Correspondence regarding: ‘Evaluation and management of symptomatic isolated spontaneous celiac trunk dissection’ by Galastri et al.

To the Editor

We read with great interest the recent article by Galastri et al. ¹ They raised an important issue on the management of isolated spontaneous celiac trunk dissection (ISCTD). The authors made an algorithm for treating ISCTD (see Figure 4 in the article). According to the algorithm, the authors declare that if the patient has true lumen compression or intestinal ischemia suspicion, the patient should undergo endovascular treatment. However, we would like to elaborate on the indications of endovascular management.

Multiple studies have reported on the management of ISCTD.^2,3 While true lumen compression is common in ISCTD patients, the malperfusion of stomach, liver and spleen is rare due to the collateral vascular system.^2,3 In addition, the ISCTD-induced intestinal ischemia/necrosis is impossible unless the mesenteric arteries are occluded.^2–4 According to our experience and the studies that have been previously reported, true lumen compression is not an indication of endovascular management of ISCTD.