Natural History of Visceral Artery Branch Dissections and the Influence of Concurrent Aortic Dissection on Overall and Intervention-Free Survival.

OBJECTIVE:Visceral branch arterial dissections (VBAD) are uncommon and may occur with or without an associated aortic dissection (AD). We hypothesized that isolated VBAD have a more benign clinical course than those with concurrent AD and compared survival outcomes stratified based on aortic involvement. METHODS:VBAD over a 5-year period were identified using ICD codes. Data related to patient demographics, comorbid conditions, clinical presentation, management (including procedural interventions), and survival were obtained from medical records. Anatomic imaging studies were reviewed to characterize anatomy, including presence or absence of concurrent AD. Overall and intervention-free survival were evaluated using Kaplan-Meier and Cox Proportional Hazards models. RESULTS:A total of 299 VBAD were identified, 174 of which were isolated VBAD and 125 of which were associated with concurrent AD. Seventy-one percent of patients were men, 77% were white, and 85% were non-Hispanic. Mean age was 61.1 ± 14.4 years. Mean follow up of 53.2 ± 50.0 months. Estimated overall survival was 88.2% and estimated overall intervention-free survival was 55.6% at 12 months. Isolated VBAD had better overall survival versus those with concurrent AD (69.2% versus 32.4%; p < 0.001). Concurrent AD was also associated with inferior intervention-free survival (57.5% versus 7.3%; p < 0.001). Acute presentation (was also associated with decreased intervention-free survival 86.1% versus 13.4%; p < 0.001). Acute presentation was also associated with decreased overall survival patients with isolated VBAD, (60.8% versus 80.0% at 180 months; p < 0.001) and inferior intervention-free survival (48.4% versus 69.5% at 180 months; p < 0.001) in the subgroup of patients with isolated VBAD. Multivariable Cox models identified age (HR 1.05, SD 0.02, p = 0.001) was associated with inferior survival and renal dissection (HR 3.08, SD 0.99, p = 0.001) or mesenteric and renal dissection (HR 3.39, SD 1.44, p = 0.004) were associated with inferior intervention-free survival. CONCLUSIONS:Isolated VBAD have superior overall and intervention-free survival versus those associated with concurrent AD. Absence versus presence of aortic involvement is useful for risk stratification and may support tailored approaches to frequency of imaging surveillance.