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Spontaneous splanchnic dissection: application and timing of therapeutic options.
J Vasc Surg. 2009 Sep; 50(3):557-63.JV

Abstract

BACKGROUND

Spontaneous splanchnic dissection (SSD) occurs infrequently and has a poorly defined natural history. Few studies address the application, timing, and consequences of therapeutic options. Our goal was to apply conservative (non-operative) management in the care of each patient, reserving interventions for specific indications that may be predictive of adverse outcomes.

METHODS

Between 2003 and 2008, 10 consecutive patients (mean age 54.7-years-old, 70.0% male) presented with 11 SSDs involving either the celiac artery (n = 6), superior mesenteric artery (n = 3), or both (n = 1). Each patient had acute, spontaneous onset of persistent abdominal pain and was diagnosed with SSD following multidetector row computed tomographic angiography (CTA). Non-operative management (anticoagulation, anti-impulse therapy, analgesics, and serial CTA examinations) was initially used in 9 patients. Endovascular (n = 2) or operative (n = 2) intervention was performed either immediately (n = 1) or following failed medical management (n = 3) in 4 patients for specific indications that included persistent symptoms (n = 3), expansion of false lumen (n = 3), and/or radiologic malperfusion (n = 3).

RESULTS

All patients were asymptomatic after successful non-operative management or following intervention. No morbidity occurred. Upon complete follow-up (mean 13.4 months, range, 2 to 36 months), all patients remained asymptomatic. Preservation of distal perfusion with either thrombosis or ongoing regression of false lumen was achieved in 5 patients who received only non-operative management and in 4 patients following intervention. A stable chronic dissection was present in 1 patient who had only non-operative management.

CONCLUSION

Successful outcomes following SSD may be achieved with either non-operative therapy alone or intervention if persistent symptoms, expansion of false lumen, and/or malperfusion occur. The unpredictable response of the false lumen to conservative management mandates close, long-term follow-up. Endovascular and operative interventions produced similar outcomes in a small number of patients with limited follow-up. Although SSD is currently perceived as rare, the increasing use of CTA may prove that the true incidence has been underestimated.

Authors+Show Affiliations

Department of Cardiothoracic and Vascular Surgery, Carolinas Heart Institute, Carolinas Health Care System, Charlotte, NC 28232-2861, USA. tjtakach@netscape.netNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19540708

Citation

Takach, Thomas J., et al. "Spontaneous Splanchnic Dissection: Application and Timing of Therapeutic Options." Journal of Vascular Surgery, vol. 50, no. 3, 2009, pp. 557-63.
Takach TJ, Madjarov JM, Holleman JH, et al. Spontaneous splanchnic dissection: application and timing of therapeutic options. J Vasc Surg. 2009;50(3):557-63.
Takach, T. J., Madjarov, J. M., Holleman, J. H., Robicsek, F., & Roush, T. S. (2009). Spontaneous splanchnic dissection: application and timing of therapeutic options. Journal of Vascular Surgery, 50(3), 557-63. https://doi.org/10.1016/j.jvs.2009.02.244
Takach TJ, et al. Spontaneous Splanchnic Dissection: Application and Timing of Therapeutic Options. J Vasc Surg. 2009;50(3):557-63. PubMed PMID: 19540708.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Spontaneous splanchnic dissection: application and timing of therapeutic options. AU - Takach,Thomas J, AU - Madjarov,Jeko M, AU - Holleman,Jeremiah H, AU - Robicsek,Francis, AU - Roush,Timothy S, Y1 - 2009/06/21/ PY - 2009/01/06/received PY - 2009/02/17/revised PY - 2009/02/21/accepted PY - 2009/6/23/entrez PY - 2009/6/23/pubmed PY - 2009/9/16/medline SP - 557 EP - 63 JF - Journal of vascular surgery JO - J Vasc Surg VL - 50 IS - 3 N2 - BACKGROUND: Spontaneous splanchnic dissection (SSD) occurs infrequently and has a poorly defined natural history. Few studies address the application, timing, and consequences of therapeutic options. Our goal was to apply conservative (non-operative) management in the care of each patient, reserving interventions for specific indications that may be predictive of adverse outcomes. METHODS: Between 2003 and 2008, 10 consecutive patients (mean age 54.7-years-old, 70.0% male) presented with 11 SSDs involving either the celiac artery (n = 6), superior mesenteric artery (n = 3), or both (n = 1). Each patient had acute, spontaneous onset of persistent abdominal pain and was diagnosed with SSD following multidetector row computed tomographic angiography (CTA). Non-operative management (anticoagulation, anti-impulse therapy, analgesics, and serial CTA examinations) was initially used in 9 patients. Endovascular (n = 2) or operative (n = 2) intervention was performed either immediately (n = 1) or following failed medical management (n = 3) in 4 patients for specific indications that included persistent symptoms (n = 3), expansion of false lumen (n = 3), and/or radiologic malperfusion (n = 3). RESULTS: All patients were asymptomatic after successful non-operative management or following intervention. No morbidity occurred. Upon complete follow-up (mean 13.4 months, range, 2 to 36 months), all patients remained asymptomatic. Preservation of distal perfusion with either thrombosis or ongoing regression of false lumen was achieved in 5 patients who received only non-operative management and in 4 patients following intervention. A stable chronic dissection was present in 1 patient who had only non-operative management. CONCLUSION: Successful outcomes following SSD may be achieved with either non-operative therapy alone or intervention if persistent symptoms, expansion of false lumen, and/or malperfusion occur. The unpredictable response of the false lumen to conservative management mandates close, long-term follow-up. Endovascular and operative interventions produced similar outcomes in a small number of patients with limited follow-up. Although SSD is currently perceived as rare, the increasing use of CTA may prove that the true incidence has been underestimated. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/19540708/Spontaneous_splanchnic_dissection:_application_and_timing_of_therapeutic_options_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(09)00789-7 DB - PRIME DP - Unbound Medicine ER -