Zhonghua Yi Xue Za Zhi. 2026 Jan 27;106(4):358-364. doi: 10.3760/cma.j.cn112137-20251029-02793.
ABSTRACT
Objective: To evaluate the therapeutic efficacy of interventional radiology (IR) combined with delayed aortic repair in patients with acute type A aortic dissection (ATAAD) with concurrent mesenteric malperfusion syndrome (MeMPS), and explore the risk factors for visceral organ failure and death after IR. Methods: A total of 693 patients with ATAAD admitted to Xijing Hospital from January 2018 to March 2022 were retrospectively analyzed. The therapeutic outcomes of IR combined with delayed aortic repair in patients with MeMPS were observed. Logistic regression was used to analyze the risk factors for mortality due to visceral organ failure after IR. Results: Among the 693 patients, 656 patients (507 males and 149 females) aged [M(Q, Q)] 52 (44, 58) years did not have any organ malperfusion syndrome, while all 37 (31 males and six females) aged 50 (46, 55) years with MeMPS underwent IR followed by delayed aortic repair after clinical improvement. The median symptom onset time in MeMPS patients was 0.3 (0.2, 0.4) d, and the overall in-hospital mortality was 43.2% (16/37). Some patients also had multiple organ malperfusion syndrome (kidney: 10 cases; lower extremity: two cases). Among the 24 MeMPS patients (64.9%) whose condition improved after IR and who subsequently underwent aortic repair, the in-hospital mortality rate showed no significant difference compared to patients without MeMPS [12.5% (3/24) vs 8.2% (54/656), P=0.714]. Similarly, there were no significant differences in the 1-, 3-, and 5-year survival rates between the two groups (79.2%, 54.4%, 54.4% vs 81.2%, 78.9%, 77.7%, respectively; P=0.300). After IR, death due to organ failure was the main reason preventing aortic repair in MeMPS patients (organ failure: 10 cases; aortic rupture: three cases). Compared with survivors after IR, patients who died of organ failure had higher age, creatinine, D-dimer, and fibrinogen degradation products (FDP), and a smaller true lumen diameter of the abdominal aorta at the diaphragm level (all P<0.05). Multivariate logistic regression analysis identified that the true lumen diameter of the abdominal aorta at the diaphragm level (OR=0.72, 95%CI: 0.52-0.99), FDP (OR=1.03, 95%CI: 1.01-1.06), and D-dimer (OR=1.07, 95%CI: 1.01-1.13) were risk factors for death due to visceral organ failure. Conclusions: For ATAAD patients with concurrent MeMPS, salvage IR can serve as a bridging therapy prior to aortic repair. The true lumen diameter of the abdominal aorta at the diaphragm level, D-dimer, and FDP are risk factors for death due to visceral organ failure.
PMID:41588313 | DOI:10.3760/cma.j.cn112137-20251029-02793