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Natural course of incidentally detected isolated Celiac Artery Dissection with hepatic artery occlusion
Chary Duraikannu1, Parthasarathy Karunakaran1, Shamim Ahamed Haithrous1
1Countess of Chester Hospital NHS Foundation Trust. Liverpool Road, Chester, CH2 1UL. United Kingdom.
Insights
Isolated celiac artery dissection (ICAD) is rare. This case highlights a 3-year asymptomatic progression of ICAD with hepatic artery occlusion, emphasizing the need for careful monitoring.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Gastroenterology
Background:
- Isolated celiac artery dissection (ICAD) is an uncommon vascular condition.
- Diagnosis is often incidental, discovered during imaging for other gastrointestinal issues.
- Management strategies range from conservative medical therapy to endovascular or surgical interventions.
Observation:
- A case of incidentally detected ICAD during CT for obscure gastrointestinal bleeding.
- The dissection progressed to involve and occlude the hepatic artery.
- Secondary collateral circulation developed in the porta hepatis region.
Findings:
- The patient remained asymptomatic for over 3 years despite the hepatic artery occlusion.
- Retrospective analysis of the natural history of ICAD with secondary hepatic artery compromise.
- Demonstrates potential for asymptomatic progression and collateral compensation.
Implications:
- ICAD may have a variable natural course, even with significant arterial involvement.
- Conservative management might be suitable for select asymptomatic cases with collateral formation.
- Further research is needed to define optimal long-term surveillance and treatment strategies for ICAD.
Abstract:
Isolated celiac artery dissection (ICAD) is a rare entity with over 160 cases described in literature. We report a case of incidentally detected isolated celiac artery dissection during computed tomography evaluation for occult gastrointestinal bleeding. Though most cases of isolated celiac artery dissection are initially managed conservatively with antiplatelet and anticoagulants, some patients may require endovascular or occasionally surgical treatment. In our case, the celiac artery dissection had already progressed to cause hepatic artery occlusion and secondary collateral formation in the porta hepatis region. We retrospectively analyze the natural course of celiac artery dissection with hepatic artery occlusion in an asymptomatic patient for over 3 years.
