Medical management of spontaneous celiac artery dissection in the surgical intensive care unit
Munie S, Dashtaei A, Moore S, Watson J, Ferranti L, Ryan J, Nypaver T, and Killu K. Medical management of spontaneous celiac artery dissection in the surgical intensive care unit. Crit Care Med 2019; 47(1).
Crit Care Med
Learning Objectives: Visceral artery dissection is a rare phenomenon with isolated celiac artery dissection being even rarer. There currently exist only a few case reports found in literature. We present a case of spontaneous celiac artery dissection and its medical management. Methods: A 50-year-old male with a past medical history of hypertension was admitted to our Surgical Intensive Care Unit for CAD management. He developed sudden onset of epigastric pain while working on his trailer. The pain was sharp and constant. Computed Tomography of the abdomen/Pelvis revealed a CAD arising approximately 1cm from the ostia, extending into the common hepatic artery and proximal splenic artery with thrombosis of the false lumen. There was no evidence of active extravasation of contrast. Blood pressure (BP) was 156/90 mmHg and heart rate (HR) of 95 bpm on admission. The abdomen was tender in the epigastric region. Pain was controlled with narcotics and BP was maintained a systolic less than 140 mmHg and HR less than 90 bpm using IV labetalol. The patient was started on an oral dose of metoprolol, losartan and aspirin. Low molecular weight heparin was later bridged to Vitamin K antagonist and was discharged home. Results: Celiac artery dissection is a rare condition with only few case reports in literature. Patients usually present with acute epigastric pain. The pathogenesis is unknown, however, hypertension, vascular disease, and pregnancy are considered risk factors. Diagnosis is usually made by CT angiogram. Few cases require endovascular or surgical intervention. The medical management is similar to aortic dissection and involves pain management, controlling the BP to systolic less than 140 mmHg (preferably <120 mmHg) and HR less than 90 bpm (preferably <70). Bowel rest is recommended for the first 24-48 hours, with adequate hydration and electrolyte management. Antiplatelet therapy with aspirin and anticoagulation for the first 6 months is usually recommended for the treatment and prevention of further thrombosis. Follow up imaging studies as early as 6-8 weeks can be done to evaluate for vessel remodeling.