Initial reperfusion of distal organs followed by central aortic repair is an emerging paradigm for managing acute type A aortic dissection with mesenteric malperfusion.
Does initial endovascular reperfusion followed by central aortic repair improve outcomes compared to conventional emergent central aortic repair in patients with acute type A aortic dissection complicated by malperfusion syndrome?
This review highlights an emerging paradigm shift in managing ATAAD with malperfusion, advocating for initial endovascular reperfusion prior to central aortic repair to improve patient outcomes.
Acute aortic dissection complicated by malperfusion syndrome is a devastating condition that significantly impacts morbidity and mortality. Malperfusion syndrome can affect any vascular bed with varying degrees of end-organ involvement. While conventional management of acute type A aortic dissection (ATAAD) with or without malperfusion syndrome is emergent central aortic repair, growing evidence suggests that this approach results in unsatisfactory outcomes for those presenting specifically with mesenteric malperfusion. With the established short and long-term benefits of thoracic endovascular aortic repair in the management of acute complicated type B aortic dissection, there is an emerging paradigm shift towards initial reperfusion of distal organs with a variety of endovascular and transcatheter techniques followed by central aortic repair in an otherwise stable patient whose risk of aortic rupture is low. A multidisciplinary team and a patient-specific approach remain paramount in the successful management of this high-risk, high-complexity subset of ATAAD patients.
Lou et al. (Sat,) conducted a review in Acute type A aortic dissection with malperfusion syndrome. Initial reperfusion of distal organs followed by central aortic repair vs. Emergent central aortic repair was evaluated. Initial reperfusion of distal organs followed by central aortic repair is an emerging paradigm for managing acute type A aortic dissection with mesenteric malperfusion.