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[Acute Aortic Dissection with Visceral Malperfusion Syndrome].
- Source :
-
Kyobu geka. The Japanese journal of thoracic surgery [Kyobu Geka] 2023 Sep; Vol. 76 (10), pp. 792-798. - Publication Year :
- 2023
-
Abstract
- Malperfusion syndrome of the visceral branches associated with acute aortic dissection brings an extremely poor outcomes leading to perioperative and long-term mortality in both Stanford type A and type B acute aortic dissection. The conventional surgical strategy for these cases has been to prioritize aortic repair and to improve blood flow of true lumen in aorta and visceral branches. Today, various techniques for early reperfusion have been reported. For bowel ischemia, it is necessary to evaluate substantial ischemia of the intestinal tract and hypoperfusion of the superior mesenteric artery( SMA) using contrast-enhanced computed tomography( CT) and intraoperative transesophageal echocardiography in addition to clinical presentation. The most important factor of the surgical intervention is the improvement of true luminal blood flow by reconstruction of the central aorta. However, an intervention to SMA prior to central aortic repair might be an important process for patients with Stanford type A acute aortic dissection to avoid irreversible bowel necrosis. In type B aortic dissection, thoracic endovascular aortic repair (TEVAR) with or without provisional extension to induce complete attachment (PETTICOAT) technique and additional SMA intervention based on intraoperative contrast findings are necessary. Renal malperfusion is also a risk factor of postoperative accute kidney injury( AKI) and perioperative mortality. The revascularizations of renal arteries might improve outcomes when renal blood flow was not recovered with central aortic repair.
- Subjects :
- Humans
Treatment Outcome
Ischemia diagnostic imaging
Ischemia etiology
Ischemia surgery
Syndrome
Retrospective Studies
Acute Disease
Stents adverse effects
Aortic Aneurysm, Thoracic complications
Aortic Aneurysm, Thoracic diagnostic imaging
Aortic Aneurysm, Thoracic surgery
Endovascular Procedures methods
Aortic Dissection complications
Aortic Dissection diagnostic imaging
Aortic Dissection surgery
Blood Vessel Prosthesis Implantation adverse effects
Subjects
Details
- Language :
- Japanese
- ISSN :
- 0021-5252
- Volume :
- 76
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Kyobu geka. The Japanese journal of thoracic surgery
- Publication Type :
- Academic Journal
- Accession number :
- 38056838