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Mesenteric Malperfusion in Acute Aortic Dissection: Challenges and Frontiers

Bashi V Velayudhan1, A Mohammed Idhrees1, K Mukesh1

  • 1Institute for Cardiac and Aortic Disease (ICAD), SIMS Hospital, Chennai, India.

Seminars in Thoracic and Cardiovascular Surgery
|April 14, 2019
PubMed

Insights

Mesenteric malperfusion (MMP) in aortic dissection significantly increases mortality. Management strategies vary, requiring a patient-specific approach for optimal outcomes in this challenging condition.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Surgery
  • Aortic Disease

Background:

  • Malperfusion syndrome, caused by end-organ ischemia during aortic dissection, presents significant challenges.
  • Mesenteric malperfusion (MMP) is a particularly severe complication, increasing mortality 3-4 fold in acute aortic dissections.
  • The high incidence (66-100%) and insidious onset of MMP complicate diagnosis and management.

Purpose of the Study:

  • To review the diagnostic and management challenges of mesenteric malperfusion in aortic dissection.
  • To explore current treatment approaches for MMP in acute type A and B aortic dissections.

Main Methods:

  • Literature review of studies on aortic dissection and mesenteric malperfusion.
  • Analysis of different management strategies for MMP.
  • Discussion of treatment variations based on aortic dissection type and ischemia severity.

Main Results:

  • Mesenteric malperfusion is a frequent and life-threatening complication of aortic dissection.
  • Management remains controversial, with ongoing debate regarding the optimal timing of aortic repair versus mesenteric reperfusion.
  • Treatment for type A dissections may involve central, endovascular, or simultaneous repair, while type B dissections predominantly utilize endovascular approaches.

Conclusions:

  • Mesenteric malperfusion poses a significant threat in aortic dissection, demanding careful consideration.
  • A patient-specific approach is essential due to the varied presentations and ischemic severity.
  • Further research is needed to refine management protocols for MMP in aortic dissections.
Keywords:
Aortic dissectionMalperfusion syndromeMesenteric malperfusion

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