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 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.