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
