Institute for Cardiac and Aortic Disease (ICAD), SIMS Hospital, Chennai, India.
Institute for Cardiac and Aortic Disease (ICAD), SIMS Hospital, Chennai, India.
Semin Thorac Cardiovasc Surg. 2019;31(4):668-673. doi: 10.1053/j.semtcvs.2019.03.012. Epub 2019 Apr 10.
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.
灌注不良综合征是由主动脉夹层导致的终末器官缺血引起的。灌注不良综合征可影响任何血管床，其中肠系膜灌注不良（MMP）最具挑战性，在急性 A 型和 B 型主动脉夹层中，死亡率增加了 3 至 4 倍。在不同文献中，MMP 的发生率在 66%至 100%之间。MMP 是不同缺血性终末器官并发症中起病隐匿的一种，这使其在诊断和治疗方面具有挑战性。MMP 的治疗仍然存在争议，即最初是进行主动脉修复还是恢复肠系膜灌注。急性 A 型主动脉夹层伴 MMP 的治疗方法包括初始的中央修复、血管内修复后再进行中央修复或同时修复。对于急性 B 型主动脉夹层伴 MMP，血管内治疗仍然是主要的治疗方式。鉴于临床表现和缺血程度的差异，需要针对个体患者采取相应的治疗方法。
