Work

Lowering blood pressure reduces dynamic malperfusion of visceral organs in acute aortic dissection

Year: 2026

Type: article

Abstract: Objective In acute aortic dissection (AAD), the dissection flap can completely cover aortic true lumen (TL) branches, causing dynamic obstruction of visceral and lower extremity branches. This study examined how systolic blood pressure (SBP) reduction improves aortic TL patency and visceral perfusion. Methods 84 patients with acute type A or B aortic dissection and dynamic malperfusion undergoing percutaneous interventional radiology (IR) assessment and treatment from 2012 to 2023 were included. Aortic TL patency was assessed on computer tomography (CT) scans and IR intravascular ultrasound. Antihypertensives were administered, and SBP was monitored at the time of CT and IR intervention. Results Of 84 patients, 58 had aortic TL collapse covering the SMA origin, of which 47 (81%) showed increased TL patency after the average SBP was lowered from 161 to 98 mmHg (39% reduction). There were 10 patients with TL collapse below the level of the SMA, 7 of whom had increased TL patency after the average SBP decreased from 170 to 89 mmHg (48% reduction). 16 patients without aortic TL collapse at any branch level, did not have improved TL patency after the average SBP decreased from 168 to 93 mmHg (45% reduction). BP reduction significantly improved TL patency on McNemar's test (p<0.001). The random effects model revealed that elevated SBP was associated with TL collapse (OR 1.029, p=0.001). Conclusion Lowering SBP in AAD reduces dynamic malperfusion and improves visceral perfusion. Upon diagnosis, prompt initiation and maintenance of SBP reduction as low as tolerated is beneficial and recommended until a definitive mechanical solution for the malperfusion is complete.

Source: JTCVS Open

DOI: 10.1016/j.xjon.2026.102069