Shiraki Hiroaki, Kasamoto Manabu, Yasutomi Masamichi, Kaji Shuichiro, Akutsu Koichi, Furukawa Yutaka, Shimizu Wataru, Inoue Nobutaka
Department of Cardiovascular Medicine, Kobe Rosai Hospital, Kobe, Japan.
Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
J Clin Med Res. 2020 Jan;12(1):13-17. doi: 10.14740/jocmr3916. Epub 2020 Jan 6.
Spontaneous isolated dissection of abdominal visceral arteries without aortic dissection is rare and its pathology and prognosis are not yet clear; therefore, therapeutic strategies for this disease have not been established. The present multi-institution investigational study analyzed the clinical features of patients with spontaneous isolated dissection of abdominal visceral arteries.
A total of 36 patients diagnosed as spontaneous isolated dissection of abdominal visceral arteries from January 2010 to October 2016 were enrolled. The medical data of the patients were retrospectively reviewed. Imaging characteristics were evaluated. Spontaneous isolated dissection of abdominal visceral arteries was detected on upper abdominal computed tomography examination in almost patients, and was detected on magnetic resonance imaging in one patient.
Of the 36 cases, 26 cases involved the superior mesenteric artery dissection, nine involved the celiac artery, two involved the splenic artery, one involved the common hepatic artery, one involved the gastroduodenal artery and one involved the left gastric artery. Among the 36 patients, 20 had hypertension and 14 were current smokers. Additionally, only one patient had diabetes and four patients had dyslipidemia. Moreover, 32 cases complained of pain including abdominal pain and back pain, one had cough and three had no symptoms. Of the 36 patients, 34 cases (94.4%) were treated conservatively, and two (5.6%) required intravascular treatment. All patients were discharged without complications.
Our findings indicate that hypertension and smoking might be closely involved in the pathogenesis of spontaneous isolated dissection of abdominal visceral arteries, whereas dyslipidemia and diabetes might be less involved. Additionally, few asymptomatic patients were accidentally diagnosed, indicating that the absence of symptoms cannot be used to rule out the presence of this disease. Randomized clinical trials cannot be performed because a considerable number of cases are required. Therefore, detailed descriptions of clinical features, as provided in our report, are important.
无主动脉夹层的自发性孤立性腹内脏动脉夹层很少见，其病理及预后尚不清楚；因此，本病的治疗策略尚未确立。本多机构研究分析了自发性孤立性腹内脏动脉夹层患者的临床特征。
纳入2010年1月至2016年10月诊断为自发性孤立性腹内脏动脉夹层的36例患者。对患者的医疗数据进行回顾性分析。评估影像学特征。几乎所有患者通过上腹部计算机断层扫描检查发现自发性孤立性腹内脏动脉夹层，1例患者通过磁共振成像检查发现。
36例中，26例累及肠系膜上动脉夹层，9例累及腹腔干，2例累及脾动脉，1例累及肝总动脉，1例累及胃十二指肠动脉，1例累及胃左动脉。36例患者中，20例有高血压，14例为现吸烟者。此外，仅1例患者有糖尿病，4例患者有血脂异常。而且，32例患者主诉疼痛，包括腹痛和背痛，1例有咳嗽，3例无症状。36例患者中，34例（94.4%）接受保守治疗，2例（5.6%）需要血管内治疗。所有患者均无并发症出院。
我们的研究结果表明，高血压和吸烟可能与自发性孤立性腹内脏动脉夹层的发病机制密切相关，而血脂异常和糖尿病可能关系较小。此外，很少有无症状患者被意外诊断，这表明不能仅凭无症状来排除本病的存在。由于需要大量病例，无法进行随机临床试验。因此，我们报告中提供的详细临床特征描述很重要。
