PS178. Non-operative Treatment of Spontaneous Visceral Artery Dissection

Abstract

Spontaneous visceral artery dissection (SVAD) is rare, and little is known about its natural history. Our goal is to determine early and late outcomes of patients managed non-operatively. A retrospective review of all consecutive patients with visceral artery dissection confirmed by imaging from 1990 to 2011. Patients with SVAD associated with fibromuscular disease, vasculitis, and iatrogenic or traumatic injury were excluded. Sixty-one men and 28 women ( mean age 54 +/- 12 years ) were treated for SVAD over 20 years. Eighty-one patients were Caucasian (96%); comorbidities included hypertension (60%), hyperlipidemia (47%), and smoking (45%). Sixty patients (67%) presented with abdominal pain or GI symptoms; 29 were asymptomatic (33%) with dissection discovered incidentally. Diagnosis was confirmed by CTA in most patients. SVAD involved an average of 2.4 +/- 2.2 vessels per patient with celiac territory involvement in 61%, SMA in 43%, and both in 27%. Average WBC was 7.9 (Normal range 4-10), CRP 4.9 (Normal <10), and ESR 16.5 (Normal <20). Seventy-three patients were managed successfully medically with initiation of anti-hypertensives in 22 (25%), anti-coagulation in 21 (24%), and aspirin in 14 (16%). Seventeen (19%) patients underwent intervention (13 surgical, 4 coil embolization) at diagnosis; 6 for rupture, 7 for worsening symptoms, and 4 for enlarging aneurysms or dissections. There were no peri-procedural deaths within 30 days. Six patients died over a mean follow-up of 5.9 +/- 3.2 years. On surveillance imaging, the majority of dissections remained stable or resolved. Estimated survival at 1, 3, 5, and 10 years was 100%, 94%, 94%, and 65%. SVAD is a rare disease. Most Caucasian patients with this problem can be treated medically with good long-term survival. Operation and/or endovascular therapy is necessary for rupture or persistent symptoms despite maximum medical therapy.