Comparative and Prognosis Study of Peripheral Arterial Dissections.

Abstract

Objective: Peripheral arterial dissections are uncommon, with cervical artery dissections being the most prevalent type. Comparative data on the evolution of renal, splanchnic, and coronary dissections are scarce. This study aimed to characterise and assess the prognosis of non-aortic arterial dissections based on their anatomical territories.

Methods: Patients with dissection of cervical, coronary, renal, or splanchnic arteries from 2017 - 2022 for which the episode was documented at Nantes University Hospital were retrospectively included.

Results: A total of 185 patients were included. Compared with other arterial territories, patients with coronary or vertebral dissections were more frequently women (p = .006), patients with vertebral or renal dissections were younger (p = .009), and patients with splanchnic dissections had more heritable connective tissue disorders (HCTDs) (p = .002); these differences were statistically significant for each comparison with the other groups. Cardiovascular risk factors did not statistically significantly differ according to the territory dissected. Ischaemic complications represented 44.8%, 91.7%, 88.2%, and 20.0% for cervical, coronary, renal, and splanchnic dissections, respectively (p < .001). The median follow up time was 19 months (range 1 - 177 months). For all territories, symptomatic recurrence of dissection was observed in 10.3%, and the median time to recurrence was thirty-four months. Symptomatic dissection recurrence rates for patients with a single dissection at diagnosis and for multiple dissections were 6.8% and 22.2%, respectively (p = .030). In the multiple territories dissection group, there were more women (83.3% vs. 34.2%; p < .001), more HCTDs were identified (11.1% vs. 1.9%; p = .024), and patients were younger (p = .049).

Conclusion: Patients' clinical phenotypes differed according to the territory initially dissected, with a higher frequency of HCTDs in splanchnic dissections. Dissections affecting several beds or territories at diagnosis were associated with a higher rate of recurrence. These data need to be confirmed in large prospective studies.