Centralization of vascular units and multidisciplinary teams are recommended to optimally manage the complex and deadly consequences of malperfusion syndrome in acute type A aortic dissection.
Optimal management of malperfusion in acute type A aortic dissection requires a multidisciplinary team and hybrid theater capabilities in centralized vascular units to address both dynamic and static obstructions.
Organ malperfusion after type A aortic dissection represents a high-risk group for open surgical repair. This is particularly the case when mesenteric ischemia occurs. Central aortic repair should be considered for all presenting with malperfusion as many are due to dynamic obstruction. However, depending on imaging and clinical appearance many should be considered for adjunctive techniques including catheter-based endovascular and even open surgical revascularisation may be appropriate. This is due to as many as 20% with a static component to the malperfusion syndrome. Improving methods of ascertaining the type of malperfusion being treated and presenting symptoms requires a multidisciplinary team with access to a hybrid theater where all techniques can be accessed 24/7. This would only be achieved by centralization of vascular units whereby sufficient funding and organization are in place to deal with the consequences of this unpredictable and invariably deadly aortic pathology.
Williams et al. (Sun,) conducted a editorial in Acute type A aortic dissection with malperfusion syndrome. Central aortic repair and adjunctive revascularization techniques was evaluated. Centralization of vascular units and multidisciplinary teams are recommended to optimally manage the complex and deadly consequences of malperfusion syndrome in acute type A aortic dissection.