Spontaneous Visceral Artery Dissections in Otherwise Normal Arteries: Clinical Features, Management, Outcomes Compared to Fibromuscular Dysplasia.

Abstract Objectives Visceral artery dissection with otherwise normally appearing arteries (VADNA), diagnosed on imaging and suggestive of segmental arterial mediolysis (SAM), is a poorly understood disease entity. Study objectives were to define the clinical features, management, and outcomes of patients with VADNA compared to patients with fibromuscular dysplasia (FMD). Methods In this single-center retrospective cohort study design, consecutive patients with a diagnosis of VADNA or FMD evaluated in the Mayo Clinic Gonda Vascular Center (1/1/2000-4/1/2017) were identified. Patient demographics, symptom presentation, management, a composite of adverse arterial events (recurrent arterial dissection, stroke/TIA, myocardial infarction, mesenteric/renal infarction or need for revascularization) and overall survival were compared among VADNA and FMD patients. Results There were 103 VADNA cases (age, MN±SD 51.7±11.0 years, 27.9% female) and 248 FMD controls (49.8 ± 8.9 years, 81.8% female) identified. The most common symptom for VADNA patients was abdominal/flank pain (80.6%). For FMD, chest pain, headache, and dizziness were more frequent presenting complaints. The median follow up was longer for VADNA (42 months; IQR 9-76) compared to FMD patients (19 months; IQR 0.6-52, p Conclusion VADNA patients carry a higher risk of recurrent arterial events compared to those with FMD. This difference was primarily driven by recurrent dissections.