Organ Malperfusion and Mortality in Acute Type 1 Aortic Dissection with Iliac Extension: A Retrospective Single-Center Study Focused on Mesenteric Malperfusion and the Source–Clearance Hypothesis

Background/Objectives: Mesenteric malperfusion is the most lethal and least recognizable complication of acute type A aortic dissection. This study aimed to examine organ-specific malperfusion patterns and 30-day mortality in acute type 1 aortic dissection with iliac extension, and to evaluate whether the lactate-to-albumin ratio (LAR) and superior mesenteric artery (SMA) origin pattern add predictive value for mesenteric malperfusion syndrome within a “source–clearance” framework.

Methods

In this retrospective single-center study, 80 consecutive patients with acute type 1 aortic dissection extending to the iliac arteries who underwent surgical repair between January 2020 and March 2026 were reviewed. Malperfusion (preoperative finding) and malperfusion syndrome (end-organ injury persisting despite central repair) were defined for six organ systems; visceral branch origin and planimetric true lumen ratio were assessed on computed tomography angiography (CTA). The primary endpoint was 30-day mortality.