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October 17, 2008
Spontaneous Splanchnic Dissection:
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Thomas J Takach*, Jeko M. Madjarov*, Jeremiah H. Holleman, Timothy S. Roush
Carolinas Medical Center, Charlotte, NC
BACKGROUND: Spontaneous splanchnic dissection (SSD) is uncommon and few studies address the application, timing, and consequences of therapeutic options. We reviewed our experience with this problem based on outcome.
METHODS: Between 2003 and 2006, 8 consecutive patients (mean age 55.4y, 62.5% male) were treated at our institution for SSD involving either the celiac (n=5) or superior mesenteric (n=3) arteries. Each patient presented following the 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 7 patients. Endovascular stent placement (n = 3) or mesenteric bypass (n = 1) 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 malperfusion (n = 4).
RESULTS: All patients were asymptomatic after successful non-operative management or following intervention. No morbidity occurred. Upon complete follow-up (mean 8.8 mo), all patients remained asymptomatic. Thrombosis of false lumen and preservation of distal perfusion was achieved in 3 patients treated with only non-operative management and in 4 patients following intervention. A stable, chronic dissection is present in 1 patient who had only non-operative management.
CONCLUSIONS: 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 stent placement and open bypass had similar outcomes in a small number of patients with limited follow-up. Although currently perceived as rare, the continued use of CTA may prove that the true incidence of SSD has been modestly underestimated.
Back to Annual Meeting
Back to Program
Spontaneous Splanchnic Dissection:
Application and Timing of Therapeutic Options
Back to Annual MeetingBack to Program
Thomas J Takach*, Jeko M. Madjarov*, Jeremiah H. Holleman, Timothy S. Roush
Carolinas Medical Center, Charlotte, NC
BACKGROUND: Spontaneous splanchnic dissection (SSD) is uncommon and few studies address the application, timing, and consequences of therapeutic options. We reviewed our experience with this problem based on outcome.
METHODS: Between 2003 and 2006, 8 consecutive patients (mean age 55.4y, 62.5% male) were treated at our institution for SSD involving either the celiac (n=5) or superior mesenteric (n=3) arteries. Each patient presented following the 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 7 patients. Endovascular stent placement (n = 3) or mesenteric bypass (n = 1) 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 malperfusion (n = 4).
RESULTS: All patients were asymptomatic after successful non-operative management or following intervention. No morbidity occurred. Upon complete follow-up (mean 8.8 mo), all patients remained asymptomatic. Thrombosis of false lumen and preservation of distal perfusion was achieved in 3 patients treated with only non-operative management and in 4 patients following intervention. A stable, chronic dissection is present in 1 patient who had only non-operative management.
CONCLUSIONS: 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 stent placement and open bypass had similar outcomes in a small number of patients with limited follow-up. Although currently perceived as rare, the continued use of CTA may prove that the true incidence of SSD has been modestly underestimated.
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