title: A new classification system for branch artery perfusion patterns in acute aortic dissection for examining the effects of central aortic repair.
abstract: OBJECTIVE
  We developed a new classification system for branch perfusion patterns in acute aortic dissection and used it to retrospectively evaluate the perfusion status of whole aortic branches and to examine the effects of central aortic repair.
  
  
  METHODS
  Thirty-four consecutive patients with acute type A aortic dissection underwent emergent surgery at our institution between August 2008 and December 2011. A retrospective review of pre- and postoperative computed tomographic angiography was performed. Branch perfusion patterns were categorized into three classes: Class I, dissection involving but not extending into the branch; Class II, dissection extending into the branch and Class III, dissection causing ostial avulsion.
  
  
  RESULTS
  In cervical branches (total 169 branches), 70 branches (41%) presented with Class I patterns, 58 (34%) with Class II and none with Class III. In abdominal branches (total 135 branches), 76 branches (56%) presented with Class I patterns, 12 (9%) with Class II and 18 (13%) with Class III. In common iliac arteries (total 68 arteries), 14 arteries (21%) presented with Class I patterns, 24 (35%) with Class II and none with Class III. After repair, among 21 high-risk cervical branches, 14 branches (67%) showed improvement, 3 (14%) preserved distal perfusion supplied through the patent branch false lumen and 4 (19%) showed no improvement in high-risk perfusion pattern or worsened. Among 22 high-risk abdominal branches, 18 branches (82%) showed improvement, 3 (14%) preserved distal perfusion supplied through the patent branch or aortic false lumen and 1 (5%) showed no improvement in high-risk perfusion pattern.
  
  
  CONCLUSIONS
  To overcome malperfusion syndromes associated with acute aortic dissection, recognition of diverse branch perfusion patterns through a universal classification system is imperative.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan. hiroshi-nagamine@arion.ocn.ne.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nagamine
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Ueno
authors.forename: Hideyasu
authors.initials: H
authors.lastname: Ueda
authors.forename: Daisuke
authors.initials: D
authors.lastname: Saito
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Tanaka
authors.forename: Manami
authors.initials: M
authors.lastname: Miyazaki
authors.forename: Hiroiku
authors.initials: H
authors.lastname: Hara
authors.forename: Yushi
authors.initials: Y
authors.lastname: Kawase
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000145:classification / Q000503:physiopathology / Q000601:surgery; D000792:Angiography / Q000379:methods; D001011:Aorta / Q000503:physiopathology / Q000601:surgery; D001014:Aortic Aneurysm / Q000145:classification / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D012039:Regional Blood Flow / Q000502:physiology; D015424:Reperfusion; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods; D014656:Vascular Surgical Procedures