Celiac artery dissection

Radiopaedia • CC-by-nc-sa 3.0 • de

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

Epidemiology

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

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

Clinical presentation

Celiac 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 superior mesenteric artery can lead to bowel ischemia.

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

Radiographic features

CT angiography

Findings include:

  • 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 optimization 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