Back to 2016 Annual Symposium Abstacts

OBJECTIVES:
Isolated visceral artery dissection (IVAD) can be spontaneous or caused by trauma. Its natural history and optimal management is not well established. Our goal was to retrospectively examine our institutional experience with IVAD.
METHODS:
A retrospective examination was undertaken of electronic medical record from a Veterans Affairs hospital and university health system from January 2005 to August 2015 for image-proven superior mesenteric artery (SMA) or celiac artery (CA) isolated dissection. Patient characteristics, symptoms, and radiographic assessments were extracted. Patients with a concomitant aortic dissection were excluded.
RESULTS:
A total of 21 patients (18 men) with median age of 56 (range 26-75 years) met study criteria. Of these, the majority presented with dissection of the CA (n=13, 62%) and the rest with SMA dissection (n=8, 38%). Most patients (n=11, 52%) were asymptomatic with incidentally found IVAD. Sudden onset, severe abdominal pain was present in 5 patients (29%) and characterized acute spontaneous IVAD. One patient with traumatic SMA dissection and no other injury presented with severe abdominal pain, while all other patients with traumatic IVAD (n=4) had no prominent abdominal pain or objective makers of ischemia. Three patients (14%) underwent endovascular intervention. Of the 15 patients with follow up imaging (median 544 days, range 3-1627), 2 patients (13%) had increase in intimal flap length, 6 patients (40%) had a decrease in flap length, and 7 patients (47%) had no change. The patients with acute symptomatic IVAD were more likely to have persistent pain at follow up than those with asymptomatic presentation (p< 0.05). No patients presenting with asymptomatic IVAD developed end organ ischemia.
CONCLUSIONS:
IVAD is a rare clinical entity with two distinct presentations, symptomatic and asymptomatic. We believe these represented two extremes on a clinical spectrum of IVAD. Acute symptomatic patients with abdominal pain are likely to have persistent pain even after treatment. Asymptomatic IVAD, whether chronic or traumatic, appears to be benign.