THE DISSECTED AORTA .3. ANATOMY AND RADIOLOGIC-DIAGNOSIS OF BRANCH-VESSEL COMPROMISE

PURPOSE: To determine the anatomic, hemodynamic, and radiologic charac teristics of branch-vessel compromise in patients with aortic dissecti on. MATERIALS AND METHODS: Sixty-two patients with aortic dissection w ere evaluated with aortography (n = 62), intravascular ultrasound (US) (n = 35), and manometry (n = 56). Branch-vessel compromise with ische mia was suspected in 40 of these patients. Radiologic and manometric f indings were correlated with clinical findings of ischemia. Femoral ar tery pulse strength was correlated with access from the respective fem oral artery to the true and false lumina of the dissected aorta. RESUL TS: Twenty-six of 40 patients suspected of having ischemia had angiogr aphic evidence of branch-vessel compromise, and intravascular US helpe d identify two types of branch-vessel compromise in them: static (diss ection intersected and narrowed the vessel origin) and dynamic (dissec tion spared the vessel origin, but the dissection flap appeared to com press the true lumen at or above the origin and covered the origin). F alse-lumen pressure in classic dissections exceeded (n = 16) or equale d (n = 30) true-lumen pressure. Branch vessels that arose exclusively from the false lumen were well perfused. Findings of a dissection flap oriented concave toward the false lumen were 91% sensitive and 72% sp ecific for a true-lumen pressure deficit. CONCLUSION: Intravascular US and manometric findings clarify the mechanisms of branch-vessel compr omise after aortic dissection and provide a rational guide for percuta neous treatment.