Cerebral malperfusion in acute aortic dissection

被引:26
作者
Orihashi, Kazumasa [1 ]
机构
[1] Kochi Med Sch, Div Cardiovasc Surg, Dept Surg 2, Oko Cho, Nankoku, Kochi 7838505, Japan
关键词
Aortic dissection; Malperfusion; Surgery; AXILLARY ARTERY PERFUSION; CAROTID-ARTERY; NEUROLOGICAL DYSFUNCTION; INNOMINATE-ARTERY; A DISSECTION; CANNULATION; REPAIR; FLOW; SURGERY; OUTCOMES;
D O I
10.1007/s00595-016-1381-x
中图分类号
R61 [外科手术学];
学科分类号
摘要
Cerebral malperfusion in association with acute type A aortic dissection is uncommon but can have a considerable effect on the outcome of treatment. Successful treatment requires the individual and effective removal of each of the factors associated with malperfusion. In addition to the conventional surgical procedures, endovascular treatment has become an option for restoring perfusion. However, artificial perfusion and/or surgical procedures can lead to new malperfusion, which is not necessarily apparent to surgeons and which is difficult to predict. Thus, a number of modalities need to be applied to monitoring the current status of perfusion to enable timely treatment. Since each of the diagnostic modalities has its merits and demerits, one should use them effectively while being mindful of the pitfalls. In addition, a delay in the diagnosis in the pre-hospital stage is an important determinant of the surgical outcomes of aortic dissection. Portable echocardiography, which has been recently developed, may be useful for improving this situation. However, an early diagnosis largely depends on the physician's awareness and basic echocardiography skills. Surgeons should make general physicians aware of this message.
引用
收藏
页码:1353 / 1361
页数:9
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