Imaging characteristics and clinical outcomes of spontaneous celiac artery dissection.

Abstract

Purpose: Spontaneous celiac artery dissection (CeAD) is a rare cause of acute abdominal pain. This study examined computed tomography (CT) scan findings, natural course, and outcomes of spontaneous CeAD.

Methods: Sixty patients who underwent CT scan and were diagnosed with CeAD between April 2003 and June 2023 were retrospectively reviewed. Patients with aortic dissection (n = 25), iatrogenic CeAD (n = 6), traumatic CeAD (n = 1), and celiac artery (CeA) aneurysm (n = 4) and those undergoing noncontrast-enhanced CT scans (n = 1) were excluded. The remaining 23 consecutive patients were divided into the acute symptomatic and chronic asymptomatic CeAD groups. Correlations between CT classification, treatment, and outcomes were investigated.

Results: Eighteen (78.2%) patients had hypertension requiring treatment. Of 23 patients, 18 were asymptomatic, and five had CeAD-related abdominal pain requiring hospitalization. Two had intraperitoneal bleeding. All hospitalized patients initially received conservative treatment. Upon the initial diagnosis, the mean CeA maximum outer diameter was 11.0 mm (range: 7-16). Ten (43.5%) patients had stenosis at the CeA origin. Based on CT findings from initial diagnosis to final follow-up, the outer diameter remained stable. CT showed that chronic CeAD was mostly Kim classification type IA or IB. In symptomatic patients, the dissection length on initial CT significantly decreased by final CT. No follow-up symptoms were related to CeAD, and the condition remained stable. No patients required vascular repair or surgery, and there were no deaths.

Conclusion: Spontaneous CeAD, asymptomatic and symptomatic, remained stable in imaging and clinical outcomes with conservative treatment. The Kim classification on CT plays a key role in identifying chronic CeAD, mostly type IA or IB.