Hosaka Akihiro, Nemoto Masaru, Miyata Tetsuro
Department of Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
Department of Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
J Vasc Surg. 2017 Mar;65(3):760-765.e1. doi: 10.1016/j.jvs.2016.09.058. Epub 2016 Dec 22.
Spontaneous celiac artery (CA) dissection without associated aortic dissection is a rare condition. Although this condition has been diagnosed more frequently with the advent of improved diagnostic imaging modalities, its pathogenesis and treatment strategy remain to be established. The present study examined the clinical features and outcomes of conservative management of this disease.
The study included 12 patients (10 men and two women) in whom spontaneous CA dissection was diagnosed between 2007 and 2015. The medical records of each patient were retrospectively reviewed.
The mean age at diagnosis was 56.4 years (range, 42-77 years). Eight patients presented with abdominal or back pain, and the remaining four patients were asymptomatic and diagnosed incidentally. Four patients had a history of hypertension, and six had a history of smoking. Celiac trunk compression by the median arcuate ligament was found in two patients. The dissection extended into the common hepatic artery in five patients and into the splenic artery in four patients. Retroperitoneal hemorrhage was found in 2 patients, splenic infarction in 3, and transient mild liver dysfunction in 2. All patients were treated conservatively: two patients received short-term anticoagulation and antiplatelet therapy, and antihypertensive treatment was initiated in three patients. The mean follow-up period was 35.5 months (range, 5-101 months). Distal extension of the dissection occurred in one patient within a week of the initial symptom, which was also managed conservatively. Late aneurysmal degeneration was not observed in any of the patients, and none required endovascular or surgical treatment.
If the general condition of the patient is stable, then CA dissection can be managed with careful conservative treatment, even in patients with associated retroperitoneal hemorrhage. Long-term anticoagulation or antiplatelet medication may not be necessary in most patients with this condition.
自发性腹腔干（CA）夹层分离且无相关主动脉夹层分离是一种罕见疾病。尽管随着诊断成像方式的改进，这种疾病的诊断频率有所增加，但其发病机制和治疗策略仍有待确定。本研究探讨了该疾病保守治疗的临床特征和结果。
本研究纳入了2007年至2015年间诊断为自发性CA夹层分离的12例患者（10例男性和2例女性）。对每位患者的病历进行了回顾性分析。
诊断时的平均年龄为56.4岁（范围42 - 77岁）。8例患者出现腹痛或背痛，其余4例患者无症状，为偶然诊断。4例患者有高血压病史，6例有吸烟史。2例患者发现正中弓状韧带压迫腹腔干。夹层分离延伸至肝总动脉的有5例，延伸至脾动脉的有4例。2例患者出现腹膜后出血，3例出现脾梗死，2例出现短暂性轻度肝功能障碍。所有患者均接受保守治疗：2例患者接受了短期抗凝和抗血小板治疗，3例患者开始了降压治疗。平均随访期为35.5个月（范围5 - 101个月）。1例患者在出现初始症状后一周内夹层分离远端扩展，该患者也接受了保守治疗。所有患者均未观察到晚期动脉瘤样退变，也无一例需要血管内或手术治疗。
如果患者的一般情况稳定，即使是伴有腹膜后出血的患者，CA夹层分离也可通过谨慎的保守治疗进行处理。大多数患有这种疾病的患者可能不需要长期抗凝或抗血小板药物治疗。
