Intraoperative intravascular ultrasound assessment of branch vessel malperfusion to guide acute intervention in acute type A aortic dissection

Objectives: To assess the safety of aortic intravascular ultrasound (IVUS) immediately after proximal repair in acute type A aortic dissections (ATAADs) and to identify malperfusion early, guiding interventions to restore arterial flow, limit end-organ damage, and improve outcomes. Methods: In this prospective cohort study, 50 consecutive patients with ATAAD were stratified according to clinical presentation into 2 groups; group 1, no malperfusion at presentation, and group 2, malperfusion at presentation. All patients underwent standard emergent operative repair and then were assessed with IVUS intraoperatively for evidence of distal malperfusion. Primary outcome included a composite of death, mesenteric, renal and limb ischemia, and vascular complications. Secondary outcomes included length of intensive care unit and hospital stay. Follow-up was completed at 30 days post-op or the date of discharge. Results: Primary outcome was observed in 10 patients (20.0%), with 7 deaths, 2 vascular complications, and 1 case of new permanent dialysis. IVUS identified distal arterial malperfusion in 5 patients after proximal aortic repair, who underwent emergent additional vascular interventions to correct the residual malperfusion. These interventions resulted in no cases of death, paralysis, renal, bowel, or limb ischemia. Individuals requiring additional vascular procedures had a similar length of intensive care unit and total stay compared with group 1. Conclusions: IVUS is safe in ATAAD and provides immediate guidance in the treatment of residual malperfusion after proximal repair. This technique eliminates any delays, provides immediate distal perfusion assessment, limits end-organ damage, and is associated with excellent clinical outcomes. The results of this study warrant further investigation.