[Acute Aortic Dissection with Visceral Malperfusion Syndrome]

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Gastrointestinal Surgery

Context:

• Acute aortic dissection (AAD) poses significant risks, particularly when complicated by visceral malperfusion.
• Malperfusion of visceral arteries in AAD leads to high perioperative and long-term mortality.
• Conventional strategies focus on aortic repair and restoring true lumen flow.

Purpose:

• To review current and emerging strategies for managing visceral and renal malperfusion in acute aortic dissection.
• To highlight the importance of timely reperfusion for preventing irreversible organ damage.
• To discuss specific interventions for superior mesenteric artery (SMA) and renal artery malperfusion.

Summary:

• Malperfusion syndrome in AAD significantly worsens patient outcomes.
• Accurate diagnosis involves clinical presentation, contrast-enhanced CT, and intraoperative echocardiography.
• Prioritizing aortic repair is key, but SMA intervention before central repair may be vital in Type A AAD to prevent bowel necrosis.
• For Type B AAD, thoracic endovascular aortic repair (TEVAR) with potential SMA intervention is indicated.
• Renal artery revascularization improves outcomes when renal blood flow is compromised post-central repair.

Impact:

• Improved understanding of malperfusion management in AAD.
• Potential for reduced mortality and morbidity in patients with complex aortic dissections.
• Guidance on tailored surgical approaches for visceral and renal ischemia in AAD.
• Enhanced strategies for preserving organ function and improving long-term survival.