Systematic Literature Review on Evaluation and Management of Isolated Spontaneous Celiac Trunk Dissection

Abstract

Background: The purpose of this study is to perform a systematic literature review of isolated spontaneous celiac trunk dissection (ISCTD), to evaluate initial clinical and diagnostic aspects, treatment modalities, and outcomes.

Methods: A retrospective search of MEDLINE, Cochrane, and SciELO databases was performed, using the terms celiac artery dissection, celiac trunk dissection, hepatic artery dissection, splenic artery dissection, or left gastric artery dissection to identify instances of ISCTD. Patients with associated aortic and/or other visceral artery dissection were excluded. When available, the following information was collected from each case: gender, age, associated risk factor, symptoms, diagnostic method, treatment modality, and outcome.

Results: A total of 60 publications were identified between 1987 and 2015, with 11 cases series and 49 case reports, achieving a total of 169 patients identified with ISCTD. Such information was collected: 99 patients were male and 17 female, with an average age of 53.1 years and the most common symptom was abdominal pain. Diagnosis was mainly made with computed tomography. The most common associated conditions were hypertension and smoking in 31% and 23% of the cases, respectively. Conservative treatment was performed in 79% of the cases.

Conclusions: The profile of patients with ISCTD is male, middle aged, and almost all suffer from abdominal pain. Initial conservative treatment seems adequate for most cases, but a few patients will require interventional treatment. Clinical and radiological long-term follow-up is mandatory, owing to the risk of later progression to aneurysm.