Can celiac artery stenosis cause hypertension?

Celiac Artery Stenosis and Hypertension: Pathophysiologic Relationship

Celiac artery stenosis can cause hypertension when it leads to renal artery stenosis or is associated with periarterial fibrosis affecting the renal arteries. While celiac artery stenosis alone rarely causes hypertension, its complications and associated conditions can significantly impact blood pressure control.

Pathophysiologic Mechanisms

Primary Mechanisms

1. Renal Artery Involvement

   • Periarterial fibrosis from celiac trunk disease can extend to renal arteries, causing stenosis 1
   • Renal artery stenosis leads to resistant hypertension through renin-angiotensin-aldosterone system activation 1
   • In patients with histiocytic disorders like Erdheim-Chester Disease (ECD), periarterial fibrosis can affect both celiac and renal arteries simultaneously 1

2. Collateral Circulation Effects

   • Severe celiac stenosis creates collateral circulation through pancreaticoduodenal arcades from the superior mesenteric artery 2
   • This altered hemodynamic state can affect renal perfusion indirectly

Clinical Presentations

• Resistant Hypertension: Patients with celiac artery stenosis who develop renal artery involvement often present with hypertension resistant to standard therapy 1
• Renovascular Disease: Celiac and renal artery stenosis can coexist, especially in patients with atherosclerosis or compression syndromes 3
• Median Arcuate Ligament Syndrome (MALS): Can cause both celiac compression and secondary hypertension when associated with renal artery involvement 4

Diagnostic Approach

1. Initial Imaging

   • CT angiography (CTA) - first-line imaging with 95-100% sensitivity and specificity 4
   • Duplex Doppler ultrasound - useful screening tool, especially for evaluating respiratory variation in flow 4

2. Confirmatory Testing

   • Mesenteric angiography - gold standard for confirming celiac stenosis and evaluating collateral circulation 4
   • Combined evaluation of celiac and renal arteries when hypertension is present 1

Management Considerations

1. When Hypertension is Present with Celiac Stenosis

   • Evaluate for renal artery involvement 1
   • Consider endovascular intervention when renal artery stenosis >30% 4
   • Monitor blood pressure response after intervention

2. Treatment Options

   • Endovascular: Stenting of celiac and/or renal arteries can improve both mesenteric perfusion and hypertension control 5, 6
   • Surgical: Decompression of median arcuate ligament and/or bypass grafting when endovascular approach is not feasible 7, 3

Important Clinical Pitfalls

• Stent-associated thrombosis can occur with celiac artery stenting, requiring careful follow-up 7
• Immediate recoil after angioplasty may indicate external compression rather than atherosclerotic disease 3
• Celiac stenosis alone without renal artery involvement is unlikely to cause hypertension 1
• In patients with histiocytic disorders, periarterial fibrosis may affect multiple vessels simultaneously, requiring comprehensive vascular assessment 1

Follow-up Recommendations

• Clinical evaluation at 1,3,6, and 12 months after intervention 4
• Duplex ultrasound or CTA at 6 months and annually thereafter to assess stent patency or surgical results 4
• Ongoing blood pressure monitoring to evaluate treatment success

In summary, while isolated celiac artery stenosis is not a direct cause of hypertension, its association with renal artery stenosis or involvement in systemic conditions affecting multiple vascular beds can lead to hypertension that improves with appropriate intervention targeting both vascular territories.