Influence Of Concurrent Aortic Dissection On Overall And Intervention-free Survival Among Patients With Visceral Branch Arterial Dissections
Drew J. Braet, MD, Mariam Maksutova, Chloé A. Powell, MD, MS, Luciano Delbono, MD, Sonali Reddy, MBA, Gloria Y. Kim, MD, MPH, MS, Peter K. Henke, MD, Dawn M. Coleman, MD, Jonathan L. Eliason, MD, Matthew A. Corriere, MD, MS.
University of Michigan, Ann Arbor, MI, USA.
Introduction:Visceral branch arterial dissections involving the celiac, superior mesenteric, and/or renal arteries are uncommon and may occur with or without an associated aortic dissection. Limited evidence exists to support specific management strategies, including surveillance. We hypothesized that isolated visceral dissections have a more benign clinical course than those with concurrent aortic dissections, and assessed survival outcomes stratified based on aortic involvement.Methods:Visceral branch dissections over a 5-year period were identified using ICD codes. Medical records and anatomic imaging studies were used to characterize anatomy, concurrent aortic dissection, patient demographics, presenting symptoms and acuity, treatment interventions, and survival. Kaplan-Meier analyses were performed to compare overall and intervention-free survival of those with isolated visceral dissections versus concurrent aortic dissection.Results:A total of 299 visceral dissections were identified, 174 of which were isolated visceral branch dissections and 125 of which were associated with concurrent aortic dissection at presentation. Mean age was 61.1 ± 14.4 years, 71% of patients were men, 77% were white, and 85% were non-Hispanic. Compared to patients with isolated visceral branch dissections, patients presenting with concurrent aortic dissections were older (P=0.003), were more likely to be of minority race (P=0.009), and more frequently presented with acute symptoms (P<0.001). Overall survival for the cohort was 23%, and overall intervention-free survival was 27% over a mean follow up of 53.2±50.0 months. Compared to isolated visceral branch dissections, those with concurrent aortic dissection were associated with inferior intervention-free survival (72% versus 24% at 12 months; P<0.001) (Figure 1). Acute presentation was associated with increased mortality (P=0.0019). No associations between demographic factors and overall or intervention-free survival were observed. Interventions performed included visceral revascularizations (76% endovascular, 18% open, 6% hybrid), aortic procedures (fenestration, aortic valve, root, or arch replacement), renal artery embolization, and nephrectomy.Conclusion:Isolated visceral dissections have superior overall and intervention-free survival compared to visceral dissections with concurrent aortic dissection. Absence versus presence of aortic involvement is useful for risk stratification and may support tailored approaches to determining frequency of imaging surveillance.
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