Malperfusion syndromes in aortic dissections

Abstract

Aortic dissection remains a challenging clinical scenario, especially when complicated by peripheral malperfusion. Improvements in medical imaging have furthered understanding of the pathophysiology of malperfusion events in association with aortic dissection, including the elucidation of different mechanisms of branch vessel obstruction. Despite these advances, malperfusion syndrome remains a deadly entity with significant mortality. This review presents the latest knowledge regarding the pathogenesis of aortic dissection complicated by malperfusion syndrome, and discusses the diagnostic and therapeutic guidelines for management of this vicious entity.

Type B Aortic Dissection with Visceral Artery Involvement Following Blunt Trauma: A Case Report

“…A report from the international registry of acute aortic dissection (IRAD) showed that 19% of in-hospital deaths in patients with TBAD were caused by visceral ischemia and that TBAD with branch vessel involvement was associated with 2.9 times higher mortality than that without [11]. Manifestations of the local and systemic inflammatory cascade caused by end organ ischemic and reperfusion injury are believed to contribute to this poor outcome [12].…”

Patient-specific haemodynamic simulations of complex aortic dissections informed by commonly available clinical datasets

“…Contrast-enhanced CT scans were analysed to detect evidence of malperfusion, as commonly done in clinical practice [20]. Asymmetric kidney enhancement indicating a reduced perfusion of the left kidney was observed in Patient 3.…”

Understanding Visceral Ischaemia in Acute Type B Dissection: State of the Art, Challenges and Future Perspectives

“…-Visceral malperfusion (with particular mention to mesenteric malperfusion) in the setting of acute type A dissection is a leading cause and independent predictor factor for in-hospital mortality; distal extension of a type A dissection to the aorta and its branches is an independent marker of a severity [5,6,9]. In-hospital mortality for patients included in the IRAD registry presenting with type A dissections complicated by mesenteric malperfusion undergoing surgical or hybrid treatment has been reported to be as high as 41.7% [7,8].…”

“…CT tomography, MR and ultrasound imaging all play an important role in the imaging of aortic dissection [9,[14][15][16].…”

“…Colour Doppler ultrasonography can be extremely helpful to evaluate a haemodynamic compromise at the level of the renal and superior mesenteric artery [9,[21][22][23]. Limitations intrinsic to the technique are represented by the availability of experienced operators in an urgent setting, the morphology and the clinical and haemodynamic status of the patient.…”