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Diagnosis and Management of Aortic Disease

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65 7.4.1.2. Management of Malperfusion COR LOE Recommendations 1 B-NR 1. In patients with acute type A aortic dissection presenting with renal, mesenteric, or lower extremity malperfusion, it is recommended to proceed to immediate operative repair of the ascending aorta. 2a C-LD 2. In patients with acute type A aortic dissection presenting with clinically significant mesenteric (celiac, SMA) malperfusion, either immediate operative repair of the ascending aorta or immediate mesenteric revascularization via endovascular or open surgical intervention by those with this expertise before ascending aortic repair is reasonable. Table 26. Clinical Evidence of Malperfusion ("Malperfusion Syndrome") End Organ Clinical Findings Cardiac Electrocardiographic changes of ischemia or infarction, troponin elevation, myocardial dysfunction Cerebral Stroke and neurologic deficits, coma and altered mental status Spinal Paraplegia Mesenteric Abdominal pain, bowel ischemia, lactic acidosis, elevation of liver function test results Renal Acute kidney injury, oliguria Extremity Loss of pulses in ≥1 extremity, sensory or motor dysfunction

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