Malperfusion Syndrome in Type B Aortic Dissection: Role of the Endovascular Procedures

Percutaneous retrograde recanalization of an occluded celiac artery complicating acute aortic dissection

“…[3] It arises when the dissection compromises the blood flow, by either extrinsic compression of the true lumen by the false channel or an intimal flap occluding the orifice of a branch artery. [4] Another possible cause is intensive antihypertensive therapy for aortic dissection, which may worsen the perfusion of the visceral artery and enhance the ischemic visceral complication. This complication sometimes requires surgical intervention, but it is associated with high morbidity and mortality.…”

Uncovered stent implantation in complicated acute aortic dissection type B

“…Intimal flap mobility, aortic or branch vessel obstruction, and perfusion of visceral organs must be reproducibly improved without increasing the risk of aortic rupture. 7,10,17,[20][21][22] In this context, the use of thoracic endovascular aortic/aneurysm repair (TEVAR) has been proposed to be beneficial for aortic remodeling; but TEVAR had no positive effect on 2-year survival. 19 Nevertheless, the main short-term goal is to establish and ensure a patent TL for adequate blood supply to the visceral arteries and lower extremities as fast as possible.…”

Acute Complex Type A Dissection associated with peripheral malperfusion syndrome treated with a staged approach guided by lactate levels

“…Lack of immediate symptoms in these patients can delay accurate diagnosis and management contributing to the high mortality. One possible treatment option includes initial endovascular fenestration of the infrarenal aorta [10]. In the last few years however, biomarkers (in particular serum lactate) have become a useful tool in assessing mesenteric ischemia.…”