Visceral Malperfusion in Aortic Dissection: The Michigan Experience

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Aortic Disease

Background:

• End-organ malperfusion is a severe complication of acute aortic dissection.
• Identifying isolated visceral malperfusion can be challenging.
• Treatment strategies differ significantly between Type A and Type B aortic dissections with malperfusion.

Purpose of the Study:

• To summarize current evidence on end-organ malperfusion in aortic dissection.
• To describe a specific treatment paradigm for malperfusion syndrome.
• To discuss the management of visceral malperfusion in Type A and Type B aortic dissections.

Main Methods:

• Review of current evidence on aortic dissection and malperfusion.
• Description of a patient-specific treatment algorithm.
• Comparison of treatment approaches for Type A versus Type B dissections with malperfusion.

Main Results:

• Thoracic endovascular aortic repair is dominant for complicated Type B dissection malperfusion.
• Fenestration may still play a role in Type B dissection treatment.
• Operative repair after initial perfusion restoration is increasingly reported for Type A dissection visceral malperfusion.

Conclusions:

• A patient-specific algorithm is applied, prioritizing fenestration before central repair for visceral malperfusion in Type A dissections.
• The optimal delay period before central repair remains uncertain.
• Further studies are needed to validate different treatment paradigms for aortic dissection malperfusion.