Comparative and Prognosis Study of Peripheral Arterial Dissections

Area of Science:

• Vascular Surgery
• Cardiology
• Genetics

Background:

• Peripheral arterial dissections, excluding aortic, are uncommon but significant vascular events.
• Cervical artery dissections are most frequent, yet comparative data on renal, splanchnic, and coronary dissections are limited.
• Understanding the characteristics and prognosis of dissections in different non-aortic territories is crucial for patient management.

Purpose of the Study:

• To characterize and assess the prognosis of non-aortic arterial dissections based on anatomical territories.
• To compare clinical phenotypes and outcomes across cervical, coronary, renal, and splanchnic artery dissections.
• To identify factors associated with dissection recurrence.

Main Methods:

• Retrospective study including 185 patients with cervical, coronary, renal, or splanchnic artery dissections from 2017-2022.
• Data collected from Nantes University Hospital.
• Analysis of patient demographics, risk factors, clinical presentation, complications, and recurrence rates based on dissection territory.

Main Results:

• Significant differences in patient demographics and underlying conditions were observed across territories: coronary/vertebral dissections more common in females, vertebral/renal dissections in younger patients, and splanchnic dissections associated with higher rates of heritable connective tissue disorders (HCTDs).
• Ischemic complications were high in coronary (91.7%) and renal (88.2%) dissections, but lower in splanchnic (20.0%) dissections.
• Overall symptomatic recurrence rate was 10.3%, with significantly higher recurrence in patients with multiple dissections (22.2%) compared to single dissections (6.8%).

Conclusions:

• Clinical phenotypes of non-aortic arterial dissections vary by anatomical location, with a notable association between splanchnic dissections and HCTDs.
• Dissections involving multiple arterial beds at diagnosis are linked to an increased risk of recurrence.
• Further validation in large prospective studies is warranted to confirm these findings and refine clinical strategies.