La radiologia medica

, Volume 118, Issue 1, pp 74–88

Aortic dissection and malperfusion syndrome: a when, what and how-to guide

  • M. Midulla
  • R. Fattori
  • J. -P. Beregi
  • M. Dake
  • H. Rousseau
Vascular and Interventional Radiology / Radiologia Vascolare e Interventistica

Abstract

Malperfusion syndrome is a complication of aortic dissection caused by branch-vessel involvement and resulting in end-organ ischaemic dysfunction. Clinical diagnosis is mandatory, and imaging plays a critical role in confirmation and treatment planning. Radiologists must focus on detecting complications (findings of aortic dilation, rupture, organ ischaemia, etc.) and defining vascular compromise and associated malperfusion mechanisms. All these factors guide the multidisciplinary discussion concerning patient management and the suitability of endovascular treatment. Application of dedicated imaging protocols is mandatory in order to answer clinical and anatomical questions. Endovascular therapy has taken a predominant role in the therapeutic management of malperfusion syndrome with aortic fenestration, peripheral stenting and stent-grafting, all of which are procedures within the domain of expertise of current interventional radiologists. The purpose of this editorial is to present a when, what and how-to guide for all radiologists who encounter complicated aortic dissection.

Keywords

Aortic dissection Malperfusion Stent-graft Fenestration 

Dissezione aortica e sindrome da malperfusione: quando intervenire, cosa e come fare

Riassunto

La sindrome da malperfusione è una complicanza della dissezione aortica (DAO) caratterizzata da un insufficiente apporto ematico a uno o più territori e risultante in una disfunzione dell’organo irrorato. La diagnosi è necessariamente clinica e i rilievi radiologici assumono un ruolo di conferma ed entrano nella pianificazione della terapia. L’analisi del radiologo è mirata a riconoscere più elementi: la presenza di complicanze identificabili all’imaging (segni imminenti di rottura aortica), l’anatomia della dissezione (presenza e localizzazione dei fori o porte d’ingresso e di rientro, estensione, diametri aortici), il meccanismo specifico di malperfusione. Tutti questi fattori guidano la decisione multidisciplinare sulla strategia terapeutica da adottare e la pianificazione di un eventuale trattamento endovascolare. L’uso di protocolli d’acquisizione specifici, in particolare di tomografia computerizzata (TC), è fondamentale per rispondere ai quesiti clinici e anatomici. La terapia endovascolare, in cui il radiologo diviene attore, ha assunto oggi un ruolo predominante, al pari e forse più della chirurgia, nei pazienti con dissezione aortica complicata da sindrome di malperfusione, sia in caso di dissezione di tipo A che di tipo B. La fenestrazione, lo stenting periferico e l’impianto di endoprotesi rappresentano il culmine di un ragionamento clinico e radiologico specifico per ogni singolo paziente e contesto, acuto e cronico. Questo articolo si propone di presentare un quadro della problematica data dalla sindrome da malperfusione, cercando di fornire una guida all’uso per il radiologo che si trovi di fronte a questo tipo di situazione.

Parole chiave

Dissezione aortica Malperfusione Stentgraft Fenestrazione 

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Copyright information

© Springer-Verlag Italia 2012

Authors and Affiliations

  • M. Midulla
    • 1
  • R. Fattori
    • 2
  • J. -P. Beregi
    • 3
  • M. Dake
    • 4
  • H. Rousseau
    • 5
  1. 1.Unité Interventionnelle Vasculaire, Service de Radiologie Cardiovasculaire, Hopital CardiologiqueCentre Hospitalier Regional Universitaire de LilleLilleFrance
  2. 2.UC Cardiologia InterventisticaOspedale San SalvatorePesaroItaly
  3. 3.Département de RadiologieCHU CaremeauNîmes Cedex 9France
  4. 4.Department of Cardiothoracic SurgeryFalk Cardiovascular Research CenterStanfordUSA
  5. 5.Hopital RangueilToulouseFrance

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