Mid to Long Term Clinical and Morphological Outcomes after Conservative Treatment for Spontaneous Coeliac Artery Dissection.

Abstract

Spontaneous coeliac artery dissection (SCAD) is an uncommon vascular disease. Conservative management is considered the mainstay of treatment, whereas the effectiveness of endovascular intervention in the acute stage has been reported recently. This retrospective cohort study aimed to elucidate the long term prognosis after conservative treatment for this disease, which is currently unclear. This was a single centre study of 50 consecutive patients who were diagnosed with SCAD from March 2010 to October 2024. Their demographics, medical history, presenting symptoms, treatment details, initial and follow up imaging findings, and clinical courses were reviewed. Twenty-eight patients were symptomatic, and 22 were asymptomatic and diagnosed incidentally. Forty-four patients (88%) were men. Twenty-three (46%) and five (10%) patients had a history of hypertension and dyslipidaemia, respectively. The common hepatic and splenic arteries were involved in 21 (42%) and 18 (36%) patients, respectively, and concomitant dissection of the superior mesenteric artery was observed in eight (16%). Among 28 symptomatic patients, seven (25%) presented with a postprandial onset, and seven (25%) and five (18%) patients had associated splenic malperfusion and retroperitoneal haemorrhages, respectively. All patients were treated conservatively. The median (quartiles 1, 3) follow up period was 50 (25, 80) months. None of the patients experienced recurrent dissection or enlargement in the coeliac artery diameter, and symptoms related to SCAD did not occur in any patients in the chronic stage. None of the patients required delayed endovascular or surgical intervention. Complete or partial remodelling was significantly more commonly observed among patients with a thrombosed false lumen at diagnosis compared with those with a dominant intimal flap (p < .001). SCAD can be safely treated with conservative therapy, even when associated with splenic malperfusion or retroperitoneal haemorrhage. Long term outcomes after conservative management are favourable.