Visceral Artery Dissections: Overview, Natural History, and Management

Purpose of review Spontaneous and isolated visceral artery dissections (VAD) are rare but potentially life-threatening conditions that occur when there is a tear or separation of the inner lining of the blood vessels that supply the organs of the abdomen. This includes the celiac artery, superior mesenteric artery (SMA), and renal arteries leading to ischemia and infarction of the affected organs. We will discuss the natural history of VAD and management options with a focus on recent literature. Recent findings Recent case series and meta-analyses indicate that VAD is a condition with overall low mortality that can be managed conservatively with observation, antiplatelet therapy, and/or anticoagulation. Few patients will require revascularization via endovascular and surgical intervention. Additionally, emerging data suggests that systematic imaging to evaluate for multiple artery aneurysm, dissection, and/or fibromuscular dysplasia (FMD) may help to prognosticate the patient’s risk for additional dissection events or identify those that will benefit from further evaluation with genetic testing for heritable arteriopathy. Summary For a majority of VAD patients, the available data suggest that symptoms resolve and dissections heal with medical management alone. In cases of on-going ischemia or symptoms, revascularization can be done safely and effectively. Patients should undergo evaluation for other signs and symptoms of systemic arteriopathy with imaging, and if appropriate genetic testing for heritable arteriopathies.