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Spontaneous Isolated Celiac Artery Dissections Exhibit A Benign Course On Long-term Follow-up
Ethan Chervonski, B.A.1, Moira A. McGevna, B.A.
2, Molly Ratner, M.D.
2, Karan Garg, M.D.
2, Thomas S. Maldonado, M.D.
2, Mikel Sadek, M.D.
2, Todd L. Berland, M.D.
2, Katherine A. Teter, M.D.
2, Caron B. Rockman, M.D.
2.
1NYU Grossman School of Medicine, New York, NY, USA,
2NYU Langone Health, New York, NY, USA.
OBJECTIVES: Spontaneous isolated celiac artery dissection (SICAD) is a rare vascular condition with an ill-defined natural history. No consensus guidelines exist regarding its optimal management. The objective of this study was to characterize the natural history of SICAD.
METHODS: In this single-center retrospective study, patients diagnosed with celiac artery dissection from January 2011-December 2022 were identified from the EMR. Celiac dissections secondary to trauma, surgery, or aortic dissection were excluded. Demographics, clinical/radiological characteristics, and follow-up data were reviewed. Endpoints included symptomatic remission, dissection remodeling, and aneurysmal dilatation.
RESULTS: 51 patients with SICAD were identified with an average clinical follow-up of 3.4±3.5 years. The mean age was 58.1±12.6 years. The majority were male sex (80.4%) and had a history of hypertension (58.8%) and hyperlipidemia (56.9%). Most patients (56.9%) were symptomatic on presentation, typically with abdominal pain; the remainder were incidentally discovered. 24 patients (50.0%) presented with aneurysmal dilatation, with mean diameter 1.4±0.4 cm (range: 0.9, 2.5). Index aneurysmal dilatation was associated with a history of CAD (p=0.022) and isolated celiac trunk involvement (p=0.011). All patients were initially managed conservatively. Other baseline characteristics and management are summarized in Table 1. Of symptomatic patients, 26 (89.7%) had complete remission, 2 (6.9%) had partial improvement, and 1 (3.4%) had symptom recurrence. Among 41 patients with a mean radiological follow-up of 3.1±3.6 years, 10 (24.4%) had complete dissection remodeling, 8 (19.5%) had partial remodeling, 20 (48.8%) had a stable dissection, and 3 (7.3%) had dissection extension. Symptomatic patients were more likely to have remodeling than patients with incidental discovery (p=0.003). Of those with index aneurysmal degeneration, 2 (11.1%) and 16 (88.9%) had aneurysmal growth and stability, respectively. 6 patients (27.3%) without index dilatation had new aneurysms on follow-up. Just one patient underwent a secondary endovascular intervention for an enlarging >2.0-cm celiac artery aneurysm. No instances of vessel rupture or significant organ malperfusion occurred. No other clinical/imaging characteristics or treatment paradigms independently influenced outcomes.
CONCLUSIONS: Most patients with SICAD can be managed conservatively with excellent outcomes. The high rates of persistent dissection and aneurysmal dilatation appear, by and large, benign and may be surveilled.
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