Ann Surg Treat Res.  2017 Apr;92(4):225-229. 10.4174/astr.2017.92.4.225.

Spontaneous dissections of multiple visceral arteries: an extremely rare case

• Le TB
• Jeon YS
• Hong KC
• Cho SG
• Park KM

• KMID: 2374689
• DOI: http://doi.org/10.4174/astr.2017.92.4.225

Abstract

Spontaneous dissections of visceral arteries without aortic involvement are very rare. The etiologies of these entities are unclear and their clinical managements remain controversial. We report a case of spontaneous multiple dissections affecting 4 visceral arteries including the superior mesenteric artery, the celiac artery and the bilateral renal arteries. The patient was managed conservatively and endovascularly. The clinical manifestation markedly improved and laboratory tests returned to normal limits within 1 week. The regular follow-up suggested a good clinical and radiological outcome until 84 months.

Keyword

Dissection; Endovascular procedure; Conservative treatment

MeSH Terms

Arteries*
Celiac Artery
Endovascular Procedures
Follow-Up Studies
Humans
Mesenteric Artery, Superior
Renal Artery

Figure

• 

  Fig. 1 Emergency computed tomographic angiography was obtained on admission. (A) Coronal reconstruction image demonstrated a dissection of the celiac trunk spreading from ostium to the proximal splenic artery with intimal flap (white arrow). The true lumen provides perfusion to the splenic artery while hepatic artery was perfused from the false lumen (not shown). (B–D) An approximately 4-cm-long dissection of the superior mesenteric artery from orifice with thrombus formation in the false lumen (black arrow) and severely narrow true lumen (white arrow) were evident on axial and maximum intensity projection sagittal reconstruction image (black circle). Bilateral focal renal infarctions (asterisk) were also noticed as a consequence of corresponding renal artery dissections (white circle).

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  Fig. 2 Aortogram and selective bilateral renal arteriograms confirmed multiple arterial dissections. (A) Proximal dissections of the celiac artery and superior mesenteric artery (circle) were demonstrated on the lateral aortogram. A guide wire was able to pass through the narrowing segment; 2 balloon-expandable stents were then deployed. Poststenting angiogram showed remarkable dilation of the true lumen (not shown). (B) Dissection of the superior segmental artery (white arrow) and subsequent upper pole infarction (asterisk) was seen on the right renal arteriogram. (C) Left renal arteriogram revealed the dissection and narrowing at the bifurcation level of the anterior division and the superior segmental artery (black arrow) with the corresponding perfusion defect in the upper pole (asterisk). A guiding catheter was exchanged, followed by the deployment of a 6-mm × 2-cm balloon-expandable renal stent at the level of bifurcation to the anterior division. Complete angiogram demonstrated full dilatation of the previous narrowing segment (not shown).

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  Fig. 3 Follow-up computed tomographic angiography obtained 54 months after treatment. (A) The false lumen of the celiac artery dissection remained patent and unchanged in size, constituting a stable and chronic dissection without flow disturbance. (B–D) The superior mesenteric artery and left renal stents were patent. Reperfusion was evident in the right renal upper pole whereas left renal upper pole was calcified and atrophied (circle).

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