Spontaneous Dissections of the Superior Mesenteric and Celiac Arteries

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Ryan M. Gobble, M.D., Caron R. Rockman, MD, Rajesh Malik, MD, Neal S. Cayne, MD, Mark A. Adelman, MD, Elizabeth Hecht, MD, Alena Sergejev, BS, Patrick J. Lamparello, MD, Thomas S. Maldonado, MD.
New York University Medical Center, New York, NY, USA.

OBJECTIVES:
Spontaneous dissection of the superior mesenteric artery (SMA) or celiac artery (CA) is exceedingly rare. Treatment options range from observation to anticoagulation to surgery (open vs. endovascular). We present our experience to date in the management of isolated visceral arterial dissections (VAD).
METHODS:
A retrospective review of the vascular surgery and radiology data bases from 1998 - 2007 was performed. 11 patients were identified who had an isolated VAD (9 SMA, 2 CA). In general, asymptomatic incidental radiologic findings of a dissection were managed expectantly. The decision to intervene was based on anatomic suitability, patient comorbidities and symptomatology, and physician preference. Follow up consisted of yearly office visits and adjunctive computerized tomography or magnetic resonance imaging when clinically indicated.
RESULTS:
There were 9 males and 2 females in our study. The mean age and follow up time were 64 years (44 - 78 years) and 40 months (4 - 109 months), respectively. 91% (10/11) of patients were hypertensive and/or had a significant history of tobacco use, both known risk factors for VAD. Presentations included an incidental radiologic finding in 36% (4/11), acute onset abdominal pain in 55% (6/11), and chronic abdominal pain in 9% (1/11). Initial treatment included expectant management in 64% (7/11), coumadinization in 27% (3/11), and endovascular stent placement (ESP) in 9% (1/11). 2 patients failed initial management (1 expectant management, 1 coumadinization) and required ESP for pain relief. One patient initially treated with an SMA stent had pain recurrence requiring placement of a second SMA stent and a CA stent. One patient was deceased at the time of follow up. There were no complications associated with ESP.
CONCLUSIONS:
VA dissection is a rare syndrome which may be managed successfully in a variety of ways based on clinical presentation. Endovascular stenting can be performed with good results in patients when expectant management is unsuccessful.

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