Presentation, treatment, and outcomes in patients with spontaneous isolated celiac artery dissection

Abstract

Abstract Objective: Spontaneous isolated celiac artery dissection (SICAD) is a rare condition, and its natural history and outcomes have not been thoroughly studied. The aim of this study was to review our institution’s experience in the evaluation, treatment, and outcomes of patients with SICAD. Methods: A retrospective review was conducted on 76 patients who presented with SICAD between January 2010 and July 2022. The clinical manifestations, initial radiological findings, methods of treatment and follow-up computed tomography were reviewed, and patients were contacted for assessment of current symptoms. Results: in this study, a total of 76 patients with SICAD were collected. The mean age of the patients was 52.8±8.7 years. The mean angle between celiac trunk and aorta in symptomatic patients was 57.78 ± 14.94°, and 59.65 ± 20.11° in asymptomatic patients. Of the 76 patients, 27underwent endovascular treatment due to refractory pain or aneurysmal dilatation. Among these 27 patients, 2 experienced failure in the endovascular intervention due to issues with the guide wire reaching the true cavity and challenges in inserting the long sheath behind the celiac artery. The remaining 49 patients were managed conservatively. Within the conservative group, one patient (1.3%) without aneurysmal dilation experienced a recurrence of abdominal pain one year after the initial hospitalization. Subsequent CT revealed slight dilation of the celiac trunk dissection compared to the initial presentation. After rehospitalization and conservative treatment, symptoms improved, and no recurrence have been observed since discharge. It is noteworthy that all patients, whether treated with endovascular or conservative methods, experienced improvement in symptoms. Conclusions:The symptoms of SICAD may not be influenced by the angle between celiac trunk and aorta. Conservative treatment is effective in more than half of the patients. Even if abdominal pain recurs, as long as the patient’s condition is stable, conservative treatment remains effective. Endovascular treatment had more favorable outcomes in achieving complete remodeling compared to conservative treatment.