Strategy for the treatment of spontaneous isolated visceral artery dissection Hidenori Yamaguchi, Satoru Murata, Shiro Onozawa, Fumie Sugihara, Hiromitsu.

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Presentation transcript:

Strategy for the treatment of spontaneous isolated visceral artery dissection Hidenori Yamaguchi, Satoru Murata, Shiro Onozawa, Fumie Sugihara, Hiromitsu Hayashi, Shin-ichiro Kumita European Journal of Radiology Open Volume 6, Pages 9-15 (January 2019) DOI: 10.1016/j.ejro.2018.11.003 Copyright © 2018 The Authors Terms and Conditions

Fig. 1 Drawings illustrate the five types classification based on the abdominal contrast-enhanced computed-tomography for spontaneous isolated visceral artery dissection. Type I: patent true and false lumen revealing entry and re-entry sites; type II: blind pouch of false lumen; type III: partial thrombosis false lumen; type IV: completely thrombosis false lumen; type V: completely thrombosis lumen. European Journal of Radiology Open 2019 6, 9-15DOI: (10.1016/j.ejro.2018.11.003) Copyright © 2018 The Authors Terms and Conditions

Fig. 2 Case 1 -- A 73-year-old man with dissection of the superior mesenteric artery (SMA) had symptoms of severe abdominal pain and vomiting. The intestinal tract was ischemic at diagnosis. (a) Axial contrast-enhanced computed-tomography (CE-CT) scans through the upper abdomen showed that the false lumen was thrombosed and the true lumen was retracted by the false lumen (arrow). The intestinal tract exhibited edema. (b) Digital subtraction angiography showed an occluded region ∼3 cm in length above the SMA (arrow). (c) Bare-stent (φ6 × 40 mm S.M.A.R.T. CONTROL®) placement in the narrowing true lumen is shown. Blood flow in the true lumen of the stent and peripheral artery was maintained. (d) Eighteen months after bare-stent placement, coronal CE-CT scans revealed the patency of the stent. European Journal of Radiology Open 2019 6, 9-15DOI: (10.1016/j.ejro.2018.11.003) Copyright © 2018 The Authors Terms and Conditions

Fig. 3 Case 2 -- In a 39-year-old man with dissection of the superior mesenteric artery, abdominal symptoms disappeared after nonoperative intervention only. (a) At diagnosis, the false lumen was thrombosed and the true lumen was narrowed and retracted by the false lumen (arrow). (b) Four months after discharge, the thrombosed false lumen and dissection were completely remodeled. European Journal of Radiology Open 2019 6, 9-15DOI: (10.1016/j.ejro.2018.11.003) Copyright © 2018 The Authors Terms and Conditions

Fig. 4 Treatment strategy -- A proposed strategy for treatment based on our results is shown.SIVAD, spontaneous isolated visceral artery dissection * Surgical or endovascular intervention recommended. European Journal of Radiology Open 2019 6, 9-15DOI: (10.1016/j.ejro.2018.11.003) Copyright © 2018 The Authors Terms and Conditions