding significance for the development of clinical treatment strategy.

Citation： PENG Zhenyu, HUA Zhaohui, JIAO Zhouyang, XU Peng, CAO Hui, LIU Shirui, LI Zhen. Morphologic characteristics and management strategy of symptomatic spontaneous isolated celiac artery dissection. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(10): 1340-1347. doi: 10.7507/1007-9424.202102055 Copy

1.	Woolard JD, Ammar AD. Spontaneous dissection of the celiac artery: a case report. J Vasc Surg, 2007, 45(6): 1256-1258.
2.	Tanaka Y, Yoshimuta T, Kimura K, et al. Clinical characteristics of spontaneous isolated visceral artery dissection. J Vasc Surg, 2018, 67(4): 1127-1133.
3.	Chen ZL, Zhang XC, Pan GR, et al. Clinical features and therapeutic options for isolated visceral artery dissection. Ann Vasc Surg, 2016, 30: 227-235.
4.	Li S, Cheng L, Tu J, et al. Effectiveness of the conservative therapy for symptomatic isolated celiac artery dissection. Cardiovasc Intervent Radiol, 2017, 40(7): 994-1002.
5.	Galastri FL, Cavalcante RN, Motta-Leal-Filho JM, et al. Evaluation and management of symptomatic isolated spontaneous celiac trunk dissection. Vasc Med, 2015, 20(4): 358-363.
6.	Kang SH, Park HS, Yoon CJ, et al. Mid- to long-term outcomes in management of spontaneous isolated coeliac artery dissection (SICAD). Eur J Vasc Endovasc Surg, 2020, 59(2): 247-253.
7.	Kim B, Lee BS, Kwak HK, et al. Natural course and outcomes of spontaneous isolated celiac artery dissection according to morphological findings on computed tomography angiography: STROBE compliant article. Medicine (Baltimore), 2018, 97(5): e9705.
8.	Sun J, Li DL, Wu ZH, et al. Morphologic findings and management strategy of spontaneous isolated dissection of the celiac artery. J Vasc Surg, 2016, 64(2): 389-394.
9.	Kim SR, Park TK, Choi SH, et al. Natural history of spontaneous isolated celiac artery dissection after conservative treatment. J Vasc Surg, 2018, 68(1): 55-63.
10.	Min SI, Yoon KC, Min SK, et al. Current strategy for the treatment of symptomatic spontaneous isolated dissection of superior mesenteric artery. J Vasc Surg, 2011, 54(2): 461-466.
11.	Naylor AR, Ricco JB, de Borst GJ, et al. Editor’s choice—management of atherosclerotic carotid and vertebral artery disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg, 2018, 55(1): 3-81.
12.	Oh S, Cho YP, Kim JH, et al. Symptomatic spontaneous celiac artery dissection treated by conservative management: serial imaging findings. Abdom Imaging, 2011, 36(1): 79-82.
13.	Wang J, He Y, Zhao J, 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): 1228-1240.
14.	Cavalcante RN, Motta-Leal-Filho JM, De Fina B, et al. Systematic literature review on evaluation and management of isolated spontaneous celiac trunk dissection. Ann Vasc Surg, 2016, 34: 274-279.
15.	D’Ambrosio N, Friedman B, Siegel D, et al. Spontaneous isolated dissection of the celiac artery: CT findings in adults. AJR Am J Roentgenol, 2007, 188(6): W506-W511.
16.	Ko SH, Hye R, Frankel DA. Management of spontaneous isolated visceral artery dissection. Ann Vasc Surg, 2015, 29(3): 470-474.
17.	Amabile P, Ouaïssi M, Cohen S, et al. Conservative treatment of spontaneous and isolated dissection of mesenteric arteries. Ann Vasc Surg, 2009, 23(6): 738-744.
18.	Jung SC, Lee W, Park EA, et al. Spontaneous dissection of the splanchnic arteries: CT findings, treatment, and outcome. AJR Am J Roentgenol, 2013, 200(1): 219-225.
19.	Takach TJ, Madjarov JM, Holleman JH, et al. Spontaneous splanchnic dissection: application and timing of therapeutic options. J Vasc Surg, 2009, 50(3): 557-563.
20.	Perini P, Baque J, Chau Y, et al. Percutaneous embolization of symptomatic dissecting aneurysms of the celiac artery. Acta Radiol, 2014, 55(9): 1076-1081.
21.	Ichiba T, Hara M, Yunoki K, et al. Impact of noninvasive conservative medical treatment for symptomatic isolated celiac artery dissection. Circ J, 2016, 80(6): 1445-1451.
22.	Shiraki H, Kasamoto M, Yasutomi M, et al. Clinical features of spontaneous isolated dissection of abdominal visceral arteries. J Clin Med Res, 2020, 12(1): 13-17.
23.	Park WJ, Seo JW. Follow-up with computed tomography after spontaneous isolated dissection of the splanchnic artery. Clin Imaging, 2018, 52: 1-7.
24.	Tokue H, Tsushima Y, Endo K. Imaging findings and management of isolated dissection of the visceral arteries. Jpn J Radiol, 2009, 27(10): 430-437.
25.	DiMusto PD, Oberdoerster MM, Criado E. Isolated celiac artery dissection. J Vasc Surg, 2015, 61(4): 972-976.
26.	Takayama T, Miyata T, Shirakawa M, et al. Isolated spontaneous dissection of the splanchnic arteries. J Vasc Surg, 2008, 48(2): 329-333.
27.	Hosaka A, Nemoto M, Miyata T. Outcomes of conservative management of spontaneous celiac artery dissection. J Vasc Surg, 2017, 65(3): 760-765.
28.	DeCarlo C, Ganguli S, Borges JC, et al. Presentation, treatment, and outcomes in patients with spontaneous isolated celiac and superior mesenteric artery dissection. Vasc Med, 2017, 22(6): 505-511.
29.	Yun WS, Kim YW, Park KB, et al. Clinical and angiographic follow-up of spontaneous isolated superior mesenteric artery dissection. Eur J Vasc Endovasc Surg, 2009, 37(5): 572-577.
30.	Loeffler JW, Obara H, Fujimura N, et al. Medical therapy and intervention do not improve uncomplicated isolated mesenteric artery dissection outcomes over observation alone. J Vasc Surg, 2017, 66(1): 202-208.
31.	Heo SH, Kim YW, Woo SY, et al. Treatment strategy based on the natural course for patients with spontaneous isolated superior mesenteric artery dissection. J Vasc Surg, 2017, 65(4): 1142-1151.
32.	Zhang T, Zhang X, Zhang X, et al. Endovascular treatment of isolated spontaneous celiac artery dissection. Vascular, 2012, 20(2): 118-120.
33.	Douard R, Chevallier JM, Delmas V, et al. Clinical interest of digestive arterial trunk anastomoses. Surg Radiol Anat, 2006, 28(3): 219-227.
34.	Batt M, Baque J. Successful percutaneous embolization of a symptomatic celiac artery dissection with aneurysmal dilation with detachable vascular plugs. J Vasc Surg, 2011, 54(6): 1812-1815.

1. Woolard JD, Ammar AD. Spontaneous dissection of the celiac artery: a case report. J Vasc Surg, 2007, 45(6): 1256-1258.
2. Tanaka Y, Yoshimuta T, Kimura K, et al. Clinical characteristics of spontaneous isolated visceral artery dissection. J Vasc Surg, 2018, 67(4): 1127-1133.
3. Chen ZL, Zhang XC, Pan GR, et al. Clinical features and therapeutic options for isolated visceral artery dissection. Ann Vasc Surg, 2016, 30: 227-235.
4. Li S, Cheng L, Tu J, et al. Effectiveness of the conservative therapy for symptomatic isolated celiac artery dissection. Cardiovasc Intervent Radiol, 2017, 40(7): 994-1002.
5. Galastri FL, Cavalcante RN, Motta-Leal-Filho JM, et al. Evaluation and management of symptomatic isolated spontaneous celiac trunk dissection. Vasc Med, 2015, 20(4): 358-363.
6. Kang SH, Park HS, Yoon CJ, et al. Mid- to long-term outcomes in management of spontaneous isolated coeliac artery dissection (SICAD). Eur J Vasc Endovasc Surg, 2020, 59(2): 247-253.
7. Kim B, Lee BS, Kwak HK, et al. Natural course and outcomes of spontaneous isolated celiac artery dissection according to morphological findings on computed tomography angiography: STROBE compliant article. Medicine (Baltimore), 2018, 97(5): e9705.
8. Sun J, Li DL, Wu ZH, et al. Morphologic findings and management strategy of spontaneous isolated dissection of the celiac artery. J Vasc Surg, 2016, 64(2): 389-394.
9. Kim SR, Park TK, Choi SH, et al. Natural history of spontaneous isolated celiac artery dissection after conservative treatment. J Vasc Surg, 2018, 68(1): 55-63.
10. Min SI, Yoon KC, Min SK, et al. Current strategy for the treatment of symptomatic spontaneous isolated dissection of superior mesenteric artery. J Vasc Surg, 2011, 54(2): 461-466.
11. Naylor AR, Ricco JB, de Borst GJ, et al. Editor’s choice—management of atherosclerotic carotid and vertebral artery disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg, 2018, 55(1): 3-81.
12. Oh S, Cho YP, Kim JH, et al. Symptomatic spontaneous celiac artery dissection treated by conservative management: serial imaging findings. Abdom Imaging, 2011, 36(1): 79-82.
13. Wang J, He Y, Zhao J, 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): 1228-1240.
14. Cavalcante RN, Motta-Leal-Filho JM, De Fina B, et al. Systematic literature review on evaluation and management of isolated spontaneous celiac trunk dissection. Ann Vasc Surg, 2016, 34: 274-279.
15. D’Ambrosio N, Friedman B, Siegel D, et al. Spontaneous isolated dissection of the celiac artery: CT findings in adults. AJR Am J Roentgenol, 2007, 188(6): W506-W511.
16. Ko SH, Hye R, Frankel DA. Management of spontaneous isolated visceral artery dissection. Ann Vasc Surg, 2015, 29(3): 470-474.
17. Amabile P, Ouaïssi M, Cohen S, et al. Conservative treatment of spontaneous and isolated dissection of mesenteric arteries. Ann Vasc Surg, 2009, 23(6): 738-744.
18. Jung SC, Lee W, Park EA, et al. Spontaneous dissection of the splanchnic arteries: CT findings, treatment, and outcome. AJR Am J Roentgenol, 2013, 200(1): 219-225.
19. Takach TJ, Madjarov JM, Holleman JH, et al. Spontaneous splanchnic dissection: application and timing of therapeutic options. J Vasc Surg, 2009, 50(3): 557-563.
20. Perini P, Baque J, Chau Y, et al. Percutaneous embolization of symptomatic dissecting aneurysms of the celiac artery. Acta Radiol, 2014, 55(9): 1076-1081.
21. Ichiba T, Hara M, Yunoki K, et al. Impact of noninvasive conservative medical treatment for symptomatic isolated celiac artery dissection. Circ J, 2016, 80(6): 1445-1451.
22. Shiraki H, Kasamoto M, Yasutomi M, et al. Clinical features of spontaneous isolated dissection of abdominal visceral arteries. J Clin Med Res, 2020, 12(1): 13-17.
23. Park WJ, Seo JW. Follow-up with computed tomography after spontaneous isolated dissection of the splanchnic artery. Clin Imaging, 2018, 52: 1-7.
24. Tokue H, Tsushima Y, Endo K. Imaging findings and management of isolated dissection of the visceral arteries. Jpn J Radiol, 2009, 27(10): 430-437.
25. DiMusto PD, Oberdoerster MM, Criado E. Isolated celiac artery dissection. J Vasc Surg, 2015, 61(4): 972-976.
26. Takayama T, Miyata T, Shirakawa M, et al. Isolated spontaneous dissection of the splanchnic arteries. J Vasc Surg, 2008, 48(2): 329-333.
27. Hosaka A, Nemoto M, Miyata T. Outcomes of conservative management of spontaneous celiac artery dissection. J Vasc Surg, 2017, 65(3): 760-765.
28. DeCarlo C, Ganguli S, Borges JC, et al. Presentation, treatment, and outcomes in patients with spontaneous isolated celiac and superior mesenteric artery dissection. Vasc Med, 2017, 22(6): 505-511.
29. Yun WS, Kim YW, Park KB, et al. Clinical and angiographic follow-up of spontaneous isolated superior mesenteric artery dissection. Eur J Vasc Endovasc Surg, 2009, 37(5): 572-577.
30. Loeffler JW, Obara H, Fujimura N, et al. Medical therapy and intervention do not improve uncomplicated isolated mesenteric artery dissection outcomes over observation alone. J Vasc Surg, 2017, 66(1): 202-208.
31. Heo SH, Kim YW, Woo SY, et al. Treatment strategy based on the natural course for patients with spontaneous isolated superior mesenteric artery dissection. J Vasc Surg, 2017, 65(4): 1142-1151.
32. Zhang T, Zhang X, Zhang X, et al. Endovascular treatment of isolated spontaneous celiac artery dissection. Vascular, 2012, 20(2): 118-120.
33. Douard R, Chevallier JM, Delmas V, et al. Clinical interest of digestive arterial trunk anastomoses. Surg Radiol Anat, 2006, 28(3): 219-227.
34. Batt M, Baque J. Successful percutaneous embolization of a symptomatic celiac artery dissection with aneurysmal dilation with detachable vascular plugs. J Vasc Surg, 2011, 54(6): 1812-1815.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Morphologic characteristics and management strategy of symptomatic spontaneous isolated celiac artery dissection

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