Mesenteric Malperfusion in Acute Aortic Dissection: Challenges and Frontiers
Malperfusion syndrome results from end-organ ischemia in the setting of an aortic dissection. Malperfusion syndrome can affect any vascular bed with mesenteric malperfusion (MMP) being the most challenging associated with a 3- to 4-fold increase in mortality in both acute type A and B aortic dissect...
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| Veröffentlicht in: | Seminars in thoracic and cardiovascular surgery 2019, Vol.31 (4), p.668-673 |
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| creator | Velayudhan, Bashi V. Idhrees, A. Mohammed Mukesh, K. Kannan, Ramachandran Nair |
| description | Malperfusion syndrome results from end-organ ischemia in the setting of an aortic dissection. Malperfusion syndrome can affect any vascular bed with mesenteric malperfusion (MMP) being the most challenging associated with a 3- to 4-fold increase in mortality in both acute type A and B aortic dissections. The incidence MMP is between 66% and 100% in different literature. The insidious onset of MMP, among the different ischemic end-organ complications, makes it a challenge for diagnosis and management. The management of MMP is still a polemic, as to whether initially the aortic repair to be done or to restore the mesenteric perfusion. The approach for acute type A aortic dissection with MMP includes initial central repair, endovascular repair followed by central repair or simultaneous repair. Endovascular remains the main mode of treatment for acute type B aortic dissection with MMP. With respect to the variation in presentation and degree of ischemia, a patient-specific approach is required for treating this condition. |
| doi_str_mv | 10.1053/j.semtcvs.2019.03.012 |
| format | Article |
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Endovascular remains the main mode of treatment for acute type B aortic dissection with MMP. 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The approach for acute type A aortic dissection with MMP includes initial central repair, endovascular repair followed by central repair or simultaneous repair. Endovascular remains the main mode of treatment for acute type B aortic dissection with MMP. With respect to the variation in presentation and degree of ischemia, a patient-specific approach is required for treating this condition.</description><subject>Aneurysm, Dissecting - diagnostic imaging</subject><subject>Aneurysm, Dissecting - mortality</subject><subject>Aneurysm, Dissecting - physiopathology</subject><subject>Aneurysm, Dissecting - surgery</subject><subject>Aortic Aneurysm - diagnostic imaging</subject><subject>Aortic Aneurysm - mortality</subject><subject>Aortic Aneurysm - physiopathology</subject><subject>Aortic Aneurysm - surgery</subject><subject>Aortic dissection</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Incidence</subject><subject>Malperfusion syndrome</subject><subject>Mesenteric Ischemia - diagnostic imaging</subject><subject>Mesenteric Ischemia - mortality</subject><subject>Mesenteric Ischemia - physiopathology</subject><subject>Mesenteric Ischemia - surgery</subject><subject>Mesenteric malperfusion</subject><subject>Mesenteric Vascular Occlusion - diagnostic imaging</subject><subject>Mesenteric Vascular Occlusion - mortality</subject><subject>Mesenteric Vascular Occlusion - physiopathology</subject><subject>Mesenteric Vascular Occlusion - surgery</subject><subject>Registries</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Splanchnic Circulation</subject><subject>Syndrome</subject><subject>Treatment Outcome</subject><subject>Vascular Surgical Procedures - adverse effects</subject><subject>Vascular Surgical Procedures - mortality</subject><issn>1043-0679</issn><issn>1532-9488</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkEtv2zAQhImgRd4_oYGOuUhZckU9eikMt0kKOOilPRMUtWpo6OFyJQP996FhN9eedoGZ2cV8QnySkEnQ-LDNmIbZ7TlTIOsMMAOpzsSl1KjSOq-qD3GHHFMoyvpCXDFvAZQsEc_FBUJdQY1wKTYvxDTOFLxLXmy_o9At7Kcx8WOycstMyWoKcxS_emZyc5Q-J-tX2_c0_iZO7Ngmj2EaZ0-Bb8THzvZMt6d5LX49fvu5fk43P56-r1eb1OUo5xS1lVpBq3KoKmo61IVsMC86Z3VVKlsoB2XVtKqA2nZYNsoiatkiVDVqRLwW98e7uzD9WYhnM3h21Pd2pGlhoxTUBZQaymjVR6sLE3OgzuyCH2z4aySYA0izNSeQ5gDSAJoIMubuTi-WZqD2PfWPXDR8ORooFt3H9oadp9FR60PkZNrJ_-fFG6Tshe4</recordid><startdate>2019</startdate><enddate>2019</enddate><creator>Velayudhan, Bashi V.</creator><creator>Idhrees, A. 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Mohammed ; Mukesh, K. ; Kannan, Ramachandran Nair</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c431t-35a1520d24088ebf3561b346fca5872a62c078bd2609af37b2a3351d308935333</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aneurysm, Dissecting - diagnostic imaging</topic><topic>Aneurysm, Dissecting - mortality</topic><topic>Aneurysm, Dissecting - physiopathology</topic><topic>Aneurysm, Dissecting - surgery</topic><topic>Aortic Aneurysm - diagnostic imaging</topic><topic>Aortic Aneurysm - mortality</topic><topic>Aortic Aneurysm - physiopathology</topic><topic>Aortic Aneurysm - surgery</topic><topic>Aortic dissection</topic><topic>Hemodynamics</topic><topic>Humans</topic><topic>Incidence</topic><topic>Malperfusion syndrome</topic><topic>Mesenteric Ischemia - diagnostic imaging</topic><topic>Mesenteric Ischemia - mortality</topic><topic>Mesenteric Ischemia - physiopathology</topic><topic>Mesenteric Ischemia - surgery</topic><topic>Mesenteric malperfusion</topic><topic>Mesenteric Vascular Occlusion - diagnostic imaging</topic><topic>Mesenteric Vascular Occlusion - mortality</topic><topic>Mesenteric Vascular Occlusion - physiopathology</topic><topic>Mesenteric Vascular Occlusion - surgery</topic><topic>Registries</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Splanchnic Circulation</topic><topic>Syndrome</topic><topic>Treatment Outcome</topic><topic>Vascular Surgical Procedures - adverse effects</topic><topic>Vascular Surgical Procedures - mortality</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Velayudhan, Bashi V.</creatorcontrib><creatorcontrib>Idhrees, A. Mohammed</creatorcontrib><creatorcontrib>Mukesh, K.</creatorcontrib><creatorcontrib>Kannan, Ramachandran Nair</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Seminars in thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Velayudhan, Bashi V.</au><au>Idhrees, A. 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The insidious onset of MMP, among the different ischemic end-organ complications, makes it a challenge for diagnosis and management. The management of MMP is still a polemic, as to whether initially the aortic repair to be done or to restore the mesenteric perfusion. The approach for acute type A aortic dissection with MMP includes initial central repair, endovascular repair followed by central repair or simultaneous repair. Endovascular remains the main mode of treatment for acute type B aortic dissection with MMP. With respect to the variation in presentation and degree of ischemia, a patient-specific approach is required for treating this condition.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30980930</pmid><doi>10.1053/j.semtcvs.2019.03.012</doi><tpages>6</tpages></addata></record> |
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| subjects | Aneurysm, Dissecting - diagnostic imaging Aneurysm, Dissecting - mortality Aneurysm, Dissecting - physiopathology Aneurysm, Dissecting - surgery Aortic Aneurysm - diagnostic imaging Aortic Aneurysm - mortality Aortic Aneurysm - physiopathology Aortic Aneurysm - surgery Aortic dissection Hemodynamics Humans Incidence Malperfusion syndrome Mesenteric Ischemia - diagnostic imaging Mesenteric Ischemia - mortality Mesenteric Ischemia - physiopathology Mesenteric Ischemia - surgery Mesenteric malperfusion Mesenteric Vascular Occlusion - diagnostic imaging Mesenteric Vascular Occlusion - mortality Mesenteric Vascular Occlusion - physiopathology Mesenteric Vascular Occlusion - surgery Registries Risk Assessment Risk Factors Splanchnic Circulation Syndrome Treatment Outcome Vascular Surgical Procedures - adverse effects Vascular Surgical Procedures - mortality |
| title | Mesenteric Malperfusion in Acute Aortic Dissection: Challenges and Frontiers |
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