LAUSR

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<0.001). Over this time interval, there were two fold more composite arterial events in the VADNA compared to FMD groups (17% vs. 8.1%, p=0.01). This difference was primarily driven by recurrent dissections. All-cause mortality was low and similar for both groups (3.8% vs. 0.4%; p=0.10). CONCLUSION VADNA patients carry a higher risk of recurrent arterial events compared to those with FMD. This difference was primarily driven by recurrent dissections.