This report presents the case of a patient with isolated spontaneous celiac artery dissection. The patient developed acute abdominal pain that was induced by eating. Computed tomography and selective angiography revealed an intimal flap that separated the true and false lumens located 3 cm from the origin of the celiac artery. We treated the patient with a stent that was deployed endovascularly into the celiac artery to seal the entry site. Postoperative angiography revealed that the graft was patent and the follow-up period was uneventful. The etiology, clinical features, diagnostic modalities and treatment options of isolated spontaneous celiac artery dissection are reported.

Background: Type II endoleak (T2EL) remains a significant cause of reintervention after endovascular aneurysm repair (EVAR). Current strategies for T2EL management remain suboptimal with low long-term efficacy. Thus, this study aimed to evaluate the feasibility and outcomes of laparoscopic transperitoneal branch artery ligation for T2EL management. Methods: This study included 6 patients with persistent T2EL and aneurysm sac expansion who underwent laparoscopic ligation of the culprit vessels, including the inferior mesenteric, lumbar, and median sacral arteries, at our center between January 2021 and January 2024. Preoperative basic clinical characteristics, operative data, postoperative outcomes, and complications of the patients were recorded and analyzed. Results: The median operative time was 225 minutes (range: 120–360 min) with blood loss of 300 mL (range: 50–500 mL). All patients achieved complete ligation of targeted vessels (median of 5 vessels per patient), with 100% success for the inferior mesenteric artery (IMA) and 50% for the median sacral artery. One patient developed a lymphatic fistula that was managed conservatively. At a median follow-up of 13.5 months (range: 4–54 months), all patients exhibited sac regression (median reduction: 3.5 mm; range: 1–8 mm). Complete endoleak resolution was observed in 4 cases (66.7%), while 2 had asymptomatic persistent T2EL without expansion. No reinterventions or mortality occurred. Conclusions: Laparoscopic transperitoneal branch artery ligation represents a promising, albeit preliminary, option for managing embolization-refractory T2EL. Our findings suggest that laparoscopic T2EL repair may provide durable sac stabilization in selected patients; however, the limited sample size underscores the need for larger studies to clarify patient selection criteria and long-term durability.

Background/Objectives: Characterizing factors associated with intensive care unit (ICU) admission among hospitalized patients with pulmonary embolism (PE) is clinically relevant, particularly when established risk-stratification variables are incompletely documented in routine electronic medical records. The D-dimer-to-albumin ratio (DAR) combines a marker of fibrin turnover with serum albumin, a marker of systemic vulnerability; however, whether DAR provides clinically meaningful information beyond D-dimer alone remains uncertain. We evaluated the association between peri-diagnostic DAR and ICU admission and compared DAR with its component biomarkers. Methods: This single-center retrospective cohort study used electronic medical record data from 2009 to 2024. Candidate PE-related hospitalizations were identified from diagnostic records and clinically reviewed to verify a current acute PE event. Patients were eligible when DAR were measured within ±48 h of the PE diagnosis timestamp in the electronic medical record; the first eligible hospitalization per patient was retained. The primary outcome was ICU admission. Logistic regression models were adjusted for age, sex, recorded malignancy, and concomitant deep vein thrombosis (DVT). Results: Among 159 clinically reviewed patients with current acute PE, 143 (89.9%) had documented objective imaging confirmation, and 22 (13.8%) were admitted to the ICU. Each 1-unit increase in log-DAR was associated with greater odds of ICU admission (odds ratio [OR], 2.02; 95% confidence interval [CI], 1.43–2.86; p < 0.001), and the highest DAR quartile (Q4) was associated with greater odds than Q1–Q3 (OR, 6.78; 95% CI, 2.52–18.20; p < 0.001). However, in a temporally restricted analysis including 145 patients and 8 subsequent ICU admissions, the associations were attenuated and no longer statistically significant. Log-DAR was almost perfectly correlated with log-D-dimer (Spearman ρ = 0.995) and did not materially improve discrimination (area under the receiver operating characteristic curve [AUC], 0.788 vs. 0.785; ΔAUC, 0.003; p = 0.471; optimism-corrected AUC, 0.738 vs. 0.737). Conclusions: Peri-diagnostic DAR was associated with ICU admission in the primary analysis, but the temporally restricted analysis did not support prospective prediction of subsequent ICU admission. Its incremental value beyond D-dimer appeared limited, and DAR should be considered an exploratory adjunct rather than a replacement for established PE risk-stratification tools.