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Isolated Dissection of the Celiac and Superior Mesenteric Arteries
Jill Zink, MD, Victor Erzurum, MD, Robert Netzley, MD, Charudutt Paranjape, MD, Dennis Wright, MD.
Akron General Medical Center, Akron, OH, USA.

OBJECTIVES: Isolated dissection of the mesenteric circulation is an unusual occurrence. Previous isolated case reports and small series have varied in treatment modalities. We report a series of 6 patients with focal dissection of the mesenteric circulation. In each case conservative management was attempted as the primary mode of therapy.
METHODS: We reviewed hospital and patient follow-up records for a series of 6 patients who presented with isolated mesenteric dissections over the last 5 years. Conservative management with anticoagulation and observation was instituted on diagnosis. Records were reviewed for initial presentation and success of therapy in both the acute and long-term setting as well as noted complications.
RESULTS: Average age at presentation was 54 years (range 44-61 years). Five patients were male. One patient had prior history of PVD. HTN was present in 5 patients. In all cases the diagnosis was made by CTA. Presenting symptoms were abdominal pain (6), nausea/vomiting (4), chest pain (3), and food intolerance (3). In 4 cases the dissection was preceded by a severe coughing or retching episode. Four cases were isolated to the celiac artery and 2 cases showed extension into the SMA. All 6 cases showed good visceral perfusion initially. Two cases showed mild aneurysmal dilation. All cases were initially managed with heparin. One patient had progressive symptoms of bowel ischemia with failed interventional/operative management and bowel resection was required. Of the remaining 5 patients, all were treated with conversion to coumadin (4) or ASA/Plavix (1). Four of five patients had complete resolution of symptoms and no further degenerative changes. One patient with both aneurysm and persistent cachexia has been considered for operative management but is not a candidate secondary to severe CHF. In the remaining 4 patients, follow-up CT scans have shown no progression of dissection (2) and partial resolution (2).
CONCLUSIONS: Isolated mesenteric dissection appears to occur at a younger age and without the hallmark symptoms of PVD. Conservative management of isolated mesenteric dissection appears both safe and effective for relief of symptoms. Ongoing follow-up with CT scanning is indicated for assessment of degenerative changes. Operative management should be considered for persistent symptomatology but may be associated with increased morbidity.


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