Coeliac artery dissection is a type of arterial dissection. Dissection of the coeliac artery is rarely seen as a primary phenomenon and is most often encountered due to propagation of an aortic dissection.

Epidemiology

Coeliac artery dissection is usually iatrogenic but may also be secondary to:

• atherosclerosis

• trauma

• pregnancy

• fibromuscular dysplasia

• segmental arterial mediolysis

• cystic medial degeneration/necrosis

• inflammatory or infectious diseases

The mean age of diagnosis is 55 years, with a male predominance.

Clinical presentation

Coeliac artery dissection is likely to be under-reported due extensive collateral networks in the foregut making the development of small bowel ischaemia 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 superior mesenteric artery can lead to bowel ischaemia.

Symptoms are similar to chronic mesenteric ischaemia, including post-prandial pain.

Radiographic features

CT angiography

Findings include:

• presence of an intimal flap

• eccentric mural thrombus in the lumen

• fat stranding around the coeliac artery

Treatment and prognosis

Endovascular management

• endovascular stent placement

• endovascular fenestration

Surgical intervention

• resection of the dissected segment with anastomosis or bypass creation

Conservative treatment

• anticoagulation and optimisation of blood pressure may be appropriate in cases with limited dissection, the aim of medical treatment is to prevent thromboembolic complications

Complications

• aneurysm formation

• arterial occlusion