Correlation of the femoral pulse and mesenteric perfusion pressure in acute aortic dissection

Figures

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  Iliac and SMA perfusion pressures are correlated when both have exclusive TL supply (found in 25% of AADs).

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  Figure 1. Flow diagram for patient inclusion and subgrouping. The symbol n refers to the number of patients within a group, whereas m refers to the number of pressure measurement pairs. The number of patients differs from the number of pressure measurement pairs due to the presence of 17 included patients with bilateral vulnerable anatomy. Percentages were calculated against the total number of initial patients with either acute type A aortic dissection (ATAAD) or acute type B aortic dissection (ATBAD), 244 in both cases to demonstrate final number of included pressure measurements against the total number of possible inclusions. The initial cohort included 488 patients. Non-true lumen (TL) exclusions occurred within each subgroup if either branch vessel of interest were thrombosed or statically obstructed by extension of intimal flap into branch vessel lumen or if there was a re-entry tear present as determined by cross-sectional imaging or procedural intravascular ultrasound. Patients were noted to have insufficient data if they did not have preintervention systolic pressures measured for the branch vessels of interest. Ultimately, 76 unique patients were included across all groups and…

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  Figure 2. Relationship between superior mesenteric artery (SMA) and external iliac artery (EIA) systolic pressures. Pressures are measured in millimeters mercury by intraluminal catheter. All measurements occurred before endovascular intervention. REIA, Right external iliac artery; LEIA, left external iliac artery.

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  Figure E1. Example of vulnerable anatomy. Shown is the computed tomography scan from an included patient with right-sided vulnerable anatomy with image levels at the SMA origin (A), proximal common iliac arteries (B), and mid common iliac arteries (C). The patient’s celiac, superior mesenteric artery, right renal artery (RRA), and right common iliac artery (RCIA) all originate exclusively off the true lumen (TL), whereas the left renal artery (LRA) and left common iliac artery (LCIA) originate off both the TL and false lumen. In this patient, a low RCIA pressure would correspond to a low SMA pressure because they both originate exclusively off the TL.

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  Figure E2. Examples of included/excluded patients. A, Shown is the computed tomography (CT) scan from a patient in whom the true lumen (TL) supplies the celiac, superior mesenteric artery (SMA), right renal artery (RRA), and right common iliac artery (RCIA). This patient experienced right lower extremity malperfusion 2 days after the onset of mesenteric malperfusion, presumably due to dynamic obstruction of the TL. The clinical urgency of this finding is heightened by the anatomical linkage of right leg and mesenteric perfusion pressures. The RCIA involvement and exclusive TL supply are suggested by the collapsed TL seen at the level of the inferior mesenteric artery (IMA) origin. B, Shown is the CT scan from a patient with exclusive TL perfusion of their SMA and RCIA. During endovascular repair, intravascular ultrasound examination of the abdominal and thoracic aorta showed marked TL collapse throughout the abdominal aorta. C, This is the CT scan from a patient who was excluded from our cohort because, although his RRA and SMA originate exclusively off the TL, bilateral CIAs originate off both the TL and the FL with visible reentry tears. Depicted in the third image is the acute aortic…