Presentation, treatment, and outcomes in patients with spontaneous isolated celiac artery dissection

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.