Dissection into abdominal arteries

Dissection into abdominal arteries

The celiac trunk, SMA and right renal artery flow usually originates from the true lumen.
Left renal artery flow mostly originates from the false lumen.
Impaired perfusion of end-organs can be due to 2 mechanisms:
1) static = continuing dissection in the feeding artery (usually treated by stenting)
2) dynamic = dissection flap hanging in front of ostium like a curtain (usually treated with fenestration).
This may be hard to discern, MPR's can be helpfull.

Look for the re-entry point, usually to be found in the iliac tract.
Provide information about tortuisity and calcifications of the iliac tract if endovascular procedures are being considered.

Left: Continued dissection into the celic trunk showing bigger false lumen, significantly contributing to organ perfusion.
Right: : SMA and renal artery involvement, illustrating possible cause of organ malperfusion

 When no end-organs are compromised and there is sufficient perfusion, dissection can be left alone.
This may persist for a long time without clinical consequence, as is seen in the patient on the left with follow-up of 2 years.
Some dissections remained unchanged during a follow up of more than 5 years. 

LEFT: Dissected SMA
RIGHT: No change at 20 months follow up