Glehen O, Feugier P, Aleksic Y, Delannoy P, Chevalier J M
Service de Chirurgie Viscérale et Thoracique, Centre Hospitalier Lyon Sud, 69495 Pierre Bénite, France.
Ann Vasc Surg. 2001 Nov;15(6):687-92. doi: 10.1007/s10016-001-0012-0.
Spontaneous dissection of the celiac artery (CA) is uncommon, considering the number of isolated lesions without associated aortic dissection and exclusive of abdominal trauma. We have treated five cases of isolated spontaneous dissection of the CA or its branches. There were three men and two women with a mean age of 54 years. The presenting manifestation was acute epigastralgia in three cases and chronic abdominal pain in one. In the remaining case, dissecting CA was a coincidental finding. All patients underwent abdominal Doppler ultrasound and CT scan imaging, which demonstrated aneurysm in three cases and dissection in two. Work-up also included arteriography in three cases and magnetic resonance (MR) angiography in one. Management consisted of emergency surgical repair in three cases and close surveillance in two. The repair procedure was resection-anastomosis in one case and prosthetic bypass to the hepatic artery in two cases. Postoperative recovery was uneventful in all three cases and patients were symptom-free at 6, 8, and 18 months. Both patients under surveillance were symptom-free at 1 and 2 years. Because of the risk of ischemic and hemorrhagic complications, surgery should be considered for any patient with CA dissection. However, some patients with uncomplicated asymptomatic lesions may be eligible for medical treatment with regular surveillance.
考虑到孤立性病变的数量，且无相关主动脉夹层且排除腹部创伤，腹腔干（CA）自发性夹层并不常见。我们治疗了5例孤立性CA或其分支的自发性夹层病例。其中男性3例，女性2例，平均年龄54岁。临床表现为3例急性上腹痛，1例慢性腹痛。在其余病例中，CA夹层是偶然发现。所有患者均接受了腹部多普勒超声和CT扫描成像，其中3例显示动脉瘤，2例显示夹层。检查还包括3例动脉造影和1例磁共振（MR）血管造影。治疗方法包括3例急诊手术修复和2例密切观察。修复手术1例为切除吻合术，2例为人工血管旁路至肝动脉。所有3例术后恢复顺利，患者在6、8和18个月时均无症状。2例接受观察的患者在1年和2年时均无症状。由于存在缺血性和出血性并发症的风险，任何CA夹层患者都应考虑手术治疗。然而，一些无并发症的无症状病变患者可能适合接受定期观察的药物治疗。
