Mesenteric ischemia in acute aortic dissection

Abstract

Mesenteric ischemia complicated by acute aortic dissection (AAD) is uncommon, but serious, as there is no established treatment strategy and it can progress rapidly to multi-organ failure. Diagnosing mesenteric ischemia before necrotic change is difficult, not only for primary care physicians, but even for gastrointestinal or cardiovascular surgeons as it can occur at any time during surgery. Thus, measures need to be in place at the bedside to enable us to obtain information on visceral perfusion. It is often difficult to decide which of laparotomy or aortic repair should be performed first, especially when there is associated shock or malperfusion of other vital organs. The standard surgical procedures for mesenteric ischemia are prompt revascularization of the mesenteric artery and, if needed, resection of necrotic intestine. However, the development of endovascular treatment and the introduction of hybrid ORs have improved the treatment strategies for mesenteric ischemia. This article reviews the issues of "diagnosis" in relation to the mechanism of mesenteric ischemia, and discusses the current "treatment strategies".

Current surgical results of acute type A aortic dissection in Japan

“…Every patient should have echocardiography and carotid artery ultrasound simultaneously in the emergency room before going to the CT scan room. Orihashi (18) underscores the important role of the vascular ultrasound in the emergency room or operating room.…”

“…Additional procedures consisted with CABG in 7, and mitral valve repair in 2. The overall hospital mortality was 13.7% [45] and the hospital mortality was 51.4% [18] in salvage surgery cases. Newly developed permanent neurological deficits occurred in 6.4% [21] of patients and transient neurological disorder occurred in 6.1% [20].…”

Critical Malperfusion Caused by Central Aortic Repair for Acute Aortic Dissection: A Case Report

“…Malperfusion may result from two types: aortic type and branch type. 8) The aortic type is caused by the retraction of TL by FL in the aorta. Therefore, the expansion of TL in the aorta is required.…”

“…Many researchers advocate that prompt intervention should be performed for aortic branch obstruction after the diagnosis of malperfusion. 5,8)…”

Abdominal ischaemia syndrome as a complication of type A acute aortic dissection

“…Ультразвуковой метод диагностики абдоминальной ишемии очень удобен, так как может быть выполнен немедленно у постели больного, позволяя получить информацию о морфологии, движении тканей, параметрах гемодинамики в режиме реального времени без воздействия радиации и введения контраста. Однако качество оценки ультразвуковой визуализации при остром расслоении аорты типа А во многом зависит от опыта специалиста, так как визуализация может быть сильно ограничена кишечными газами [14].…”