Endovascular Stent Graft for Treatment of Complicated Spontaneous Dissection of Celiac Artery: Report of Two Cases
A 47-year-old man, who had presented with acute abdominal pain to a different healthcare facility, was transferred to our emergency room for further evaluation and treatment of dissection of the splanchnic arteries. The patient had a history of uncomplicated dissection of the superior mesenteric artery, and had been taking anti-hypertension medication for 1 year. However, he had stopped taking his prescription medication 10 months prior to admission to the emergency room. On arrival to the emergency room of a local hospital, his blood pressure was 95/60 mm Hg and the pulse rate was 110 beats per min. Laboratory test revealed a hemoglobin level of 10.5 g/dL. Other blood chemistry parameters were within the normal range. After blood transfusion and fluid therapy in local hospital, the patient's blood pressure had increased to 150/100 mm Hg, and there were no obvious abnormalities on the physical examination or in the laboratory findings on admission to our hospital. A contrast-enhanced CT scan showed a newly developed saccular dissecting aneurysm in the celiac artery with surrounding retroperitoneal hematoma, measuring 2.8 × 7.9 × 12.0 cm (). The dissection of the superior mesenteric artery had not changed, compared to the previous CT scan. One day after admission, the patient's hemoglobin level had decreased to 9.6 g/dL again, after cessation of blood transfusion. The patient was offered a less invasive endovascular procedure to avoid surgical repair.\nAfter puncturing of his right common femoral artery, an 8F guiding catheter (Vista brite tip, Cordis, Miami, FL, USA) was inserted into the orifice of the celiac artery, which allowed for celiac angiography that revealed a dissecting aneurysm at the entry point (). The proximal splenic artery was occluded, and the true lumen of the left gastric artery and common hepatic artery were narrowed by intramural hematoma. We placed the 4-9 × 38 mm peripheral stent graft (Jostent, Abbott Vascular, Rangendingen, Germany), which was mounted over a 6 × 40 mm savvy balloon (Cordis, Miami, FL, USA) from the origin of the celiac artery to the common hepatic artery. Post-procedure angiography showed complete coverage of the dissecting aneurysm with the use of a stent graft (). The left gastric artery was visualized by collateral flows from the right gastric artery. The postoperative course was uneventful with normalized hemoglobin level without blood transfusion. Follow-up CT scan, obtained 1 week after the procedure, showed a complete obliteration of the dissecting aneurysm in the celiac artery with preservation of the hepatic arterial flow and marked reduction of the retroperitoneal hematoma. Although occlusion of the proximal splenic artery and proximal left gastric artery after stent graft placement persisted, no abnormalities (i.e., splenic infarction, gastric ischemia, or signal of irritated peritoneum) were noted due to an abundance of collateral blood flow.