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Updated: Dec 11, 2025
Author Spotlight: Advancing Spectral Characterization of Physiological and Malperfused Tissues
Published on: July 5, 2024
Revascularization-first strategy in acute aortic dissection with mesenteric malperfusion
Kayo Sugiyama1, Hirotaka Watanuki1, Masaho Okada1
1Department of Cardiac Surgery, Aichi Medical University Hospital, Nagakute, Japan.
Background And Aim:
Mesenteric malperfusion is a complication with a higher risk of in-hospital mortality because diagnosing mesenteric ischemia before necrotic change is difficult, and when it occurs, the patient's condition has worsened. Although it contradicts the previous consensus on central repair-first strategy, the revascularization-first strategy was found to be significantly associated with lower mortality rates. This study aimed to present our revascularization-first strategy and the postoperative results for acute aortic dissection involving mesenteric malperfusion.
Methods:
Among 58 patients with acute type A aortic dissection at our hospital between January 2017 and December 2019, mesenteric malperfusion was noted in six. Four hemodynamically stable patients underwent mesenteric revascularization with endovascular intervention in a hybrid operation room before central repair, and two hemodynamically unstable patients underwent central repair before mesenteric revascularization.
Results:
No in-hospital mortality was recorded. All four patients with mesenteric revascularization-first strategy recovered with no symptoms related to mesenteric ischemia. Two patients with central repair-first strategy developed paralytic ileus for 1 week; one of them needed exploratory laparotomy, but no patients needed colon resection.
Conclusion:
No in-hospital mortality was recorded. All four patients with mesenteric revascularization-first strategy recovered with no symptoms related to mesenteric ischemia. Two patients with central repair-first strategy developed paralytic ileus for 1 week; one of them needed exploratory laparotomy, but no patients needed colon resection.
Insights
The revascularization-first strategy for acute aortic dissection with mesenteric malperfusion significantly lowers mortality. This approach led to no in-hospital deaths and faster recovery compared to central repair first.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Gastrointestinal Surgery
Background:
- Mesenteric malperfusion in acute aortic dissection increases mortality risk.
- Early diagnosis of mesenteric ischemia is challenging, often indicating a worsened patient condition.
- A revascularization-first strategy may offer improved outcomes over traditional central repair-first approaches.
Purpose of the Study:
- To present a revascularization-first strategy for acute aortic dissection with mesenteric malperfusion.
- To evaluate the postoperative outcomes of this strategy.
Main Methods:
- Retrospective review of 6 patients with acute type A aortic dissection and mesenteric malperfusion (Jan 2017-Dec 2019).
- Four hemodynamically stable patients underwent mesenteric revascularization (endovascular) before central repair.
- Two hemodynamically unstable patients underwent central repair before mesenteric revascularization.
Main Results:
- No in-hospital mortality was observed in the study cohort.
- Patients treated with the revascularization-first strategy showed complete recovery without mesenteric ischemia symptoms.
- The central repair-first group experienced paralytic ileus, with one requiring exploratory laparotomy.
Conclusions:
- The revascularization-first strategy is associated with excellent outcomes in acute aortic dissection involving mesenteric malperfusion.
- This approach potentially reduces complications like paralytic ileus and the need for further surgical intervention.
- No in-hospital mortality was recorded, highlighting the efficacy of the revascularization-first approach.
