Idiopathic multiple peripheral arterial dissections:A case report

Introduction: Compared to aortic dissection and isolated visceral artery dissection, multiple peripheral arterial dissections have not been formally reported to date. Currently, there is no wellestablished treatment for this condition, and large-scale studies with extensive sample data are lacking. Case presentation: A 56-year-old male, was provisionally diagnosed with " idiopathic multiple peripheral arterial dissections." The patient primarily presented with lower left abdominal pain. Routine abdominal computed tomography (CT) revealed a right internal iliac artery aneurysm. Further evaluation using aortic computed tomography angiography (CTA) revealed multiple peripheral arterial dissections throughout the body. To screen for the same condition in the cervical and intracranial arteries, a comprehensive head and neck CTA was performed, which revealed a left internal carotid artery dissection. Subsequent positron emission tomographycomputed tomography (PET-CT) shows increased glucose metabolism in the left external iliac artery, suggesting arterial inflammation. The patient is treated with intravenous methylprednisolone at a dose of 40 mg per day for six days, followed by the addition of intravenous cyclophosphamide at an initial dose of 0.2g, gradually increasing to a maintenance dose of 1.0 g once a month. After six months of treatment, follow-up aortic CTA and head and neck CTA revealed the disappearance of an arc-shaped low-density shadow in the left external iliac artery. Conclusion: The etiology of idiopathic multiple peripheral arterial dissection remains unclear, and the case is rare. The long-term prognosis requires ongoing follow-up. As research progresses, it may become necessary to reconsider the diagnosis of this disease.