Annals of vascular surgery · 2026
Single-Center Multidisciplinary Experience with Type A Dissections with Malperfusion.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Brennan Livia, Wahidi Ryan, Liu Tullis, Seyoum Nahom, Wanken Zachary J, Brescia Alexander, Kachroo Puja, Sanchez Luis, Zayed Mohamed A, Ohman J Westley, Washington University Collaborative for Aortic Research (WashU-CAR)
Аннотация
BACKGROUND: Malperfusion of the viscera and/or lower extremities in type A aortic dissection carries high morbidity and mortality. However, risk factors associated with organ or limb malperfusion are not well understood. We evaluated these risk factors in a population of patients who developed malperfusion in the setting of an acute type A dissection and reviewed the surgical interventions performed.
METHODS: A retrospective analysis was conducted on 178 patients with acute type A aortic dissection at a single quaternary care center from 2017 to 2023. Data collection included demographics, aortic dissection anatomy, peripheral neurovascular exam, surgical repair, and postoperative survival and limb outcomes. Limb malperfusion was defined as pulse deficit, sensory loss/pain, or motor loss in one or both limbs. Visceral malperfusion was defined as any ischemia of the intraabdominal viscera informed by radiographic evidence.
RESULTS: Patients in our cohorts were predominantly male (n = 118; 66%) with comorbidities of a typical cardiovascular cohort. Malperfusion of any type occurred in n = 36 (20%) patients; n = 16 (9.0%) underwent fasciotomies, n = 8 underwent extra-anatomic bypasses, and 1 underwent major amputation. Twenty-two (64.7%) cases of malperfusion were alleviated with type A repair alone. Malperfusion was associated with distal dissection zone (P < 0.001) and higher lactate at presentation (P = 0.02).
CONCLUSION: We present a large single-center retrospective analysis of type A aortic dissection and vascular interventions for malperfusion. Distal dissection zone and lactate were associated with malperfusion. Early mortality was similar between patients with malperfusion who did or did not receive additional vascular surgery intervention.
METHODS: A retrospective analysis was conducted on 178 patients with acute type A aortic dissection at a single quaternary care center from 2017 to 2023. Data collection included demographics, aortic dissection anatomy, peripheral neurovascular exam, surgical repair, and postoperative survival and limb outcomes. Limb malperfusion was defined as pulse deficit, sensory loss/pain, or motor loss in one or both limbs. Visceral malperfusion was defined as any ischemia of the intraabdominal viscera informed by radiographic evidence.
RESULTS: Patients in our cohorts were predominantly male (n = 118; 66%) with comorbidities of a typical cardiovascular cohort. Malperfusion of any type occurred in n = 36 (20%) patients; n = 16 (9.0%) underwent fasciotomies, n = 8 underwent extra-anatomic bypasses, and 1 underwent major amputation. Twenty-two (64.7%) cases of malperfusion were alleviated with type A repair alone. Malperfusion was associated with distal dissection zone (P < 0.001) and higher lactate at presentation (P = 0.02).
CONCLUSION: We present a large single-center retrospective analysis of type A aortic dissection and vascular interventions for malperfusion. Distal dissection zone and lactate were associated with malperfusion. Early mortality was similar between patients with malperfusion who did or did not receive additional vascular surgery intervention.