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Lou et al. Vessel Plus 2022;6:38 Vessel Plus
DOI: 10.20517/2574-1209.2021.108

Review Open Access

Malperfusion syndromes in acute type A aortic

dissection

1,#
Xiaoying Lou , Edward P. Chen 2,#
1
Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA.
2
Duke University Medical Center, Duke University School of Medicine, Durham, NC 27710, USA.
#
Authors contributed equally.
Correspondence to: Prof. Edward P. Chen, Duke University Medical Center, Duke University School of Medicine, DUMC 3442,
Durham, NC 27710, USA. E-mail: edward.p.chen@duke.edu
How to cite this article: Lou X, Chen EP. Malperfusion syndromes in acute type A aortic dissection. Vessel Plus 2022;6:38.
https://dx.doi.org/10.20517/2574-1209.2021.108
Received: 24 Jul 2021 First Decision: 6 Sep 2021 Revised: 19 Jan 2022 Accepted: 14 Feb 2022 Published: 9 Jun 2022

Academic Editors: Davide Pacini, Yajing Wang Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
Acute aortic dissection complicated by malperfusion syndrome is a devastating condition that significantly impacts
morbidity and mortality. Malperfusion syndrome can affect any vascular bed with varying degrees of end-organ
involvement. While conventional management of acute type A aortic dissection (ATAAD) with or without
malperfusion syndrome is emergent central aortic repair, growing evidence suggests that this approach results in
unsatisfactory outcomes for those presenting specifically with mesenteric malperfusion. With the established short
and long-term benefits of thoracic endovascular aortic repair in the management of acute complicated type B
aortic dissection, there is an emerging paradigm shift towards initial reperfusion of distal organs with a variety of
endovascular and transcatheter techniques followed by central aortic repair in an otherwise stable patient whose
risk of aortic rupture is low. A multidisciplinary team and a patient-specific approach remain paramount in the
successful management of this high-risk, high-complexity subset of ATAAD patients.

Keywords: Aortic dissection, mesenteric malperfusion, malperfusion syndrome, thoracic endovascular aortic repair

INTRODUCTION
In patients presenting with acute aortic dissection, malperfusion syndrome is an often-devastating
condition that significantly impacts morbidity and mortality. Malperfusion can impact any vascular bed
with varying degrees of end-organ involvement, necessitating a multi-disciplinary, patient-specific approach

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