Immediate Hospital Admission is Strongly Recommended
You should go to the hospital immediately for evaluation and management of your >50% proximal celiac artery stenosis with distal dissection and 14-mm aneurysm. This combination of findings—particularly the dissection and aneurysm in the setting of median arcuate ligament compression—represents a potentially life-threatening vascular emergency that requires urgent specialist assessment.
Why Immediate Evaluation is Critical
High-Risk Vascular Pathology Requiring Urgent Assessment
The presence of a celiac artery dissection combined with a 14-mm aneurysm represents an unstable vascular condition with significant rupture risk. 1
Celiac artery dissection associated with median arcuate ligament syndrome can lead to aneurysm formation and rupture, causing retroperitoneal hemorrhage. This has been documented in multiple case reports where patients presented with acute abdominal pain and life-threatening bleeding. 2, 3
Aneurysms in the setting of celiac stenosis from median arcuate ligament compression are prone to complications due to abnormal hemodynamics and post-stenotic turbulent flow. 4, 5
Documented Cases Support Urgent Intervention
In reported cases of median arcuate ligament syndrome with celiac dissection and aneurysm, treatment has ranged from conservative management with close monitoring to urgent endovascular or surgical intervention, depending on hemodynamic stability and rupture risk. 2
One documented case required emergency transcatheter arterial embolization for retroperitoneal hemorrhage from aneurysm rupture in the pancreaticoduodenal arcade secondary to celiac dissection. 3
The combination of >50% stenosis, dissection, and aneurysm formation creates a high-risk scenario where the compressed celiac artery causes increased pressure proximally, contributing to dissection and aneurysmal dilation distally. 6
What to Expect at the Hospital
Immediate Diagnostic Workup
You will likely undergo repeat CT angiography with both inspiratory and expiratory phases to assess the dynamic nature of the median arcuate ligament compression and to evaluate the dissection and aneurysm in detail. 1, 3
Mesenteric angiography in lateral projection during inspiration and expiration may be performed to demonstrate dynamic worsening of stenosis and to evaluate collateral circulation. 1
Assessment should include evaluation for involvement of other mesenteric vessels (superior mesenteric artery, inferior mesenteric artery) and presence of collateral pathways, as multi-vessel disease significantly impacts treatment decisions. 1
Treatment Options That May Be Considered
Endovascular stenting alone is NOT recommended as initial therapy for median arcuate ligament syndrome because the extrinsic compression persists, leading to stent fracture or migration risk. 1, 7
The American College of Radiology recommends surgical release of the median arcuate ligament as first-line treatment, with 84.6% of patients achieving symptomatic relief. 1
In your case with dissection and aneurysm, a combined approach will likely be necessary:
Urgent endovascular stent placement may be required first to stabilize the dissection and exclude the aneurysm from circulation, particularly if there is evidence of expansion or impending rupture. 6, 3
This would be followed by surgical median arcuate ligament release to address the underlying compression. 1, 3
If residual celiac stenosis >30% persists after ligament release, additional revascularization (endovascular or surgical bypass) may be needed. 1
Critical Pitfalls to Avoid
Do Not Delay Seeking Care
Celiac artery aneurysms associated with median arcuate ligament syndrome can rupture, causing life-threatening retroperitoneal hemorrhage. 3
The dissection component adds instability and can propagate or lead to acute thrombosis of the celiac artery. 2, 6
Conservative Management Requires Strict Criteria
Conservative management has only been reported in highly selected cases where patients were hemodynamically stable, had no evidence of rupture, and demonstrated stable aneurysm size on serial imaging. 2
Even in conservatively managed cases, close outpatient follow-up with scheduled vascular surgery consultation within 2 weeks was mandatory. 2
Your 14-mm aneurysm size, combined with dissection and significant stenosis, likely exceeds the threshold for safe conservative management without specialist evaluation. 2
Bottom Line
Go to the emergency department now or call emergency services. Inform them you have been diagnosed with celiac artery stenosis, dissection, and a 14-mm aneurysm. This is not a condition that can be safely managed on an outpatient basis without urgent vascular surgery consultation and likely intervention. 1, 2, 3
The combination of median arcuate ligament compression, dissection, and aneurysm formation represents a rare but serious vascular emergency that requires immediate specialist assessment to prevent potentially fatal complications such as rupture and hemorrhage. 2, 4, 3