Endovascular Stent Graft for Treatment of Complicated Spontaneous Dissection of Celiac Artery: Report of Two Cases
A 57-year-old man, presented with acute abdominal pain, was admitted to the emergency room. The patient had a previous medical history of spontaneous celiac artery and of the superior mesenteric artery dissection. An abdominopelvic CT scan, obtained 3 months prior to admission, demonstrated a 7 mm-sized saccular aneurysm, with a mural hematoma along the celiac artery to the common hepatic artery and a dissection of the superior mesenteric artery with a mural hematoma (). Infiltration of the fat surrounding the celiac artery was noticed as a secondary sign of acute spontaneous celiac artery dissection. Other than the acute abdominal pain, the patient was healthy and had no risk factors associated with the occurrence of visceral artery dissection. He had been treated with an anticoagulant to prevent a thromboembolic complication for 3 months, because he had no major complication associated with the dissection of the celiac artery and superior mesenteric artery. The patient had no obvious abnormality on physical examination or in his laboratory findings. Vital signs were stable. Contrast enhanced CT revealed a progressive dissecting aneurysm along the celiac artery, which had a maximal inner diameter of 2 cm (). The aneurysm originated 2 cm distal from celiac artery orifice without compromised distal flow to the distal hepatic artery. In addition, the patient's previous superior mesenteric artery dissection with mural thrombus had improved completely without associated complications. The patient was transferred to an interventional suite for endovascular treatment, because the risk of rupture was high, due to the progressive enlargement of an aneurysm sac. Celiac angiography, obtained after an insertion of the 8 Fr guiding catheter (Cordis), showed a dissecting aneurysm, which obviously defined the celiac artery, proximal to splenic artery and left gastric artery orifice (). The involved vessel course had a relatively smooth curvature. We placed the 4-9 × 38 mm peripheral stent graft (Jostent, Abbott Vascular, Rangendingen. Germany), which was mounted over a 6 mm × 40 mm savvy balloon (Cordis) from the origin of celiac artery to the bifurcation of the common hepatic artery and the splenic artery. Post-procedure angiography showed complete exclusion of the dissecting aneurysm (). There was no noticeable compromise in the blood flow to the distal hepatic artery, gastroduodenal artery, and splenic artery. The postoperative course was uneventful and the patient's symptoms abated after the procedure. The follow-up CT scan, obtained 3 months after the procedure, showed a complete disappearance of the dissecting aneurysm.