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To the Editor: In his article about the diagnosis of the acute aortic dissection, Dr Klompas¹ describes some of the complications that result from occlusion of major arteries originating from the aorta including cardiac, neurologic, renal, and limb syndromes. He does not mention, however, that acute aortic dissection may also compromise the mesenteric artery. In a retrospective review of peripheral vascular complications of aortic dissection, of the 28% of patients with aortic branch occlusion, 20% had mesenteric malperfusion, which was associated with a 36% mortality rate.² There are also several case reports that describe presentations of acute aortic dissection with mesenteric compromise, including abdominal pain, hematochezia, melena, and obstructive jaundice.^3-5

Bradley A. Sharpe, MD
Department of Medicine
University of California at San Francisco

1. Klompas M. Does this patient have an acute thoracic aortic dissection? JAMA. 2002;287:2262-2272. FREE FULL TEXT 2. Lauterbach SR, Cambria RP, Brewster DC, et al. Contemporary management of aortic branch compromise resulting from acute aortic dissection. J Vasc Surg. 2001;33:1185-1192. FULL TEXT | ISI | PUBMED 3. Fabre O, Vincentelli A, Willoteaux S, et al. Preoperative fenestration for type A acute aortic dissection with mesenteric malperfusion. Ann Thorac Surg. 2002;73:950-951. FREE FULL TEXT 4. Ninomiya M, Makuuchi H, Naruse Y, et al. Type I acute aortic dissection accompanied by ischemic enterocolitis due to blood flow insufficiency in the superior mesenteric artery. Jpn J Thorac Cardiovasc Surg. 1999;47:465-469. PUBMED 5. Bret PM, Partensky C, Bretagnolle M, et al. Obstructive jaundice by a dissecting aneurysm of the celiac axis and hepatic artery. Dig Dis Sci. 1987;32:1431-1434. FULL TEXT | ISI | PUBMED

In Reply: Dr Sharpe correctly states that the panoply of different presentations of acute aortic dissection includes mesenteric ischemia. Indeed, symptoms of ischemia anywhere in the body . . . [Full Text of this Article]

RELATED ARTICLE

Does This Patient Have an Acute Thoracic Aortic Dissection?
Michael Klompas
JAMA. 2002;287(17):2262-2272.
ABSTRACT | FULL TEXT