Response to correspondence regarding ‘Evaluation and management of symptomatic isolated spontaneous celiac trunk dissection’ by Galastri et al.

To the Editor

We appreciate the letter to the editor regarding our study. Isolated spontaneous celiac trunk dissection (ISCTD) is an uncommon disease. Owing to the wider use of computed tomography for evaluation of abdominal pain, diagnosis is increasing in recent years.^1,2

The rarity and unpredictable occurrence of ISCTD makes prospective studies unfeasible. The current available literature of symptomatic patients consists mainly of case reports and case series with fewer than 10 patients. ² For this reason, there is a lack of high quality evidence and management decisions are complex.

In our study, we have proposed an objective and straightforward management algorithm for ISCTD. ¹ Recently, our group has also published a systematic literature review on ISCTD which reinforces the idea that conservative treatment should be preferred and that intervention (endovascular or open surgery) should be performed only in four situations: failure of conventional medical therapy, hemodynamic instability, visceral ischemia, or aneurysmal degeneration during the follow-up period.^1,2 We believe that compression of the true lumen, associated with visceral ischemia, should be an indication for intervention; however, there is no consensus for the management of cases of severe stenosis without ischemia.

Also, since two out of 10 patients in our series presented with aneurysmal dilatation after 6 and 44 months of conservative treatment, it is important to maintain close follow-up of these cases, as further intervention may be required.