Evolution of visceral arteries and distal aorta following reperfusion-first strategy for acute type A aortic dissection with mesenteric malperfusion

OBJECTIVES This retrospective cohort study aims to evaluate the radiological changes of superior mesenteric artery (SMA), distal aorta and visceral branches following reperfusion-first strategy with SMA stenting for acute type A dissection (ATAAD) complicated with mesenteric malperfusion. METHODS Computed tomographic angiograms (CTA) of 25 survivors undergoing reperfusion-first strategy for ATAAD and mesenteric malperfusion syndrome were longitudinally evaluated at 2.5 ± 0.9 years (CTA was 100% available; 2.1 scans/patient). CTA Measurements include the areas of the false lumen (FL) of SMA proximal and distal to the stent; areas of the FL, true lumen (TL) of aorta, and the FL area to TL area ratios at zones 4–9. Mixed linear models were used to assess the temporal trends of CTA measurements across pre-stenting, (within) 30 days, 1 year, 2 years, and 3 years. RESULTS The areas of FL proximal and distal to the SMA stent showed a significant trend of decrease overtime (P < 0.001 and P = 0.031). Areas of SMA proximal and distal to the stent dropped sharply immediately after stenting, then slowly increased or fluctuated, but remained significantly smaller than preoperative values (P < 0.001 and P = 0.010); Aorta at zones 4–7 showed a significant trend of TL expansion up to 3 years (all P < 0.050), which was not seen in zones 8–9. The coeliac artery showed a significant trend of FL shrinkage up to 3 years (P < 0.050). The FL area to TL area ratios in zones 4, 8 and 9 showed a significant trend of decrease through 3 years (all P < 0.050), which was seen in zones 5–7 only through 2 years (all P < 0.050), not at 3 years. CONCLUSIONS In patients with ATAAD complicated by mesenteric malperfusion syndrome, a reperfusion-first strategy with SMA stenting may induce significant FL shrinkage in the SMA, which was most pronounced within 30 days and persisted through 3 years. The FET could induce significant TL expansion in zones 4–7, which was most obvious within 30 postoperative days. The TL expansion effect of the FET was more pronounced at proximal levels (zones 4–7) than distal segments (zones 8–9).