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Updated: Oct 18, 2025
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Endovascular Management of Malperfusion Syndromes in Aortic Dissection
Sukhdeep Grewal1, Benjamin N Contrella1, William M Sherk2
1Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, VA.
Abstract:
Malperfusion Syndrome (MPS) refers to inadequate perfusion of end organs secondary to ongoing arterial obstruction of the aorta and its branches resulting in increased morbidity and mortality. While uncomplicated type B dissection can typically be monitored, type A or type B dissections with malperfusion syndrome are should be considered for hybrid treatment with an endovascular intervention. In addition to pre-procedure CTA and labs, intra-procedure evaluation of the true lumen, false lumen, and branch vessels is performed with intravascular ultrasound (IVUS) and manometry to delineate static versus dynamic obstruction. Dynamic obstruction of the visceral arteries is typically treated first and can be relieved either with supraceliac dissection flap fenestration or exclusion of the entry tear by thoracic endovascular aortic repair, both of which will restore flow to the true lumen. Static obstruction requires stenting or other branch-artery intervention including branch artery fenestration, suction embolectomy, or thrombolysis. Throughout the procedure, IVUS and manometry are used to evaluate results of interventions with respect to continued hemodynamically significant obstruction. Endovascular intervention should be performed in conjunction with a multi-disciplinary team as patients are often complex and may require further procedures such as bowel resection or open aortic repair.
Insights
Malperfusion syndrome, a serious complication of aortic dissection, requires timely intervention. Hybrid endovascular repair effectively addresses both dynamic and static obstructions, improving organ perfusion and patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Vascular Medicine
- Interventional Radiology
Background:
- Malperfusion syndrome (MPS) results from arterial obstruction, leading to significant morbidity and mortality.
- While uncomplicated type B aortic dissection is often monitored, dissections with MPS necessitate intervention.
Purpose of the Study:
- To outline the hybrid endovascular treatment strategy for aortic dissection with malperfusion syndrome.
- To differentiate and address dynamic versus static obstructions in visceral arteries.
Main Methods:
- Intra-procedure evaluation using intravascular ultrasound (IVUS) and manometry to assess true lumen, false lumen, and branch vessels.
- Treatment of dynamic obstruction via supraceliac dissection flap fenestration or thoracic endovascular aortic repair (TEVAR) to exclude entry tears.
- Management of static obstruction through stenting, fenestration, suction embolectomy, or thrombolysis.
Main Results:
- Hybrid endovascular interventions restore flow to the true lumen by relieving dynamic obstructions.
- Static obstructions are managed with targeted branch-artery interventions.
- Continuous IVUS and manometry guide interventions to resolve hemodynamically significant obstructions.
Conclusions:
- Hybrid endovascular repair is a crucial treatment for aortic dissection with malperfusion syndrome.
- A multidisciplinary approach is essential for managing complex patients, potentially requiring further procedures like bowel resection or open aortic repair.
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