Correlation of True Lumen Femoral and Mesenteric Perfusion Pressure in Acute Aortic Dissection

B. Pinsky

Purpose: The purpose of this study of acute aortic dissection is to report the correlation between common iliac (CIA) and superior mesenteric artery (SMA) perfusion pressures when both arise exclusively from the true lumen, and to highlight the loss of the femoral pulse in these patients as an early indicator of visceral malperfusion.

Materials and Methods: We performed a retrospective review of 488 patients with acute aortic dissection evaluated at the University of Michigan from February 1996 to August 2022. To evaluate the association between CIA and SMA pressures, patients’ pre-intervention branch artery systolic pressures, measured by intraluminal catheter, were subdivided into groups based on type of acute aortic dissection (A or B) and laterality of the iliac artery (RCIA or LCIA). Within each subgroup, patients were excluded if either the CIA or SMA were thrombosed or statically obstructed by extension of intimal flap into branch vessel lumen or if there was a re-entry tear present as determined by cross-sectional imaging or procedural intravascular ultrasound. Linear regression and significance analysis were performed for each of the CIA-SMA subgroups in RStudio version 2022.07.2.

Results: Amongst patients with acute type A dissections, the RCIA group (n = 27) had a slope of 0.78 and correlation coefficient of 0.86 (95% CI: 0.71-0.93, P-value: 1.03e-8). Whereas the acute type A LCIA group (n = 22) had a slope of 0.92 and correlation coefficient of 0.86 [95% CI: 0.69-0.94,P-value: 2.85e-7].

In patients with Acute Type B dissections, the RCIA group(n=24) had a slope of 0.84 and correlation coefficient of 0.92 [95%CI: 0.83-0.97, p-value: 1.59e-10]. Whereas, the acute type B LCIA group (n=20) had a slope of 0.82 and correlation coefficient of 0.87 [95%CI: 0.70-0.95, p-value: 6.12e-7].

Conclusions: In patients with acute aortic dissection in whom the SMA and a CIA are supplied exclusively by the true lumen, systolic CIA pressures correlate significantly with systolic SMA pressures, and clinical loss of the femoral pulse indicates significant decrease in SMA pressures, raising concern for visceral malperfusion.