Acute Symptomatic Isolated Abdominal Aortic Dissection – Clinical Characteristics, Outcome, and Sex Differences

Abstract

Acute isolated abdominal aortic dissection (IAAD) is a rare condition and treatment recommendations are lacking. Most previous studies included both symptomatic and asymptomatic patients. The aims were to determine the proportion of IAAD among patients with acute type B aortic dissection (TBD) as well as to describe patient characteristics, radiological findings and frequency of early and late complications and to explore sex differences. This was a retrospective cohort study including all patients hospitalized with acute symptomatic IAAD in Stockholm County during 2012-2021. A total of 277 patients with acute TBD were identified, of whom 10% (n=28/277) had acute IAAD. Median age was 56 years and 43% (n=12/28) were women. Hypertension was diagnosed in 46% (n=13/28) prior to admission. At onset, abdominal pain was the predominant complaint (93%, n=26/28) and 93% (n=26/28) were hypertensive on admission. The suprarenal aorta was involved in 39% (n=11/28) and at least one of the iliac arteries in 50% (n=14/28). All but one patient had uncomplicated IAAD (96%, n=27/28). One patient presented with aortic rupture, treated with open surgical repair. Among patients with primarily uncomplicated IAAD, 7% eventually developed chronic complications (n=2/27). Median maximum aortic diameter at 1-year follow-up was 21 mm (IQR 17-28). Only one patient had an aortic diameter exceeding 30 mm. None of the patients died during follow-up, median follow-up was 3.0 years (IQR 2-8). Early and late complications are rare in patients with acute symptomatic IAAD and a conservative approach with antihypertensive treatment and surveillance in uncomplicated cases seems reasonable.