Zhou Fushuo, Zheng Zhi, Pan Youmin
Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Surg. 2022 Oct 21;9:972276. doi: 10.3389/fsurg.2022.972276. eCollection 2022.
Spontaneous isolated celiac artery dissection (SICAD) is a rare condition that has not been fully investigated and reported, and very little is known regarding its prognosis and management. Here, we aimed to provide more evidence on the management strategy and outcome for symptomatic SICAD based on the experience of a single center.
From January 2018 to December 2021, a total of consecutive 51 patients with symptomatic SICAD were retrospectively included in this study. These patients had been selectively treated with conservative treatment ( = 31) or endovascular treatment ( = 20). Baseline data, imaging findings, treatment strategy, outcomes, and follow-up data have been described and analyzed.
The mean age of the patients was 53.2 ± 9.6 years, 44 (86.3%) were male, and 36 (70.6%) had hypertension. The median length of stay was 10.0 days. The complete remission rate was 92.2% on discharge. The median follow-up time was 21.0 months. A secondary intervention was required for two patients during follow-up in the conservative group, wherein one underwent a stent placement three months after discharge because of progression of symptoms and extension of dissection, and the other required intervention one month after discharge because of symptomatic progression. No secondary intervention was required in the endovascular group. Occasional and mild relapse of symptoms occurred in two patients in both the conservative and endovascular groups, with no secondary intervention. The length of dissection (25.5 ± 11.8 mm vs. 19.1 ± 7.4 mm, = 0.022) and complete remodeling rate (85.7% vs. 15.4%, < 0.001) in the endovascular group were greater than that in the conservative group.
Patients with symptomatic SICAD who were selectively treated with conservative treatment or endovascular treatment had satisfactory early and medium-term outcomes. Endovascular treatment showed significant advantages in the complete remodeling of the celiac artery and presented with a lower rate of secondary intervention. Moreover, it was found to be a safe and effective remedy for failed conservative treatment.
自发性孤立性腹腔干动脉夹层（SICAD）是一种罕见疾病，尚未得到充分研究和报道，对其预后和治疗了解甚少。在此，我们旨在基于单中心经验，为有症状的SICAD的治疗策略和结果提供更多证据。
2018年1月至2021年12月，本研究共回顾性纳入51例有症状的SICAD患者。这些患者被选择性地采用保守治疗（n = 31）或血管内治疗（n = 20）。已描述并分析了基线数据、影像学表现、治疗策略、结果及随访数据。
患者的平均年龄为53.2±9.6岁，44例（86.3%）为男性，36例（70.6%）患有高血压。中位住院时间为10.0天。出院时完全缓解率为92.2%。中位随访时间为21.0个月。保守治疗组在随访期间有2例患者需要二次干预，其中1例在出院3个月后因症状进展和夹层扩展接受了支架置入术，另1例在出院1个月后因症状进展需要干预。血管内治疗组无需二次干预。保守治疗组和血管内治疗组均有2例患者出现偶尔的轻度症状复发，无需二次干预。血管内治疗组的夹层长度（25.5±11.8 mm vs. 19.1±7.4 mm，P = 0.022）和完全重塑率（85.7% vs. 15.4%，P < 0.001）均高于保守治疗组。
选择性采用保守治疗或血管内治疗的有症状SICAD患者的早期和中期结果令人满意。血管内治疗在腹腔干动脉的完全重塑方面显示出显著优势，二次干预率较低。此外，它被发现是保守治疗失败后的一种安全有效的补救措施。
