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Thomas J. Takach, MD, Jeko M. Madjarov, MD, Jeremiah H

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1 Spontaneous splanchnic dissection: Application and timing of therapeutic options 
Thomas J. Takach, MD, Jeko M. Madjarov, MD, Jeremiah H. Holleman, MD, Francis Robicsek, MD, Timothy S. Roush, MD  Journal of Vascular Surgery  Volume 50, Issue 3, Pages (September 2009) DOI: /j.jvs Copyright © Terms and Conditions

2 Fig 1 Computed tomographic scan cross-section (a) and three-dimensional (3D) reconstruction (b and c) views of a 43-year-old female treated with conservative management only demonstrating (a) classic “double-lumen” sign (arrow) on initial study, (b) localized celiac artery dissection at time of initial diagnosis, and (c) complete resolution of dissection with thrombosis of false lumen and unimpeded distal flow at 9-month follow-up. Interval staged examinations (not depicted) had demonstrated gradual reduction in size of false lumen. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © Terms and Conditions

3 Fig 2 Computed tomographic scan three-dimensional (3D) reconstruction of a 55-year-old female with a diffuse celiac artery dissection extending to and involving the origins of all major branch vessels. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © Terms and Conditions

4 Fig 3 Computed tomographic scan cross-section (a) and three-dimensional (3D) reconstructions (b, c, and d) of a hemodynamically stable, asymptomatic 53-year-old male with a celiac artery dissection undergoing conservative management at 30 days follow-up demonstrating (a) malperfusion (near occlusion of true lumen), see arrow; (a, b) false lumen expansion (16.3 × 9.4 mm vs 9.0 × 5.0 mm at initial diagnosis), note mechanical compression of true lumen by the expanded false lumen, see arrow; (c) key pre-intervention anatomy notable for false lumen/dissection origin at distal celiac artery with uninvolved origins of major branch vessels; and (d) completion study following endovascular stent placement confirming complete regression with thrombosis of false lumen and unimpeded patency of major branch vessels (left gastric, splenic, and common hepatic arteries). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © Terms and Conditions

5 Fig 4 Computed tomographic scan sagittal view (a) and three-dimensional (3D) reconstruction (b) of superior mesenteric artery dissection in a 49-year-old male demonstrating distal malperfusion due to mechanical compression of true lumen by false lumen (see arrows) at time of initial diagnosis that required placement of endovascular stent. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © Terms and Conditions

6 Fig 5 Computed tomographic scan sagittal view of superior mesenteric artery dissection in a 54-year-old male with the true lumen providing perfusion of first major colic branch and false lumen providing perfusion of a replaced right hepatic artery and all remaining colic branches. The false lumen remained patent and unchanged in size on follow-up, constituting a stable, chronic dissection. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © Terms and Conditions

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