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Objectives: Due to the extensive collateralization between the celiac artery (CA) and the superior mesenteric artery (SMA) it has been argued that isolated atherosclerotic CA stenoses do not result in symptomatic ischemia requiring intervention. This report addresses whether isolated CA stenoisis can manifest symptoms and whether single vessel CA endovascular revascularization can lead to symptom relief.
Methods: A retrospective chart review was done on 6 cases of isolated celiac artery (CA) endovascular revascularization performed by two fellowship-trained vascular surgeons in our institution since January 2007. The lesions were detected by Duplex Ultrasonography, CT angiography (CTA), or Magnetic Resonance Angiography (MRA). They were then confirmed by angiography and treated concomitantly with stent placement. Completion angiogram confirmed patency. The patients were then maintained on Plavix for three months after the procedure. Data gathered included: gender, age, presenting symptoms, pre-operative testing, intra-operative angiographic findings, type of procedure, symptom resolution and length of follow up.
Results: All six patients (all female, with mean age of 57.6 years old) had a patent SMA and underwent successful stenting of isolated CA lesions. The patients presented with chronic abdominal symptoms including; diarrhea (33%), nausea and vomiting (33%), chronic abdominal pain including postprandial (100%), duodenal/gastric ulcers refractory to medical treatment (33%), and/or weight loss (33%). All of the patients had more than one symptom and underwent a work-up that excluded other primary causes. One patient, who was previously treated for symptomatic isolated celiac stenosis, presented two years later with recurrent symptoms and inter-stent stenosis which required re-intervention.
100% of the patients reported improvement of symptoms on follow up. Two patients presenting with gastric and duodenal ulcers due to isolated celiac artery stenosis had resolution of these ulcers postoperatively. None of our patients had any significant morbidity postoperatively, with 0% thrombosis, peripheral arterial injury, kidney failure, infection, significant bleeding or MI. The length of follow up ranges from 3 weeks to 2.5 years.
Conclusions: We have shown that endovascular treatment of isolated celiac artery stenosis can result in resolution of symptoms consistent with intestinal ischemia. Further, our results would indicate that these procedures can be performed with very low morbidity and mortality rates.