Coeliac artery dissection is usually iatrogenic but may also be secondary to:
- fibromuscular dysplasia
- cystic medial degeneration
- inflammatory or infectious diseases
The mean age of diagnosis is 55 years, with a male predominance.
Coeliac artery dissection is likely to be under-reported due extensive collateral networks in the foregut making the development of small bowel ischemia infrequent and presenting symptoms varied.
Extension into the visceral arteries (e.g. splenic artery aneurysm or hepatic artery aneurysm) may lead to abdominal pain. Extension into the SMA can lead to bowel ischemia.
Symptoms are similar to chronic mesenteric ischemia, including post-prandial pain.
- presence of an intimal flap
- eccentric mural thrombus in the lumen
Treatment and prognosis
Surgical intervention including resection of the dissected segment with anastamosis or bypass creation.
Endovascular management with careful assessment of collateral supply is an option
Conservative treatment with anticoagulation and optimisation of blood pressure may be appropriate in cases with limited dissection. The aim of medical treatment is to prevent thromboembolic complications.
- aneurysm formation
- arterial occlusion
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