PS28 Isolated Infrarenal Aortic Dissection and Penetrating Aortic Ulcer: A Nonmorbid Condition

Abstract

Isolated infrarenal aortic dissection is uncommon. The natural history and optimal management are unclear. We hypothesize that many of these dissections can be managed expectantly. The radiology database at a single institution was queried to identify all imaging between July 2003 and August 2013 that included aortic dissections. A retrospective record review identified baseline patient characteristics, anatomic characteristics of the dissections, symptoms, management, and outcomes. Twenty-nine infrarenal dissections were identified. Most started below the inferior mesenteric artery (18 of 29) and extended to either the iliac bifurcation (13 of 29) or only into the common iliac arteries (10 of 29). Average dissection length was 77 ± 65 mm (range, 15-204 mm). Many of these dissections had a component of penetrating aortic ulcer. Only 21% (six of 29) of patients presented with symptoms (abdominal or back pain). Eighty-three percent (24 of 29) were managed with observation alone, including all six symptomatic patients. Five patients were treated with EVAR, all on an elective basis. Indications for intervention were concomitant aneurysm (four) and claudication (one). Technical success was 100%. Average follow-up was 26 ± 37 months (range, 0-138 months). Factors that were associated with isolated infrarenal aortic dissection included hypertension (20 of 29), male gender (19 of 29), significant aortic ulcerated plaque (15 of 29), and smoking history (12 of 29). Family history (three of 29) and Marfan disease (two of 29) were less common. Forty-five percent (13 of 29) of patients had other evidence of aortic pathology, with nearly one-third found to have an abdominal aortic aneurysm at some point during the follow-up period. Isolated infrarenal aortic dissections can be treated successfully with observation even in symptomatic patients. When treatment is required, it is generally for an associated abdominal aortic aneurysm and can often be managed successfully electively using endovascular techniques. Many of these dissections are likely part of the spectrum of evolution of penetrating aortic ulcer.