Zhang Xinyang, Zhu Feng, Zhang Liqiang, Guo Chao, Li Chunting, Shang Dan
Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 JieFang Avenue, Wuhan, 430022, Hubei Province, China.
Department of Vascular Surgery, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China.
Sci Rep. 2025 May 30;15(1):18994. doi: 10.1038/s41598-024-72587-6.
Spontaneous isolated celiac artery dissection (SICAD) is a rare condition, with its natural history and outcomes have not been thoroughly studied. The aim of this study is to review our institution's experience in evaluating, treating, and determining outcomes for patients with SICAD. A retrospective review was conducted on 76 patients who presented with SICAD between January 2010 and July 2022. The clinical manifestations, initial radiological findings, methods of treatment and follow-up computed tomography were reviewed, and patients were subsequently contacted for assessment of ongoing symptoms. In this study, a total of 76 patients diagnosed with SICAD were collected, comprising 67 males (88.2%) and 9 females (11.8%), with an average age of 52.8 ± 8.7 years (range 26-71 years). In this study, 61 patients (80.3%) exhibited symptoms, while 15 patients (19.7%) were asymptomatic. The main clinical manifestations in patients with symptoms included epigastric pain, lower abdominal pain, generalized abdominal pain, flank pain, vomiting. The mean angle between celiac trunk and aorta in symptomatic patients was 57.78 ± 14.94°, and 59.65 ± 20.11° in asymptomatic patients. Of the 76 patients, 27 underwent endovascular treatment due to refractory pain or aneurysmal dilatation, utilizing techniques such as bare stent placement, bare stent implantation combined with coil embolization, or covered stent implantation. However, 2 patients experienced failure in the endovascular intervention due to issues with the guide wire reaching the true cavity and challenges in inserting the long sheath behind the celiac artery. The remaining 49 patients were managed conservatively. Conservative treatment measures included fasting, pain management, fluid and nutritional support, strict blood pressure control, and improvement of circulation. Within the conservative group, only one patient (1.3%) experienced recurrence of abdominal pain, with subsequent CT revealing slight dilation of the celiac trunk dissection. However, symptoms improved following rehospitalization and conservative therapy, with no recurrence observed post-discharge. Notably, both endovascular and conservative approaches demonstrated symptomatic improvement in all patients. The symptoms of SICAD may not be influenced by the angle between celiac trunk and aorta. Conservative treatment is effective in more than half of the patients. Endovascular treatment has more favorable outcomes in achieving complete remodeling compared to conservative treatment.
自发性孤立性腹腔干动脉夹层（SICAD）是一种罕见疾病，其自然病程和转归尚未得到充分研究。本研究的目的是回顾我院在评估、治疗SICAD患者并确定其转归方面的经验。对2010年1月至2022年7月间76例诊断为SICAD的患者进行了回顾性研究。回顾了患者的临床表现、初始影像学检查结果、治疗方法及随访CT检查结果，并对患者进行随访以评估当前症状。本研究共纳入76例诊断为SICAD的患者，其中男性67例（88.2%），女性9例（11.8%），平均年龄52.8±8.7岁（范围26 - 71岁）。本研究中，61例患者（80.3%）有症状，15例患者（19.7%）无症状。有症状患者的主要临床表现包括上腹部疼痛、下腹部疼痛、全腹部疼痛、侧腹痛、呕吐。有症状患者腹腔干与主动脉之间的平均夹角为57.78±14.94°，无症状患者为59.65±20.11°。76例患者中，27例因顽固性疼痛或动脉瘤样扩张接受了血管内治疗，采用裸支架置入、裸支架置入联合弹簧圈栓塞或覆膜支架置入等技术。然而，2例患者因导丝进入真腔困难及在腹腔干后方插入长鞘困难而血管内介入治疗失败。其余49例患者接受保守治疗。保守治疗措施包括禁食、疼痛管理、液体及营养支持、严格控制血压及改善循环。在保守治疗组中，仅1例患者（1.3%）出现腹痛复发，随后CT显示腹腔干夹层轻度扩张。然而，再次住院并接受保守治疗后症状改善，出院后未再复发。值得注意的是，血管内治疗和保守治疗均使所有患者的症状得到改善。SICAD的症状可能不受腹腔干与主动脉夹角的影响。超过半数患者保守治疗有效。与保守治疗相比，血管内治疗在实现完全重塑方面有更良好的转归。
