Natural History and Risk Factors Associated with Intervention-free Survival Among Patients with Visceral (Mesenteric and/or Renal) Artery Dissections

Visceral arterial dissections, including mesenteric and renal artery dissections, are uncommon with limited evidence to guide their management. We evaluated patient characteristics associated with visceral dissections as well as anatomic and symptomatic factors associated with intervention and survival. Visceral dissections over a 5-year period were identified using International Classification of Diseases codes. Medical records and anatomic imaging studies were used to characterize patient characteristics, presenting symptoms and acuity, associated nonvisceral anatomic findings, procedural interventions, and survival. Kaplan-Meier analyses were performed to evaluate overall survival stratified by symptoms, acuity, and anatomic factors. A total of 299 visceral dissections were identified, 125 of which were associated with concurrent aortic dissection at presentation. Of the remaining 174 patients with isolated mesenteric and/or renal dissection, 71% were men, 83% were White, and 88% were non-Hispanic (87.9%). Mean age was 59.0 ± 15.0 years. Overall survival was 69% and intervention-free survival was 58% over a mean follow-up of 49.5 ± 45.6 months. Factors associated with increased mortality included acute presentation (P = .015), inpatient hospitalization at time of presentation (P < .001) and number of visceral arteries affected (P = .0026). One-year intervention-free survival among patients with nonacute presentation was 69% compared with 56% among patients with acute presentation (P = .001) (Figure). No significant associations between race or gender with overall survival were observed. Interventions performed for visceral dissections included revascularizations (72% endovascular, 25% surgical, 3% hybrid), embolization, and nephrectomy. Acute visceral dissections are associated with increased mortality and rates of procedural intervention. Lower rates of mortality and intervention associated with chronic visceral dissections may justify more liberal approaches to imaging and clinical follow-up.