Endovascular Strategies for Addressing Acute Malperfusion in Aortic Dissection

Abstract

Aortic dissection (AD) involves a tear in the intimal layer of the aorta that creates a false lumen within the aortic wall and can result in malperfusion of distal branch vessels. Herein, a comprehensive examination of malperfusion in the context of acute AD is provided, with a focus on the mechanisms underlying dynamic and static obstructions, their effects on branch vessel perfusion, and the diagnostic challenges they present. The use of endovascular strategies such as thoracic endovascular aortic repair (TEVAR), branch vessel stenting, and aortic flap fenestration are presented. We also discuss the importance of timely intervention through staged aortic repair to optimize organ perfusion and minimize adverse outcomes in high-risk patients. Additionally, hybrid repair highlights the complex pathology of AD with malperfusion. By integrating scientific evidence with clinical expertise, this chapter intends to serve as a valuable resource for clinicians seeking to improve the management of acute malperfusion in AD using endovascular techniques.