Abstract

Aim: Peripheral artery dissections are rare but clinically significant vascular events with heterogeneous presentations, and there is still no consensus on optimal treatment. This study aimed to evaluate the early and mid-term outcomes of endovascular, hybrid, open surgery, and conservative strategies in a single-center cohort.
Material and Methods: Between January 2018 and December 2024, 19 consecutive patients diagnosed with peripheral artery dissection were retrospectively included. Demographic data, cardiovascular risk factors, clinical presentations, dissection etiology, ABI, treatment strategies, and outcomes were recorded. Dissection severity was graded using a predefined institutional peripheral arterial dissection grading system adapted from the NHLBI classification. The treatment strategy was individualized according to dissection grade, arterial segment, hemodynamic significance, common femoral artery involvement, and suitability for endovascular, hybrid, open, or conservative management.
Results: 78.9% of dissections were iatrogenic, 21.1% were traumatic, and mostly affected the iliac arteries. Treatments included endovascular (n = 11), hybrid (n = 6), open surgery (n = 1), and conservative management (n = 1). Technical success among interventional procedures was 94.4%. The ABI improved significantly from 0.54 ± 0.21 to 0.75 ± 0.21 (p = 0.0002). At a mean follow-up of 10.8 months, the primary patency rate was 89.5%, limb salvage was 94.7%, and the 30-day complication rate was 26.3% (10.5% major). Preoperative ABI was significantly lower in the endovascular group compared to the hybrid group (0.51 vs. 0.71; p = 0.044), but ABI improvement was comparable (p = 0.208). Higher dissection grades showed lower primary patency (E-F grades: 67% vs. B-D grades: 100%).
Conclusion: Both endovascular and hybrid approaches achieved high technical success and favorable short- to medium-term outcomes in this cohort. Significant hemodynamic improvement was observed using ABI measurement. However, given the small sample size and population heterogeneity, these findings should be considered exploratory. The degree of dissection may be associated with outcomes, but this should be confirmed in larger studies.

Key words: Peripheral artery dissection, endovascular treatment, hybrid surgery, ankle-brachial index, arterial dissection