Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492013000100014
Jornal Vascular Brasileiro
Case report

Dissecção espontânea do tronco celíaco: qual a melhor abordagem terapêutica?

Spontaneous dissection of the celiac trunk: what is the best therapeutic approach?

Francisco Leonardo Galastri; Felipe Nasser; Breno Boueri Affonso; Jorge Eduardo de Amorim; Fabiellen Berzoini Travassos

http://dx.doi.org/10.1590/S1677-54492013000100014 J Vasc Bras, vol.12, n1, p.68-74, 2013
PDF Português
PDF English
SciELO
Downloads: 7
Views: 1468

Resumo

A dissecção espontânea das artérias viscerais é um evento relativamente raro. Dor abdominal súbita no epigástrio é o sintoma mais frequentemente manifestado pelos pacientes. O avanço das técnicas de exames de imagem possibilitou o diagnóstico deste evento com maior facilidade, aumentando a incidência das dissecções das artérias viscerais. O tratamento clínico conservador, a revascularização cirúrgica, e a terapia endovascular são as três possíveis opções terapêuticas. Neste artigo, relatamos os casos de dois pacientes com dissecção espontânea do tronco celíaco conduzidos de formas diversas, de acordo com a apresentação clínica e exames de imagem, além de realizar uma revisão bibliográfica sobre esta doença.

Palavras-chave

tronco celíaco, dissecção espontânea, endovascular

Abstract

Spontaneous dissection of visceral arteries is a quite rare event. Sudden abdominal pain in the epigastrium is the most frequent symptom. Advances in imaging techniques have made it easier to establish the diagnosis of this event, increasing the incidence of dissections of visceral arteries. Conservative medical treatment, surgical revascularization, and endovascular therapy are the three treatment options available. We report two cases of patients with spontaneous dissection of the celiac trunk that received different treatments based on clinical presentation and imaging studies. We also conducted a literature review on this disease.

Keywords

celiac trunk, spontaneous dissection, endovascular

References

Takachi TJ, Madjarov JM, Holleman JH, Robicsck F, Roush TS. Spontaneous splanchnic dissection: application and timing of therapeutic options. J Vasc Surg. 2009;50:557-63.

Takayama T, Miyata T, Shirakawa M, Nagawa H. Isolated spontaneous dissection of the splanchnic arteries. J Vasc Surg. 2008;48:329-33.

Muller MF, Kim D. Spontaneous dissection of the hepatic artery. Abdom Imaging. 1995;20:462-5.

Yasuhara H, Shigematsu H, Muto T. Self-limited spontaneous dissection of the main trunk of the superior mesenteric artery. J Vasc Surg. 1998;27:776-9.

D'Ambrosio N, Friedman B, Siegel D, Katz D, Newatia A, Hines J. Spontaneous isolated dissection of the celiac artery: CT findings in adults. AJR Am J Roentgenol. 2007;188:W506-11.

Sparks SR, Vasquez JC, Bergan JJ, Owens EL. Failure of nonoperative management of isolated superior mesenteric artery dissection. Ann Vasc Surg. 2000;14:105-9.

Goueffic Y, Costargent A, Dupas B, Heymann MF, Chaillou P, Patra P. Superior mesenteric artery dissection: case report. J Vasc Surg. 2002;35:1003-5.

Krupski WC, Effeney DJ, Ehrenfeld WK. Spontaneous dissection of the superior mesenteric artery. J Vasc Surg. 1985;2:731-4.

Vignati PV, Welch JP, Ellison L, Cohen JL. Acute mesenteric ischemia caused by isolated superior mesenteric artery dissection. J Vasc Surg. 1992;16:109-12.

Solis MM, Ranval TJ, McFarland DR, Eidt JF. Surgical treatment of superior mesenteric artery dissecting aneurysm and simultaneous celiac artery compression. Ann Vasc Surg. 1993;7:457-62.

Suzuki S, Furui S, Kohtake H. Isolated dissection of the superior mesenteric artery: CT findings in six cases. Abdom Imaging. 2004;29:153-7.

Woolard JD, Ammar AD. Spontaneous dissection of the celiac artery: a case report. J Vasc Surg. 2007;45:1256-8.

Glehen O, Feugier P, Aleksic Y, Delannoy P, Chevalier JM. Spontaneous dissection of the celiac artery. Ann Vasc Surg. 2001;15:687-92.

Matsuo R, Ohta Y, Ohya Y. Isolated dissection of the celiac artery: a case report. Angiology. 2000;51:603-7.

McGuinness B, Kennedy C, Holden A. Spontaneous coeliac artery dissection. Australas Radiol. 2006;50:400-1.

Hirakawa E, Inada K, Tsuji K. Asymptomatic dissecting aneurysm of the celiac artery: a variant of segmental arterial mediolysis. Histopathology. 2005;47:544-6.

Batsis JA, Arora AS. Celiac artery dissection: an uncommon cause of abdominal pain and weight loss. Clin Gastroenterol Hepatol. 2005:3.

Fenoglio L, Allione A, Scalabrino E. Spontaneous dissection of the celiac artery: a pitfall in the diagnosis of acute abdominal pain. Presentation of two cases. Dig Dis Sci. 2004;49:1223-7.

Ruggieri F, Amann-Vesti BR, Nigg C. Spontaneous dissection of visceral blood vessels: a rare cause of epigastric pain. Schweiz Rundsch Med Prax. 2004;93:285-9.

Takeda H, Matsunaga N, Sakamoto I, Obata S, Nakamura S, Hayashi K. Spontaneous dissection of the celiac and hepatic arteries treated by transcatheter embolization. AJR Am J Roentgenol. 1995;165:1288-9.

Sakamoto I, Ogawa Y, Sueyoshi E, Fukui K, Murakami T, Uetani M. Imaging appearances and management of isolated spontaneous dissection of the superior mesenteric artery. Eur J Radiol. 2007;64:103e10.

Nagai T, Torishima R, Uchida A. Spontaneous dissection of the superior mesenteric artery in four cases treated with anticoagulation therapy. Intern Med. 2004;43:473-478.

Takayama H, Takeda S, Saitoh SK, Hayashi H, Takano T, Tanaka K. Spontaneous isolated dissection of the superior mesenteric artery. Intern Med. 2002;41:713-716.

Cho YP, Ko GY, Kim HK, Moon KM, Kwon TW. Conservative management of symptomatic spontaneous isolated dissection of the superior mesenteric artery. Br J Surg. 2009;96:720-723.

Kochi K, Orihashi K, Murakami Y, Sueda T. Revascularization using arterial conduits for abdominal angina due to isolated and spontaneous dissection of the superior mesenteric artery. Ann Vasc Surg. 2005;19:418-420.

Tsuji Y, Hino Y, Sugimoto K, Matsuda H, Okita Y. Surgical intervention for isolated dissecting aneurysm of the superior mesenteric artery: A case report. Vasc Endovasc Surg. 2004;38:469-472.

Cormier F, Ferry J, Artru B, Wechsler B, Cormier JM. Dissecting aneurysms of the main trunk of the superior mesenteric artery. J Vasc Surg. 1992;15:424-30.

Leung DA, Schneiber E, Kubik-Huch R, Marineck B, Pfammatter T. Acute mesenteric ischemia caused by spontaneous isolated dissection of the superior mesenteric artery: treatment by percutaneous stent placement. Eur Radiol. 2000;10:1916-1919.

Zimmerman-Klima PM, Wixon CL, Bogey Junior WM, Lalikos JF, Powell CS. Considerations in the Management of Aneurysms of the Superior Mesenteric Artery. Ann Vasc Surg. 2000;14:410-414.

Yun WS, Kim YW, Park KB. Clinical and angiographic follow-up of spontaneous isolated superior mesenteric artery dissection. Eur J Vasc Endovasc Surg. 2009;37:572-577.

Chaillou P, Moussu P, Noel SF. Spontaneous dissection of the celiac artery. Ann Vasc Chir. 1997;11:413-5.

Farber MA. Visceral vessel relocation techniques. J Vasc Surg. 2006;43(2^sSupplement):A81-A84.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5ddfb43b0e8825604e61c40c jvb Articles
1677-7301 (Electronic)
J Vasc Bras ©2024 All rights reserved.

J Vasc Bras

Share this page
Page Sections