Mid to Long Term Clinical and Morphological Outcomes after Conservative Treatment for Spontaneous Coeliac Artery
1Department of Vascular Surgery, Tokyo Metropolitan Tama Medical Centre, Tokyo, Japan.
Insights
Conservative treatment for spontaneous coeliac artery dissection (SCAD) is safe and effective. Patients experienced favorable long-term outcomes with no recurrent dissections or need for delayed interventions.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Gastroenterology
Background:
- Spontaneous coeliac artery dissection (SCAD) is a rare vascular condition.
- Conservative management is the primary treatment, but long-term prognosis remains unclear.
- Endovascular intervention effectiveness in acute SCAD is recently reported.
Purpose of the Study:
- To determine the long-term prognosis of patients with SCAD treated conservatively.
- To evaluate the safety and efficacy of conservative management for SCAD.
Main Methods:
- Retrospective cohort study of 50 consecutive SCAD patients (March 2010 - October 2024).
- Review of demographics, medical history, symptoms, treatments, and imaging findings.
- Analysis of clinical courses and follow-up data.
Main Results:
- 88% of patients were male; 46% had hypertension.
- Common hepatic and splenic arteries were most frequently involved.
- No recurrent dissections or need for delayed intervention observed during a median 50-month follow-up.
Conclusions:
- Conservative therapy is a safe treatment for SCAD, including cases with splenic malperfusion or retroperitoneal hemorrhage.
- Long-term outcomes following conservative management of SCAD are favorable.
- Complete or partial remodeling was more common with a thrombosed false lumen.
Objective:
Spontaneous coeliac artery dissection (SCAD) is an uncommon vascular disease. Conservative management is considered the mainstay of treatment, whereas the effectiveness of endovascular intervention in the acute stage has been reported recently. This retrospective cohort study aimed to elucidate the long term prognosis after conservative treatment for this disease, which is currently unclear.
Methods:
This was a single centre study of 50 consecutive patients who were diagnosed with SCAD from March 2010 to October 2024. Their demographics, medical history, presenting symptoms, treatment details, initial and follow up imaging findings, and clinical courses were reviewed.
Results:
Twenty-eight patients were symptomatic and 22 were asymptomatic and diagnosed incidentally. Forty-four patients (88%) were men. Twenty-three (46%) and five (10%) patients had a history of hypertension and dyslipidaemia, respectively. The common hepatic and splenic arteries were involved in 21 (42%) and 18 (36%) patients, respectively, and concomitant dissection of the superior mesenteric artery was observed in eight (16%). Among 28 symptomatic patients, seven (25%) presented with a postprandial onset, and seven (25%) and five (18%) patients had associated splenic malperfusion and retroperitoneal haemorrhage, respectively. All patients were treated conservatively. The median (interquartile range) follow up was 50 (25, 80) months. None of the patients experienced recurrent dissection or coeliac artery diameter enlargement, and symptoms related to SCAD did not occur in any patients in the chronic stage. None of the patients required delayed endovascular or surgical intervention. Complete or partial remodelling was significantly more commonly observed among patients with a thrombosed false lumen at diagnosis compared with those with a dominant intimal flap (p < .001).
Conclusion:
SCAD can be safely treated conservatively even when associated with splenic malperfusion or retroperitoneal haemorrhage. Long term outcomes after conservative management are favourable.
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