Progress in management of malperfusion syndrome from type B dissections

Ryan, Colin; Vargas, Lina; Mastracci, Tara M.; Srivastava, Sunita; Eagleton, Matthew J.; Kelso, Rebecca; Clair, Daniel G.; Sarac, Timur P.

doi:10.1016/j.jvs.2012.10.101

Cited by 38 publications

(39 citation statements)

References 28 publications

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“…Cerebral ischemia may also be iatrogenic in nature. Coverage of the left subclavian artery (LSA) during TEVAR has been independently associated with increased rates of stroke and peri-operative mortality (48). These findings were corroborated in the STABLE trial, a prospective multicenter study involving 40 patients with complicated Type B dissections, in which all patients who suffered a post-operative stroke had required coverage of the LSA (41).…”

Section: Endovascular Therapy For Malperfusion Syndromementioning

confidence: 99%

Malperfusion syndromes in aortic dissections

et al. 2016

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Aortic dissection remains a challenging clinical scenario, especially when complicated by peripheral malperfusion. Improvements in medical imaging have furthered understanding of the pathophysiology of malperfusion events in association with aortic dissection, including the elucidation of different mechanisms of branch vessel obstruction. Despite these advances, malperfusion syndrome remains a deadly entity with significant mortality. This review presents the latest knowledge regarding the pathogenesis of aortic dissection complicated by malperfusion syndrome, and discusses the diagnostic and therapeutic guidelines for management of this vicious entity.

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Section: Endovascular Therapy For Malperfusion Syndromementioning

confidence: 99%

Malperfusion syndromes in aortic dissections

et al. 2016

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“…In our study, early mortality with TEVAR was 6.3%, and the main cause of in‐hospital mortality was malperfusion syndrome (mesenteric ischemia), increasing the risk of early death by 4.6×. Ryan et al reported a 30‐day mortality of 21.3% in patients with malperfusion syndrome, and ischemic territory was not independently associated with mortality . Other authors have reported 10.8% mortality .…”

Section: Discussionmentioning

confidence: 41%

“…Ryan et al reported a 30-day mortality of 21.3% in patients with malperfusion syndrome, and ischemic territory was not independently associated with mortality. 22 Other authors have reported 10.8% mortality. 20 Early mortality in our patients with malperfusion syndrome undergoing endovascular repair was 9.5%.…”

Section: Discussionmentioning

confidence: 95%

Complicated Acute Aortic Syndromes Affecting the Descending Thoracic Aorta: Endovascular Treatment Compared With Open Repair

Eid-Lidt

Hernández

González‐Pacheco

et al. 2015

Clinical Cardiology

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Background: For patients with complicated acute thoracic aortic syndromes, endovascular treatment, when feasible, is preferred over open surgery. However, there are limited data on the long-term benefits of endovascular treatment in complicated acute aortic syndromes affecting the descending thoracic aorta. Hypothesis: The endovascular treatment is expected to have more favorable long-term mortality and fewer late reintervention in complicated acute thoracic aortic syndromes. Methods: Of 155 consecutive patients with acute aortic syndromes, 94 met the inclusion criteria of the study; 63 underwent endovascular repair (group 1) and 31 underwent open repair (group 2). Patients with a diagnosis of acute aortic syndrome localized in the descending thoracic aorta distal to the emergence of the left subclavian artery, complicated by rupture, malperfusion syndrome, and/or acute aortic expansion, were included. Indications for repair of the descending thoracic aorta included impending rupture in 70.2%, malperfusion syndrome in 29.8%, and persistence of pain with aortic expansion (aortic diameter >40 mm) in 2 patients. Results: During the follow-up period (63.0 ± 24.6 months), the cumulative survival free from cardiovascular death rates at 5 years was 92.0% and 51.4% in group 1 and 2, respectively (log rank P = 0.0001). Late mortality related to the aorta was 1.6% with thoracic endovascular aortic repair and 0% with surgical treatment. Conclusions: Endovascular treatment in patients with complicated acute thoracic aortic syndromes localized at the descending thoracic aorta is feasible and safe, with a lower rate of early complications and similar long-term benefits when compared with surgical treatment.

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“…[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.…”

Section: Discussionmentioning

confidence: 99%

“…This complication sometimes requires surgical intervention, but it is associated with high morbidity and mortality. [3] Recently, endovascular revascularization has become the first treatment of choice for visceral malperfusion. [2] Generally, ischemia due to isolated celiac artery occlusion is rare because there are extensive collateral pathways for the mesenteric circulation.…”

Section: Discussionmentioning

confidence: 99%

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

Oki

Kawasaki

Sugimoto

2016

Acta Chirurgica Belgica

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A 79-year-old woman with a complaint of persistent upper abdominal pain was admitted to our hospital for the treatment of thrombosed acute type B aortic dissection. Computed tomography showed the complete static occlusion of the celiac artery. Because of progressive symptom with elevation of liver enzymes and metabolic acidosis 11 h after admission, endovascular revascularization was attempted on an emergent basis. After a failed catheterization of the celiac ostium in an antegrade fashion due to a hard occlusion, we succeeded in a retrograde recanalization through the pancreaticoduodenal arcade via the superior mesenteric artery with stent placement using a pull-through technique. This technique is useful and safe when an antegrade approach seems difficult.

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Progress in management of malperfusion syndrome from type B dissections

Cited by 38 publications

References 28 publications

Malperfusion syndromes in aortic dissections

Malperfusion syndromes in aortic dissections

Complicated Acute Aortic Syndromes Affecting the Descending Thoracic Aorta: Endovascular Treatment Compared With Open Repair

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

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