Clinical Outcomes of Conservative Treatment in Patients with Symptomatic Isolated Spontaneous Renal Artery Dissection and Comparison with Superior Mesenteric Artery Dissection.

OBJECTIVES: The aims of this study were to report the clinical outcomes of conservative medical treatment in patients with symptomatic isolated spontaneous renal artery dissection (SRAD) and compare them with those of spontaneous superior mesenteric artery dissection (SSMAD).

METHODS: This was a single centre, observational comparative study between SRAD and SSMAD. Data from a prospective visceral artery dissection registry were analysed retrospectively. Between June 2010 and December 2016, 23 consecutive patients with symptomatic isolated SRAD who initially received conservative medical treatment were included. The primary outcomes were the aggravation of dissection requiring intervention and dissection related mortality. To evaluate the prognosis of symptomatic isolated SRAD, the clinical outcomes of isolated SRAD were compared with those of symptomatic isolated SSMAD (n = 40) during the same study period.

RESULTS: The primary outcome incidence was 39% (9/23) in patients with symptomatic isolated SRAD during the median follow up period of 20 months (range 0-63 months). The dissection related mortality rate was 17% (4/23), and the cause of death in all cases was an abrupt rupture of the dissecting aneurysm with significant true lumen stenosis. None of the patients without aneurysm or with true lumen occlusion had dissection related mortality. During the same study period, compared with the patients with symptomatic isolated SSMAD who initially received conservative medical treatment, the primary outcome incidence (39% vs. 10%, p = .009) and dissection related mortality rate (17% vs. 0%, p = .016) were statistically significantly higher in patients with symptomatic isolated SRAD.

CONCLUSIONS: Although the present analysis involved only a small number of patients, it revealed that symptomatic isolated SRAD with dissection related aneurysm and true lumen stenosis is a potentially life threatening condition and that aggressive surgical or endovascular interventions should be considered in these patients, who are refractory to conservative medical treatment.