Characteristics and diagnostic pitfalls of spontaneous visceral artery dissection in the emergency department

Abstract

Background: Spontaneous visceral artery dissection (VAD) is a rare disease that mainly occurs in the superior mesenteric artery and celiac artery. However, VAD has been detected more frequently in the past several years because of the increasing use of computed tomography (CT) for the evaluation of abdominal symptoms. A prompt diagnosis and referral to a specialist should be made, because VAD occasionally causes critical bowel ischemia. However, there is no well-established management approach. We performed a retrospective analysis to evaluate the characteristics and prognoses of patients diagnosed with VAD.

Methods: We retrospectively examined data on patients who visited the Emergency Department (ED) at Fukui Prefectural Hospital, and were diagnosed with VAD using enhanced CT scanning from April 2004 to March 2015. All data were collected from the hospital's electronic medical records. We analyzed the clinical characteristics, comorbidity, risk factors, imaging findings, and treatment of patients.

Results: Fifty-six patients were identified (superior mesenteric artery: 40 patients, celiac artery: 16 patients). The median age of the patients was 54 years (range, 32-86 years) and 89.3% were men. The majority of the patients complained of abdominal pain (37 patients, 66%). Thirty-nine of the patients (69.6%) were hospitalized. All hospitalized patients received conservative treatment initially. Three patients received endovascular therapy, and 2 patients received surgery. No fatal cases were observed. Twenty-eight patients presented with ED at their initial visit, and 8 cases (29%) were undiagnosed on their initial visit by emergency physicians, though enhanced CT scans were obtained.

Conclusion: Patients with VAD often present with sudden onset abdominal pain. Most patients were managed successfully with conservative treatment. No fatal cases were observed; however, some cases were missed, even with an enhanced CT scan. It is necessary to include VAD among the differential diagnoses of acute abdominal pain. Patients with VAD should be referred to a specialist, because this disease occasionally causes critical bowel ischemia, necessitating surgical intervention.