Mousa Albeir Y, Coyle Brian W, Affuso John, Haser Paul B, Vogel Todd R, Graham Alan M
UMDNJ- Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Vascular. 2009 Nov-Dec;17(6):359-64. doi: 10.2310/6670.2009.00053.
Isolated dissection of the origin of both celiac and superior mesenteric arteries is a rare vascular pathology with limited management guidelines. The presentation is generally nonspecific, most often manifesting with epigastric pain radiating to the back. A high diagnostic index of suspicion and stepwise management are essential for a successful outcome. This case report details the clinical course of a 57-year-male who presented with a 2-week history of epigastric discomfort with back pain and was found to have focal celiac artery dissection with aneurysmal dilation of 1.2 cm. His vital signs were stable, and the physical examination was unremarkable. At this time, he was placed on antiplatelet medication and was scheduled for endovascular repair of his celiac aneurysm with a covered stent graft. Two weeks later, recurrent abdominal pain prompted a repeat computed tomographic scan that revealed sequential superior mesenteric artery (SMA) dissection. The patient was admitted and anticoagulated. A complete workup ruled out underlying collagen vascular and autoimmune pathology. He remained stable, with significant symptomatic improvement. After 6 months, anticoagulation was discontinued and antiplatelet therapy was instituted for long-term management. Subsequent operative or endovascular intervention was not required. The patient was continuing to do well on his 18-month clinical follow-up. There are 71 cases of SMA and 12 cases of celiac artery dissection in the literature. This report outlines this rare presentation of isolated, proximal sequential celiac artery and SMA dissection. This case illustrates that conservative management may be warranted in uncomplicated, isolated visceral arterial dissection.
腹腔干动脉和肠系膜上动脉起始部的孤立性夹层是一种罕见的血管病变，治疗指南有限。其临床表现通常不具特异性，最常见的表现是上腹部疼痛并向后背部放射。高度的怀疑诊断指数和逐步治疗对于取得成功的治疗结果至关重要。本病例报告详细介绍了一名57岁男性的临床病程，该患者有2周的上腹部不适伴背痛病史，经检查发现患有局灶性腹腔干动脉夹层，动脉瘤扩张达1.2厘米。他的生命体征稳定，体格检查无异常。此时，他开始服用抗血小板药物，并计划使用覆膜支架移植物对其腹腔干动脉瘤进行血管内修复。两周后，反复出现的腹痛促使再次进行计算机断层扫描，结果显示相继出现肠系膜上动脉（SMA）夹层。患者入院并接受抗凝治疗。全面检查排除了潜在的胶原血管病和自身免疫性病变。他病情稳定，症状有显著改善。6个月后，停止抗凝治疗，开始使用抗血小板治疗进行长期管理。后续无需进行手术或血管内干预。在18个月的临床随访中，患者情况良好。文献中报道了71例肠系膜上动脉夹层和12例腹腔干动脉夹层。本报告概述了这种罕见的孤立性、近端相继出现的腹腔干动脉和肠系膜上动脉夹层表现。该病例表明，对于无并发症的孤立性内脏动脉夹层，保守治疗可能是合理的。
