Revascularization-first strategy in acute aortic dissection with mesenteric malperfusion
| Autor: | Kayo Sugiyama, Masaho Okada, Katsuhiko Matsuyama, Yasuhiro Futamura, Hirotaka Watanuki, Rei Wakayama |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Risk Pulmonary and Respiratory Medicine medicine.medical_specialty Exploratory laparotomy medicine.medical_treatment 030204 cardiovascular system & hematology Revascularization 03 medical and health sciences Hemodynamically stable Postoperative Complications 0302 clinical medicine medicine Postoperative results Humans Hospital Mortality Aged Aortic dissection Laparotomy business.industry Endovascular Procedures Intestinal Pseudo-Obstruction Middle Aged medicine.disease Aortic Aneurysm Surgery Aortic Dissection Treatment Outcome 030228 respiratory system Mesenteric ischemia Mesenteric Ischemia Acute Disease Female Cardiology and Cardiovascular Medicine business Complication Lower mortality |
| DOI: | 10.22541/au.159284836.64551048 |
| Popis: | Background and aim Mesenteric malperfusion is a complication with a higher risk of in-hospital mortality because diagnosing mesenteric ischemia before necrotic change is difficult, and when it occurs, the patient's condition has worsened. Although it contradicts the previous consensus on central repair-first strategy, the revascularization-first strategy was found to be significantly associated with lower mortality rates. This study aimed to present our revascularization-first strategy and the postoperative results for acute aortic dissection involving mesenteric malperfusion. Methods Among 58 patients with acute type A aortic dissection at our hospital between January 2017 and December 2019, mesenteric malperfusion was noted in six. Four hemodynamically stable patients underwent mesenteric revascularization with endovascular intervention in a hybrid operation room before central repair, and two hemodynamically unstable patients underwent central repair before mesenteric revascularization. Results No in-hospital mortality was recorded. All four patients with mesenteric revascularization-first strategy recovered with no symptoms related to mesenteric ischemia. Two patients with central repair-first strategy developed paralytic ileus for 1 week; one of them needed exploratory laparotomy, but no patients needed colon resection. Conclusion No in-hospital mortality was recorded. All four patients with mesenteric revascularization-first strategy recovered with no symptoms related to mesenteric ischemia. Two patients with central repair-first strategy developed paralytic ileus for 1 week; one of them needed exploratory laparotomy, but no patients needed colon resection. |
| Databáze: | OpenAIRE |
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