Mesenteric ischemia in acute aortic dissection

Despite improved outcomes in acute aortic dissection in Japan, mesenteric ischemia remains a problem. This is largely due to difficulties in early diagnosis and treatment. To address this problem, this article will review several diagnostic modalities such as ultrasound and near-infrared spectroscopy, as well as surgical treatments. Ultrasound is useful for assessing mesenteric ischemia because it can be performed at bedside and it provides information on both morphology and perfusion in real time without exposure to radiation or contrast media. Malperfusion can be assessed at four sites between the aorta and intestine. Two causes of malperfusion, aortic type and branch type, can be assessed. Lack of intestinal movement can also indicate ischemia. Near-infrared light assesses regional oxygen saturation in the tissue, while fluorescent visualization using indocyanin green demonstrates vessels and tissue perfusion. Information provided by these imaging modalities can help guide treatment strategies. Future treatments include endovascular interventions combined with conventional surgical procedures. The hybrid OR may be helpful for such sophisticated treatments.